When birth is not as expected: a systematic review of the impact of a mismatch between expectations and experiences.

BACKGROUND: Pregnancy and childbirth are significant events in women's lives and most women have expectations or plans for how they hope their labour and birth will go. It is possible that strong expectations about labour and birth lead to dissatisfaction or other negative outcomes if these expectations are not met, but it is not clear if this is the case. The aim was therefore to synthesise prospective studies in order to understand whether unmet birth expectations are associated with adverse outcomes for women, their partners and their infants. METHOD: Searches were carried out in Academic Search Complete; CINAHL; Medline; PsycINFO, PsychArticles, PubMed, SCOPUS and Web of Science. Forward and backward searches were also completed. Studies were included if they reported prospective empirical research that examined the association between a mismatch in birth expectations/experience and postnatal outcomes in women, their children and/or their partners. Data were synthesised qualitatively using a narrative approach where study characteristics, context and methodological quality were extracted and summarised and then the differences and similarities among studies were used to draw conclusions. RESULTS: Eleven quantitative studies were identified for inclusion from nine countries. A mismatch between birth expectations and experiences was associated with reduced birth satisfaction. Three studies found a link between a mismatch and the development of postnatal post-traumatic stress disorder (PTSD). The evidence was inconsistent for postnatal depression, and fear of childbirth. Only one study looked at physical outcomes in the form of health-related quality of life. CONCLUSIONS: A mismatch between birth expectations and experiences is associated with birth satisfaction and it may increase the risk of developing postnatal PTSD. However, it is not clear whether a mismatch is associated with other postnatal mental health conditions. Further prospective research is needed to examine gaps in knowledge and provide standardised methods of measuring childbirth expectations-experiences mismatch. To ensure women's expectations are met, and therefore experience a satisfying birth experience, maternity providers should provide sensitive care, which acknowledges women's needs and preferences, is based on open and clear communication, is delivered as early in pregnancy as possible, and enables women to make their own decisions about care. TRIAL REGISTRATION: Protocol registration: PROSPERO CRD42020191081 .

A Supported Online Resilience-Enhancing Intervention for Pregnant Women: A Non-Randomized Pilot Study.

A 28-week supported online intervention for pregnant women, informed by the Behavior Change Wheel Framework, was developed. The intervention included exercises, group sessions and a peer support platform. The aim of this study was to examine the potential effectiveness of the intervention in enhancing resilience and promoting maternal mental health. Using a quasi-experimental design, assessments were conducted at baseline, postintervention and follow-ups at six and 12 months after childbirth. Resilience, resilience attributes, and maternal mental health were measured using standardised scales. The intervention group received the intervention (N = 70), while the control group (N = 32) received care-as-usual. A repeated-measures ANOVA was used to determine within- and between-group changes. Results showed no significant differences between groups regarding resilience and maternal mental health. However, the intervention group demonstrated stable resilience (p = 0.320) compared to a significant decrease in the control group (p = 0.004). Within the intervention group, perceived social support remained stable during the intervention, but decreased significantly at the first follow-up (p = 0.012). All participants faced additional stress from the COVID-19 pandemic alongside the challenges of parenthood. This study contributes to maternal mental health literature with an innovative, supported online intervention. The intervention consists of different deployable components, designed to be offered online, and the current pilot data are promising. Further research is warranted to explore its full potential in clinical practice.

Birth expectations, birth experiences and childbirth-related post-traumatic stress symptoms in mothers and birth companions: Dyadic investigation using response surface analysis.

OBJECTIVES: During the perinatal period, women and their birth companions form expectations about childbirth. We aimed to examine whether a mismatch between birth expectations and experiences predict childbirth-related post-traumatic stress symptoms (CB-PTSS) for mothers and birth companions. We also explored the influence of the mismatch between mothers' and birth companions' expectations/experiences on CB-PTSS. DESIGN: Dyadic longitudinal data from the Self-Hypnosis IntraPartum Trial. METHODS: Participants (n = 469 mothers; n = 358 birth companions) completed questionnaires at 27 and 36 weeks of gestation and 2 and 6 weeks post-partum. We used the measures of birth expectations (36 weeks gestation), birth experiences (2 weeks post-partum) and CB-PTSS (6 weeks post-partum). RESULTS: Correlations revealed that birth expectations were associated with experiences for both mothers and birth companions but were not consistently associated with CB-PTSS. Birth experiences related to CB-PTSS for both mothers and birth companions. The response surface analysis results showed no support for the effect of a mismatch between expectations and experiences on CB-PTSS in mothers or birth companions. Similarly, a mismatch between mothers' and birth companions' expectations or experiences was unrelated to CB-PTSS. CONCLUSIONS: Following previous literature, birth expectations were associated with experiences, and experiences were associated with CB-PTSS. By testing the effect of the match between birth experiences and expectations using an advanced statistical method, we found that experiences play a more substantial role than the match between experiences and expectations in CB-PTSS. The impact of birth experiences on CB-PTSS highlights the importance of respectful and supportive maternity care.

Development of a resilience-enhancing intervention during and after pregnancy: a systematic process informed by the behaviour change wheel framework.

BACKGROUND: Pregnancy and the transition to parenthood are accompanied by multiple changes and stress exposure. Resilience has the potential to counteract the negative impact of stress and can be a protective factor against mental health problems. To date, the use of a theoretical framework in the development or application of resilience interventions during pregnancy up to one year postpartum is missing. The aim of this study is to develop an intervention to enhance resilience for pregnant women up to one year postpartum. METHODS: A systematic and theory-based approach informed by the Behaviour Change Wheel framework and the theoretical model of perinatal resilience was applied. The development took place in three phases and during the process, the target group, researchers and clinicians were involved. RESULTS: A combination of resilience-enhancing exercises, group sessions and an online support platform, including follow-up at six and twelve months after delivery, was designed to enhance resilience during pregnancy and up to one year postpartum. This intervention incorporates 5 intervention functions delivered by 18 behaviour change techniques. CONCLUSIONS: This study responds to the need for theory-based intervention programs aiming to enhance resilience to improve the psychological health of pregnant women. We developed a multicomponent resilience-enhancing intervention for pregnant women up to one year postpartum.

Care When It Counts: Establishing Trauma-Sensitive Care as a Preventative Approach for 0-3-Year-Old Children Suffering from Trauma and Chronic Stress.

Adverse childhood experiences are an important societal concern. Children aged 0-3 are particularly vulnerable to unpredictable chronic stress due to the critical period for brain development and attachment. Trauma-sensitive care is a preventative approach to reduce the burden of stressful experiences by committing to positive relationships. Professional caregivers are ideally placed to offer trauma-sensitive care; however, earlier research reveals that the tools they need to consciously apply trauma-sensitive care principles are missing. The current study organized living labs (co-creative research method) to present trauma-sensitive care as a preventative approach aimed at children aged 0-3. Two living labs were organized in Belgium and Hungary, where professional caregivers collaborated to create a protocol that offers guidelines on how to implement trauma-sensitive care. The resulting protocol included a theoretical foundation on trauma as well as a translation of these guidelines into practical recommendations. The protocol was evaluated by incorporating it into a training intervention delivered to 100 professional caregivers from childcare organizations across four European countries. The protocol received positive feedback from participants, with results indicating a self-reported increase in knowledge, attitude and practice of trauma-sensitive care principles. We conclude that this trauma-sensitive care protocol is a promising answer to the needs of professional caregivers working with children aged 0-3.

"Nobody Listened". Mothers' Experiences and Needs Regarding Professional Support Prior to Their Admission to an Infant Mental Health Day Clinic.

Challenges during the perinatal period can lead to maternal distress, negatively affecting mother-infant interaction. This study aims to retrospectively explore the experiences and needs regarding professional support of mothers with difficulties in mother-infant interaction prior to their admission to an infant mental health day clinic. In-depth semi-structured interviews were conducted with 13 mothers who had accessed an infant mental health day clinic because of persistent severe infant regulatory problems impairing the wellbeing of the infant and the family. Data were transcribed and analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL). Three themes were identified: 'experience of pregnancy, birth, and parenthood'; 'difficult care paths'; and 'needs and their fulfillment'. The first theme consisted of three subthemes: (1) 'reality does not meet expectations', (2) 'resilience under pressure', and (3) 'despair'. Mothers experienced negative feelings that were in contradiction to the expected positive emotions associated with childbirth and motherhood. Resilience-related problems affected the mother-child relationship, and infants' regulatory capacities. Determined to find solutions, different healthcare providers were consulted. Mothers' search for help was complex and communication between healthcare providers was limited because of a fragmented care provision. This hindered the continuity of care and appropriate referrals. Another pitfall was the lack of a broader approach, with the emphasis on the medical aspects without attention to the mother-child dyad. An integrated care pathway focusing on the early detection of resilience-related problems and sufficient social support can be crucial in the prevention and early detection of perinatal and infant mental health problems.

Perinatal Resilience for the First 1,000 Days of Life. Concept Analysis and Delphi Survey.

BACKGROUND: The ability to cope with challenges and stress in life is generally understood as resilience. Pregnancy and parenthood are challenging times. The concept of resilience is receiving increasing interest from researchers, clinicians, and policy staff because of its potential impact on health, well-being, and quality of life. Nevertheless, the concept is less studied during the perinatal period. OBJECTIVES: The aim of this study is to understand the concept of perinatal resilience, including the underlying processes and more specifically for the first 1,000 days of life. METHODS: A concept analysis according to the Walker and Avant (2011) framework was used, to investigate the basic elements of the concept. Concurrently, a two-round Delphi survey involving researchers, clinicians, epidemiologists, mothers, and fathers (N = 21), was conducted to prioritize the terms associated with perinatal resilience. Data collection took place between January and April 2019. RESULTS: Through concept analysis and Delphi survey, five defining attributes for perinatal resilience were identified: social support, self-efficacy, self-esteem, sense of mastery and personality. The additional terms, rated important by the Delphi survey, were linked to the consequences of being resilient during the perinatal period for the individual and his/her family. Specifically, highlighted were the experiences of families in personal growth and achieving family balance, adaptation, or acceptance. CONCLUSION: Based on the results of the concept analysis and Delphi survey, we describe perinatal resilience for the first 1,000 days as a circular process towards a greater well-being in the form of personal growth, family balance, adaptation or acceptance, when faced with stressors, challenges or adversity during the perinatal period. The presence of resiliency attributes such as social support, sense of mastery, self-efficacy, and self-esteem enhance the capacity to be resilient and probably prevent mental health problems.