Disrespect during childbirth and postpartum mental health: a French cohort study

Abstract

Background While the World Health Organisation (WHO) warned about mistreatment, disrespect and/or abuse during childbirth as early as 2014. This same year a social media movement with #payetonuterus brought to light the problematic of obstetrical violence in French speaking countries, and more specifically on issues of disrespect. The experience of care is an integral part of the quality of care, and perception on inadequate support during labour and loss of control in labour are some of the most frequently reported risk factors for childbirth-related post-traumatic stress disorder (CB-PTSD). Therefore, it seems crucial to study the associations between disrespect during childbirth and the mental well-being of mothers. Methods We performed a multicentered cohort study using auto-questionnaires within a French perinatal network. The main outcome was women’s report of disrespect during childbirth measured by the Behavior of the Mother’s Caregivers – Satisfaction Questionnaire (BMC-SQ) 3 days and 2 months after childbirth. CB-PTSD and Postpartum Depression (PPD) were assessed 2 months after childbirth using respectively the Post-Traumatic Checklist Scale (PCLS) and the Edinburgh Postnatal Depression Scale (EPDS). Results This study followed 123 mothers from childbirth to 2 months postpartum. Among them, 8.13% (n = 10/123) reported disrespect during childbirth at 3 days after childbirth. With retrospect, 10.56% (n = 13/123) reported disrespect during childbirth at 2 months postpartum, i.e. an increase of 31%. Some 10.56% (n = 13/123) of mothers suffered from postpartum depression, and 4.06% (n = 5/123) were considered to have CB-PTSD at 2 months after childbirth. Reported disrespect during childbirth 3 days after birth was significantly associated with higher CB-PTSD 2 months after birth (R2 = 0.11, F(1,117) = 15.14, p < 0.001 and β = 9.11, p = 0.006), PPD at 2 months after childbirth was positively associated to reported disrespect in the birth room, 3 days after birth (R2 = 0.04, F(1, 117) = 6.28, p = 0.01 and β = 3.36, p = 0.096). Meanwhile, PPD and CB-PTSD were significantly associated 2 months after childbirth (R2 = 0.41, F=(1,117) = 82.39, p < 0.01 and β = 11.41, p < 0.001). Conclusions Disrespect during childbirth was associated with poorer mental health during the postpartum period. Given the high prevalence of mental health problems and the increased susceptibility to depression during the postpartum period, these correlational results highlight the importance of gaining a deeper awareness of healthcare professionals about behaviours or attitudes which might be experienced as disrespectful during childbirth.

Fatores de risco associados à depressão pós-parto

“…Dentre os fatores obstétricos que foram elencados mais vezes estão as intercorrências na gestação, parto cesariana, parto traumático/insatisfatório e complicações no pós-parto (Muller et al, 2021;Arrais et al, 2018;Lima et al, 2023;Ahmadpour et al, 2023;Leavy et al, 2023). Baseado nisso, pode-se inferir que, a experiência da gestação e parto é um momento intenso para a mulher e a ocorrência de complicações ou eventos que fogem do seu controle durante o processo podem trazer perturbações à mãe (Arrais et al, 2018).…”

The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review

“…In 9 of the 11 studies exploring associations with birth experiences, having a negative birth experience significantly increased the likelihood of PPD symptoms (n = 4) and diagnosis (n = 5). Experiencing mistreatment by maternity care personnel was significantly associated with increased PPD symptoms (n = 1) [101] and diagnosis (n = 2) [89,108]. Similarly, experiencing obstetric violence was associated with a greater likelihood of PPD diagnosis (n = 3) [93,110,113].…”

“…Similarly, the presence of a companion or doula during labor and birth was associated with significantly fewer symptoms of PTSD (n = 4) [75,111,113,117]. The influence of mistreatment and obstetric violence on PTSD were investigated in one study each [89,117]. Experiencing mistreatment from the healthcare team was significantly associated with an increased likelihood of PTSD diagnosis [89], while experiencing obstetric violence was associated with a significant increase in PTSD symptoms [117].…”

“…The influence of mistreatment and obstetric violence on PTSD were investigated in one study each [89,117]. Experiencing mistreatment from the healthcare team was significantly associated with an increased likelihood of PTSD diagnosis [89], while experiencing obstetric violence was associated with a significant increase in PTSD symptoms [117]. One study reported that as socioeconomic status decreased, PTSD diagnosis significantly increased [67].…”

Incidence of Perinatal Post-Traumatic Stress Disorder in Catalonia: An Observational Study of Protective and Risk Factors

“…Postpartum depression was present in 10.56% (n = 13/123) of mothers, and 4.06% (n = 5/123) could be considered as suffering from post-traumatic stress disorder related to childbirth. Disrespect was positively associated with postpartum depression at 2 months after delivery [30].…”