Improving mental health and physiological stress responses in mothers following traumatic childbirth and in their infants: study protocol for the Swiss TrAumatic biRth Trial (START)

Abstract

IntroductionEmergency caesarean section (ECS) qualifies as a psychological trauma, which may result in postnatal post-traumatic stress disorder (PTSD). Maternal PTSD may not only have a significant negative impact on mother–infant interactions, but also on long-term infant development. The partner’s mental health may also affect infant development. Evidence-based early interventions to prevent the development of postpartum PTSD in mothers are lacking. Immediately after a traumatic event, memory formation is vulnerable to interference. There is accumulating evidence that a brief behavioural intervention including a visuospatial task may result in a reduction in intrusive memories of the trauma.Methods and analysisThis study protocol describes a double-blind multicentre randomised controlled phase III trial testing an early brief maternal intervention including the computer game ‘Tetris’ on intrusive memories of the ECS trauma (≤1 week) and PTSD symptoms (6 weeks, primary outcome) of 144 women following an ECS. The intervention group will carry out a brief behavioural procedure including playing Tetris. The attention-placebo control group will complete a brief written activity log. Both simple cognitive tasks will be completed within the first 6 hours following traumatic childbirth. The intervention is delivered by midwives/nurses in the maternity unit.The primary outcome will be differences in the presence and severity of maternal PTSD symptoms between the intervention and the attention-placebo control group at 6 weeks post partum. Secondary outcomes will be physiological stress and psychological vulnerability, mother–infant interaction and infant developmental outcomes. Other outcomes will be psychological vulnerability and physiological regulation of the partner and their bonding with the infant, as well as the number of intrusive memories of the event.Ethics and disseminationEthical approval was granted by the Human Research Ethics Committee of the Canton de Vaud (study number 2017–02142). Dissemination of results will occur via national and international conferences, in peer-reviewed journals, public conferences and social media.Trial registration numberNCT 03576586.

The Lausanne Infant Crying Stress Paradigm: Validation of an Early Postpartum Stress Paradigm with Women at Low vs. High Risk of Childbirth-Related Posttraumatic Stress Disorder

“…The following inclusion criteria were applied: (a) being ≥ 18 years old, (b) having given birth to a live baby at ≥34 weeks of gestation during the previous ≤5 days, (c) having given written consent, and (d) obtaining a certain score in response to screening questions that allowed the allocation to the groups at low vs. high risk of CB-PTSD. For this purpose, willing mothers answered screening questions consisting of two items related to perceived life threat during childbirth (based on PTSD stressor criteria of DSM-5) [1,18,48]. Responses were scored on a 7-point Likert scale (1 = not at all to 7 = extremely): "Did you think that your life was in danger?"…”

“…As part of the Swiss Traumatic Birth Trial (START) [18], this study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee for research in humans (study number 2017-02142). Before enrolling in the current study, participants received an information sheet and gave written consent.…”

“…Consequently, we cannot compare whether this early stress phase termination is higher in our sample than in other populations. Finally, although the screening questions were based on PTSD stressor criteria of DSM-5 and previously used [1,18,48,63], assessing CB-PTSD risk with only these two items is an important limitation, and validated assessment of CB-PTSD risk should be developed to be considered in future studies.…”

“…There are several arguments to assume that CB-PTSD might differ from PTSD by the nature of its trauma [18,19]. As a positive and expected life event, childbirth is generally perceived positively by society.…”

Recognizing childbirth-related posttraumatic stress disorder

“…Some studies link low maternal cortisol levels and their association with the mother's diffi culty in attuning to her infant's cues, ultimately impacting infant reactivity to and ability to recover effectively from a stressor. 18 The birth partner relationship. The potential for long-term impact on the relationship of the birth partner dyad is signifi cant.…”