Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked

Muraca, Giulia M; Ralph, Laura E; Christensen, Penny; D’Souza, Rohan; Geoffrion, Roxana; Lisonkova, Sarka; Joseph, K S

doi:10.1136/bmj-2022-073991

Cited by 4 publications

(3 citation statements)

References 68 publications

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“…Also, these two instruments are mostly used when the birth is not progressing fast enough or there is an acute danger to the child. Thus, AVD presumably leads to trauma-predictive sensations such as lack of subjective safety, helplessness, or fear for the child and is associated with an elevated PCL-5 Score [49]. This supports, for example, the research who found negative delivery experiences, inadequate education, and time pressure in the expulsion phase of women giving birth via AVD [30,50].…”

Section: Discussionsupporting

confidence: 64%

Are 6 more accurate than 4? The delivery mode and its influence on postpartum depression and PTSD.

Beck-Hiestermann,

Hartung,

Richert

et al. 2023

Preprint

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Background Empirical evidence shows that 2–6% of all women develop post-traumatic stress disorder (PTSD) and about 10–15% postpartum depression (PPD) after childbirth. This study examines PTSD and PPD in the context of delivery mode, focusing 4 different caesarean section modes, elective primary (Grade 4), medically indicated primary (Grade 3), secondary from relative indication (Grade 2) and emergency secondary caesarean section (Grade 1), compared to vaginal and assisted vaginal delivery (AVD). The impact of the six subdivided delivery mode categories on the level of postpartum depression and PTSD will be investigated using common predictors (for postpartum depression psychological treatment before childbirth, Fear of childbirth, Planning of pregnancy, social support after childbirth and for PTSD psychological treatment before childbirth, fear of childbirth, induction of labor, birth debriefing and social support after childbirth). Methods Between four weeks and two years postpartum, 1223 women were surveyed once via an anonymous online questionnaire on demographic and gynecological data, type of delivery, PTSD (PCL-5) and PPD (EPDS). Results For both psychiatric disorders, ANOVA revealed significant differences between delivery mode and PPD and PTSD. With weak effects for PPD and medium to strong effects for PTSD. Post-hoc tests showed increased levels of postpartum depression for all caesarean section types compared to both vaginal delivery types. For PTSD, secondary relative indication (Grade 2), emergency secondary caesarean section (Grade 1) and assisted vaginal delivery (AVD) were associated with elevated levels of PTSD. Regression analysis revealed the delivery mode as a significant predictor of EPDS- (medium effect size) and PCL-5-Score (medium to high effect size). Limitation: Delivery was assumed to be the traumatic event; previous traumas were not recorded. The definition of the delivery mode was reported subjectively and not medically confirmed. Conclusion The study highlights the influence of delivery modes on the mental health of postpartum mothers: different modes influence different postpartum disorders in different ways. However, the definition of the delivery mode was only stated subjectively and not medically confirmed. Further research should investigate which aspects of the different delivery modes influence maternal mental health and how the perception of the birth may depend on a specific delivery mode.

show abstract

Section: Discussionsupporting

confidence: 64%

Are 6 more accurate than 4? The delivery mode and its influence on postpartum depression and PTSD.

Beck-Hiestermann,

Hartung,

Richert

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Also, these instruments are typically used when the birth is not progressing fast enough or when there is an imminent danger to the child. Consequently, AVD presumably leads to trauma-predictive sensations such as lack of subjective safety, helplessness, or fear for the child and is associated with an elevated PCL-5 Score [ 49 ]. This supports, for example, the research who found negative delivery experiences, inadequate education, and time pressure in the expulsion phase of women giving birth via AVD [ 30 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Are 6 more accurate than 4? The influence of different modes of delivery on postpartum depression and PTSD

Beck-Hiestermann,

Hartung,

Richert

et al. 2024

BMC Pregnancy Childbirth

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Background Empirical evidence shows that 4.6–6.3% of all women develop a post-traumatic stress disorder (PTSD) and approximately 10–15% postpartum depression (PPD) following childbirth. This study explores the relationship between delivery mode and the occurrence of PTSD and PPD, specifically examining four distinct caesarean section (CS) modes: primary on maternal request (Grade 4), medically indicated primary (Grade 3), secondary CS from relative indication (Grade 2) and emergency secondary CS (Grade 1), compared to vaginal and assisted vaginal delivery (AVD). The research aims to understand how these six subcategories of delivery modes impact PPD and PTSD levels. Common predictors, including the need for psychological treatment before childbirth, fear of childbirth, planning of pregnancy, induction of labor, birth debriefing, and lack of social support after childbirth, will be analyzed to determine their association with postpartum mental health outcomes. Methods The study was planned and carried out by a research team of the psychology department at the Medical School Hamburg, Germany. Within an online-study (cross-sectional design) N = 1223 German speaking women with a baby who did not die before, during or after birth were surveyed once between four weeks and twelve months postpartum via an anonymous online questionnaire on demographic and gynecological data, delivery mode, PTSD (PCL-5) and PPD (EPDS). Results For both psychiatric disorders, ANOVA revealed significant differences between delivery mode and PPD and PTSD. With weak effects for PPD and medium to strong effects for PTSD. Post-hoc tests showed increased levels of PPD for two CS types (Grade 1, Grade 3) compared to vaginal delivery. For PTSD, secondary CS from relative indication (Grade 2), emergency secondary CS (Grade 1) and assisted vaginal delivery (AVD) were associated with elevated levels of PTSD. Regression analysis revealed delivery mode as a significant predictor of EPDS- (medium effect size) and PCL-5-Score (medium to high effect size). Limitation Delivery was considered as the potential traumatic event, and any previous traumas were not documented. Additionally, the categorization of delivery modes relied on subjective reports rather than medical confirmation. Conclusion The study highlights the influence of delivery mode on the mental health of postpartum mothers: different modes influence postpartum disorders in various ways. However, the definition of delivery mode was only stated subjectively and not medically confirmed. Further research should investigate which aspects of the different delivery modes affect maternal mental health and explore how the perception of childbirth may be influenced by specific delivery experiences.

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“…Datta mentions the association between race or ethnicity and obstetric anal sphincter injury (OASI) 12. Several studies have reported higher rates of OASI in Asian women—between 1.5 and 3.0 times as high as in white women—in high income countries such as Australia,3 Canada,4 Norway,5 the United Kingdom,6 and the United States 7.…”

mentioning

confidence: 99%

Authors’ reply to Datta

Muraca,

Joseph

2023

BMJ

Self Cite

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Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked

Abstract: Giulia Muraca and colleagues argue that Canada’s high rates of maternal and neonatal trauma following operative vaginal delivery warrant urgent recognition, transparency, and action

Cited by 4 publications

References 68 publications

Are 6 more accurate than 4? The delivery mode and its influence on postpartum depression and PTSD.

Are 6 more accurate than 4? The delivery mode and its influence on postpartum depression and PTSD.

Are 6 more accurate than 4? The influence of different modes of delivery on postpartum depression and PTSD

Authors’ reply to Datta

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