Post-traumatic stress disorder following childbirth: an update of current issues and recommendations for future research

McKenzie‐McHarg, Kirstie; Ayers, Susan; Ford, Elizabeth; Horsch, Antje; Jomeen, Julie; Sawyer, Alexandra; Stramrood, Claire A. I.; Thomson, Gill; Slade, Pauline

doi:10.1080/02646838.2015.1031646

Cited by 140 publications

(109 citation statements)

References 84 publications

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“…Our study has also provided new insights into the number of women who continue to and/or re-experience childbirth-related distress during a future pregnancy. Furthermore, the finding that more women experienced negative cognitions and emotions following a distressing birth event, and particularly during a 15 future conception, contributes to the debate on how the inclusion of this symptom category in the DSM-V will impact on PTSD perinatal rates (McKenzie et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Emotions and support needs following a distressing birth: Scoping study with pregnant multigravida women in North-West England

Thomson

Downe

2016

Midwifery

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Emotions and support needs following a distressing birth: Scoping study with pregnant multigravida women in North-West England AbstractObjective: To identify the emotional and support needs of pregnant multigravida women who have experienced adverse responses associated with a previous childbirth experience.Setting: Four maternity hospitals in North-West England.Design: 100 surveys were distributed at an anomaly scan clinic in each of four maternity hospitals (total n=400). The survey included an adapted version of a Post-Traumatic Stress Disorder Symptom Scale to explore trauma responses at two broad time points: a) following a previous birth and b) during the current pregnancy. Participants were also asked about the optimal time to receive support post-birth, and the type and provider of support they had accessed/would have liked to access. Descriptive and inferential statistics were undertaken on the quantitative data. The qualitative data was analysed using a basic thematic approach.Participants: Multigravida pregnant women aged 18+ years. Findings:The overall response rate was 28% (n=112); 43% (n=46) of these had experienced negative/trauma responses associated with a previous birth, 74% of whom (n=34) continued/reexperienced adverse responses in their current pregnancy. Most commonly reported trauma responses were difficulties in recalling the previous birth(s), avoiding memories associated with it, and the distress associated with these memories when they were recalled.Approximately 54% (n=25) had received some form of support post-birth, and variations in preferred timing of postnatal support provision were reported. Information on available support and opportunities to discuss the birth with a maternity professional were identified most frequently as preferred support options. Conclusion & Implications for Practice:Women's views about what might work should form the basis for effectiveness studies in this area. Among the participants in this study there was evidence of unmet support needs relating to negative or traumatic responses to a previous birth.The range of preferred timing and types of support indicate that flexible needs-based support options should be provided. Further research should assess if these findings are reinforced in a more diverse sample with a higher response rate.

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Section: Discussionmentioning

confidence: 99%

Emotions and support needs following a distressing birth: Scoping study with pregnant multigravida women in North-West England

Thomson

Downe

2016

Midwifery

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“…The impact of traumatic birth and postpartum PTSD symptoms on infants' development is unclear because research in this area is scarce (McKenzie-McHarg et al, 2015). However, there are a number of ways in which PTSD might affect the mother-baby relationship and have a negative impact on infant development.…”

Section: Introductionmentioning

confidence: 99%

The impact of postpartum post-traumatic stress disorder symptoms on child development: a population-based, 2-year follow-up study

et al. 2016

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“…As PTSD after childbirth is highly comorbid with postpartum depression (McKenzie-McHarg et al, 2015), we also included the Edinburgh Postnatal Depression Scale (EPDS; Bergant, Nguyen, Heim, Ulmer, & Dapunt, 1998). This brief measure consists of 10 items covering the most important depressive symptoms during the previous 7 days and has good psychometric properties.…”

Section: Methodsmentioning

confidence: 99%

“…Experts agree that in Western countries, prevalence rates of PTSD due to childbirth are between 1 and 2% (Ayers, Joseph, McKenzie-McHarg, Slade, & Wijma, 2008; McKenzie-McHarg, et al, 2015), and PTSD in the postpartum period in general (including cases due to other traumas) is above 3% in the general population and almost 16% in risk groups (Grekin & O'Hara, 2014). …”

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confidence: 99%

Interplay of demographic variables, birth experience, and initial reactions in the prediction of symptoms of posttraumatic stress one year after giving birth

König

Schmid

Löser³

et al. 2016

European Journal of Psychotraumatology

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BackgroundThere has been increasing research on posttraumatic stress disorder (PTSD) following childbirth in the last two decades. The literature on predictors of who develops posttraumatic stress symptoms (PSS) suggests that both vulnerability and birth factors have an influence, but many studies measure predictors and outcomes simultaneously.ObjectiveIn this context, we aimed to examine indirect and direct effects of predictors of PSS, which were measured longitudinally.MethodWe assessed women within the first days (n=353), 6 weeks, and 12 months (n=183) after having given birth to a healthy infant. The first assessment included questions on demographics, pregnancy, and birth experience. The second and third assessments contained screenings for postpartum depression, PTSD, and general mental health problems, as well as assessing social support and physical well-being. We analysed our data using structural equation modelling techniques (n=277).ResultsOur final model showed good fit and was consistent with a diathesis-stress model of PSS. Women who had used antidepressant medication in the 10 years before childbirth had higher PSS at 6 weeks, independent of birth experiences. Subjective birth experience was the early predictor with the highest total effect on later PSS. Interestingly, a probable migration background also had a small but significant effect on PSS via more episiotomies. The null results for social support may have been caused by a ceiling effect.ConclusionsGiven that we measured predictors at different time points, our results lend important support to the etiological model, namely, that there is a vulnerability pathway and a stress pathway leading to PSS. PSS and other psychological measures stayed very stable between 6 weeks and 1 year postpartum, indicating that it is possible to identify women developing problems early.Highlights of the articleOur results are consistent with a diathesis-stress model: vulnerability (antidepressant use in the previous 10 years) influenced posttraumatic stress symptoms at 6 weeks and 1 year, independently of stress (birth-related variables).The strongest predictor of posttraumatic stress symptoms 1 year postpartum was posttraumatic stress symptoms 6 weeks postpartum. This means that women who develop problems could be identified during routinely offered postpartum care.Women with a probable migration background experienced more PSS 1 year after the birth, which was an indirect effect through more episiotomies and more PSS after 6 weeks.

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Post-traumatic stress disorder following childbirth: an update of current issues and recommendations for future research

Cited by 140 publications

References 84 publications

Emotions and support needs following a distressing birth: Scoping study with pregnant multigravida women in North-West England

Emotions and support needs following a distressing birth: Scoping study with pregnant multigravida women in North-West England

The impact of postpartum post-traumatic stress disorder symptoms on child development: a population-based, 2-year follow-up study

Interplay of demographic variables, birth experience, and initial reactions in the prediction of symptoms of posttraumatic stress one year after giving birth

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