Traumatic birth and childbirth-related post-traumatic stress disorder: International expert consensus recommendations for practice, policy, and research

Ayers, Susan; Horsch, Antje; Garthus-Niegel, Susan; Nieuwenhuijze, Marianne; Bogaerts, Annick; Hartmann, Katharina; Karlsdottir, Sigfridur Inga; Oosterman, Mirjam; Tecirli, Gulcan; Turner, Jonathan D.; Lalor, Joan

doi:10.1016/j.wombi.2023.11.006

Cited by 6 publications

(6 citation statements)

References 30 publications

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“…In our sample, interpersonal difficulties significantly predicted CB-PTSS. Together with the literature on low social support by the staff as a risk factor for CB-PTSS (Dekel et al, 2017), this suggests that providing supportive, traumainformed obstetric care might be a promising starting point for preventing CB-PTSS (Ayers et al, 2023).…”

Section: Discussionmentioning

confidence: 86%

Childbirth-related posttraumatic stress symptoms: exploring the predictive potential of intrapartum hotspots

Blecker,

Dähn,

Engel

et al. 2024

Preprint

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Childbirth can be a highly stressful event, in some cases leading to posttraumatic stress symptoms. While the subjective experience of childbirth (SBE) is a key predictor of childbirth-related posttraumatic stress symptoms (CB-PTSS), the specific defining characteristics of stressful birth experiences remain poorly understood. This study aims to shed light on a specific aspect of SBEs by exploring intrapartum hotspots (i.e., moments of extreme distress during childbirth) and their association with CB-PTSS. In a cross-sectional online study of N = 1,140 individuals who had given birth eight-ten weeks before, we examined the following: 1) the types of hotspots experienced, 2) differences in hotspot-related distress, interpersonal difficulties during the hotspot, and CB-PTSS between the various types of hotspots, and 3) whether hotspot-related distress and interpersonal difficulties during the hotspot independently predicted CB-PTSS. Participants completed the newly developed Hotspot Scale. Based on previous qualitative research, the scale evaluates various types of hotspots, hotspot-related distress, and interpersonal difficulties during intrapartum hotspots. Additionally, participants completed the City Birth Trauma Scale to measure CB-PTSS, alongside relevant pregnancy- and birth-related questions. Findings revealed that medical interventions were the most frequently experienced hotspot. Participants who reported separation from the child experienced the highest levels of hotspot-related distress, interpersonal difficulties, and CB-PTSS. Hotspot-related distress and interpersonal difficulties independently predicted CB-PTSS while accounting for known risk factors. Screening individuals after giving birth for the type of hotspot they experienced and assessing distress and interpersonal difficulties during the hotspot could be a promising approach to identify individuals at risk for CB-PTSS.

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Section: Discussionmentioning

confidence: 86%

Childbirth-related posttraumatic stress symptoms: exploring the predictive potential of intrapartum hotspots

Blecker,

Dähn,

Engel

et al. 2024

Preprint

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“…In the ECS sample, CB-PTSS and probable CB-PTSD were measured at six weeks and six months postpartum, with the French version of the PTSD Checklist for DSM-5-TR (PCL-5) ( 2 , 36 ). The PCL-5 is a 20-item self-report questionnaire, each item measuring the presence of a PTSD symptom linked to childbirth, over the past month ( 2 ), on a five-point scale ranging from 0 to 4. Higher total scores (range: 0−80) reflect more severe symptoms, with a total score ≥ 31 indicating probable CB-PTSD ( 36 ).…”

Section: Methodsmentioning

confidence: 99%

“…Higher total scores (range: 0−80) reflect more severe symptoms, with a total score ≥ 31 indicating probable CB-PTSD ( 36 ). It is also possible to compute a total score with the four PTSD symptom clusters ( 2 ) (intrusions, avoidance, negative alteration in cognitions and mood, and hyperarousal). In this study, PCL-5 Cronbach alpha was 0.91 at six weeks and 0.93 at six months.…”

Section: Methodsmentioning

confidence: 99%

“…According to the posttraumatic stress disorder (PTSD) criterion A of the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5), a traumatic event is a direct or indirect exposure to a life threat or severe injury (1). As parents can perceive a maternal and/or infant life threat during childbirth, this event can fulfil the PTSD criterion A and lead to childbirth-related PTSD (CB-PTSD) (2)(3)(4). Up to 33-46% of mothers appraise their childbirth as traumatic (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

“…CB-PTSD has four symptom clusters: intrusions (e.g., childbirth-related flashbacks and nightmares); avoidance of birth-related cues (e.g., not talking about the birth); negative cognitions and mood (e.g., anhedonia and low mood); and hyperarousal (e.g., increased startle response and hypervigilance towards the infant) ( 2 , 9 ). Childbirth-related posttraumatic stress disorders has been shown to consist of birth-related and general posttraumatic stress symptoms ( 10 ), and researchers have recently argued that CB-PTSD is a distinct sub-type of PTSD ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

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A two-item screening of maternal or infant perceived life threat during childbirth prospectively associated with childbirth-related posttraumatic stress symptoms up to six months postpartum: two observational longitudinal studies

Gilbert,

Sandoz,

Deforges

et al. 2024

Front. Psychiatry

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ObjectiveThis study investigated prospective relationships between the perception of threat to one’s own life or to that of one’s infant during childbirth and maternal childbirth-related posttraumatic stress symptoms (CB-PTSS) and probable childbirth-related posttraumatic stress disorder (CB-PTSD) in a community and a community and an emergency cesarean section (ECS) sample.MethodsStudy samples included 72 mothers from a community sample and 75 mothers after emergency cesarean section. Perceived maternal and infant life threat were assessed at ≤1 week postpartum. Maternal CB-PTSS and probable CB-PTSD were assessed with validated questionnaires up to 6 months postpartum. Covariates were extracted from hospital records. Secondary data analysis with logistic and linear regressions was performed.ResultsGlobally, mothers were significantly more likely to perceive their infant’s life to be threatened, rather than their own. Both types of perceived threat were prospectively but differentially associated with maternal CB-PTSS and probable CB-PTSD at 4-6 weeks and 6 months postpartum. Statistical significance was set at p<0.05.ConclusionThe type of perceived threat differently influences maternal CB-PTSS and probable CB-PTSD up to 6 months postpartum. These results may be the basis for the development of a short screening instrument after traumatic childbirth in clinical settings. Future studies need to assess the psychometric properties and acceptability of such a brief screening tool.

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Unmet Expectations, Unmet Needs, and Uncertainty–A Qualitative Survey Study of Women Who Described Giving Birth as Traumatic

Pavlenko,

Nathan,

Yom

et al. 2024

International Perspectives in Psychology

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Traumatic childbirth can have wide-ranging consequences for birthing individuals. Data were obtained from a large-scale ( N = 1,210) online survey of perinatal experiences in the United States. Utilizing a Reproductive Justice framework, we analyzed open-ended responses regarding the most difficult aspects of pregnancy and childbirth from 54 participants who solely identified their births as traumatic. We identified the following themes: Mental and Emotional Toll; The Toll of Relentless Work Expectations; The Embodied Toll; Complications and Interventions; Loss of Control: Bodily Autonomy; and Loss of Control: Interactions with Medical Systems and Professionals. Results underscore the inadequacy of perinatal support in the United States, highlighting the imperative to address policy and research to advance the UN Sustainable Development Goals of Good Health and Wellbeing and Gender Equality.

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Traumatic birth and childbirth-related post-traumatic stress disorder: International expert consensus recommendations for practice, policy, and research

Cited by 6 publications

References 30 publications

Childbirth-related posttraumatic stress symptoms: exploring the predictive potential of intrapartum hotspots

Childbirth-related posttraumatic stress symptoms: exploring the predictive potential of intrapartum hotspots

A two-item screening of maternal or infant perceived life threat during childbirth prospectively associated with childbirth-related posttraumatic stress symptoms up to six months postpartum: two observational longitudinal studies

Unmet Expectations, Unmet Needs, and Uncertainty–A Qualitative Survey Study of Women Who Described Giving Birth as Traumatic

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