Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis

Abstract

Background Pre-term or full-term childbirth can be experienced as physically or psychologically traumatic. Cumulative and trans-generational effects of traumatic stress on both psychological and physical health indicate the ethical requirement to investigate appropriate preventative treatment for stress symptoms in women following a routine traumatic experience such as childbirth. Objective The objective of this review was to investigate the effectiveness of early psychological interventions in reducing or preventing post-traumatic stress symptoms and post-traumatic stress disorder in post-partum women within twelve weeks of a traumatic birth. Methods Randomised controlled trials and pilot studies of psychological interventions preventing or reducing post-traumatic stress symptoms or PTSD, that included women who had experienced a traumatic birth, were identified in a search of Cochrane Central Register of Randomised Controlled Trials, MEDLINE, Embase, Psychinfo, PILOTS, CINAHL and Proquest Dissertations databases. One author performed database searches, verified results with a subject librarian, extracted study details and data. Five authors appraised extracted data and agreed upon risk of bias. Analysis was completed with Rev Man 5 software and quality of findings were rated according to Grading of Recommendation, Assessment, Development, and Evaluation. Results Eleven studies were identified that evaluated the effectiveness of a range of early psychological interventions. There was firm evidence to suggest that midwifery or clinician led early psychological interventions administered within 72 hours following traumatic childbirth are more effective than usual care in reducing traumatic stress symptoms in women at 4–6 weeks. Further studies of high methodological quality that include longer follow up of 6–12 months are required in order to substantiate the evidence of the effectiveness of specific face to face and online early psychological intervention modalities in preventing the effects of stress symptoms and PTSD in women following a traumatic birth before introduction to routine care and practice. Prospero registration CRD42020202576, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=202576

Preterm Birth and Maternal Mood States: What Is the Impact on Bonding?

“…Correlation analyses illustrate that there is indeed an association between some maternal mood states and impaired bonding. What emerged is consistent with research that identifies maternal mood as a fundamental variable in the definition of the bonding relationship with the child [58]. Starting from the present study's data, it should be remembered that tension, anger, and confusion experienced by the mother were predictive of the quality of bonding.…”

Symptoms of post-traumatic stress disorder in parents of preterm newborns: A systematic review of interventions and prevention strategies

“…In contrast with a previous Cochrane ( 50 ), a recent review demonstrates that there is insufficient evidence to recommend the introduction of any universal early intervention to all individuals exposed to a traumatic event to prevent PTSD ( 55 , 56 ). Similarly, another literature review found insufficient evidence to estimate the effectiveness of universal interventions in the primary or secondary prevention of PTSD or PTS symptoms following childbirth ( 55 , 57 ).…”

“…In contrast with a previous Cochrane ( 50 ), a recent review demonstrates that there is insufficient evidence to recommend the introduction of any universal early intervention to all individuals exposed to a traumatic event to prevent PTSD ( 55 , 56 ). Similarly, another literature review found insufficient evidence to estimate the effectiveness of universal interventions in the primary or secondary prevention of PTSD or PTS symptoms following childbirth ( 55 , 57 ). However, given the higher prevalence of PTSD in parents of preterm newborns (up to 53% in mothers and 33% in fathers) ( 4 ) with respect to general postpartum population (20.7% in mothers, 7.2% in fathers at 1 month post-partum) ( 58 ), interventions for PTSD prevention could be offered to all parents of NICU-admitted infants.…”

Childbirth as a traumatic event for attendant fathers

“…Studies have demonstrated the impact of the parents’ mental state on their relationship, as well as on parent–baby bonding and baby development, and early detection is important. In addition, interventions that relieve or even prevent mothers’ PTSD related to childbirth (Taylor Miller et al, 2021 ) may also be relevant for fathers, and this aspect should be explored.…”