Early mother-infant interactions within the context of childbirth-related posttraumatic stress symptoms.

BACKGROUND: Childbirth may lead to perinatal mental health issues, such as childbirth-related posttraumatic stress symptoms (CB-PTSS), depression, and anxiety. Despite well explored mother-infant interactions in the context of maternal depression and anxiety, only limited studies investigated mother-infant interactions in the context of CB-PTSS, which is the aim of the present study. METHODS: One-hundred mother-infant dyads in the French speaking part of Switzerland were classified into three groups: birth-related symptoms (BRS, i.e., symptoms of re-experiencing and avoidance) (n = 20), general symptoms (GS, i.e., symptoms of negative cognition and mood and hyperarousal) (n = 46), and non-symptomatic (NS) (n = 34) based on maternal report on PTSD Checklist for DSM-5 (PCL-5). At six months postpartum, mother-infant interactions were video-recorded and their quality was assessed using the Global Rating Scale. Data was analyzed using ordinal logistic and negative binomial regressions. RESULTS: In the adjusted model, mothers in BRS group engaged in more frequent coercions compared to the NS group (B = -1.46, p = 0.01, 95%CI = -2.63, -0.36) and showed lower reciprocity in their interactions with their infants compared to the GS group (B = 1.21, p = 0.03, 95%CI = 0.05, 2.37). LIMITATIONS: The use of a cross-sectional design limited the exploration of how consistent these findings are regarding mother-infant interactions between groups over time. CONCLUSIONS: Mothers with higher BRS may need support to improve interactions with their infants. Future studies should consider longitudinal design to observe mother-infant interaction changes between CB-PTSS groups over time.

The relationship between traumatic childbirth and first-time mothers' social identity and wellbeing: a cross-sectional observational study.

BACKGROUND: Experiencing childbirth as traumatic is common and can have long-lasting negative consequences for women's mental health. However, fostering a sense of social identity has been shown to protect psychological wellbeing and mental health during life transitions, such as entering parenthood. This study therefore investigated the relationship between traumatic childbirth and first-time mothers' social identity and their psychological wellbeing, and more specifically whether strength of identity as a first-time mother protected psychological wellbeing following traumatic childbirth. METHOD: Women over the age of 18 who were living in the UK and had given birth to their first child in the past nine months were recruited to the study from clinical and community settings. They completed digital self-report questionnaires about their birth experience, social identity, mental health, and psychological wellbeing. Women who perceived themselves to have had a traumatic birth (the trauma group; N = 84) were compared to women who did not perceive themselves to have had a traumatic birth (the control group, N = 39). T-tests and chi square tests assessed preliminary group differences before multivariate analyses of covariance controlled for covariates. Post-hoc tests identified the direction of differences. Multiple regression and moderation analyses analysed interaction effects. RESULTS: The trauma group had significantly lower psychological wellbeing (mean = 41.5, 95% CI [39.4-43.7], p = .008, partial η2 = 0.059), compared to the control group (mean = 48.4, 95% CI [45.3-51.5]), but the two groups did not differ in the strength of their first-time mother identity, which was high across both groups. Strength of identity did not moderate the relationship between traumatic childbirth and psychological wellbeing. Giving birth by caesarean section independently reduced the strength of the first-time mother identity (p = .017, partial η2 = 0.049). All analyses controlled for emotional and practical support, perceptions of healthcare staff, and mode of birth. CONCLUSIONS: Having a traumatic birth was associated with lower psychological wellbeing, and the strength of first-time mother identity does not appear to moderate this relationship. Factors such as mode of birth may be more important. Further research, including longitudinal designs, is needed to understand the relationship between these constructs and identify more effective ways of protecting first-time mothers' mental health.

Determinants of Psychosocial Health Status in Pregnant and Postpartum Women Experiencing Earthquake in Turkey.

OBJECTIVE: It is well known that natural disasters such as earthquakes negatively affect physical and mental health by exposing people to excessive stress. The aim of this study was to investigate determinants of psychosocial health status among the pregnant and postpartum women who experienced earthquake in Türkiye. METHODS: Pregnant and postpartum women (n = 125) living in tent cities in the Kahramanmaras region formed the study sample. Data were collected between February 20 and 26, 2023, through face-to-face interviews. The instruments used for data collection were the Introductory Form, the Depression Anxiety Stress Scale, the Traumatic Childbirth Perception Scale, and the Post-Traumatic Stress Disorder-Short Scale. RESULTS: A moderate positive relationship was found between stress and posttraumatic stress and traumatic childbirth perception in pregnant and postpartum women, and a high positive relationship was found between anxiety and depression. A high level of relationship was found between anxiety and stress and depression. CONCLUSIONS: It is seen that the psychosocial health of pregnant and postpartum women, who belong to the risk group in the earthquake zone, is at high risk. Psychological support is urgently needed to preserve and improve their psychosocial health.

The intersection of traumatic childbirth and obstetric racism: A qualitative study.

BACKGROUND: Traumatic childbirth experiences are common in the United States - affecting a third to a fourth of mothers - with significant negative impacts on maternal health. Yet most research on traumatic childbirth focuses on white mothers' experiences. Drawing on a racially and ethnically diverse sample of mothers who experienced traumatic childbirth, this exploratory qualitative study examined Black, Latina, and Asian mothers' traumatic birth experiences and the role of obstetric racism in shaping these experiences. METHODS: In-depth, semi-structured interviews were conducted in 2019-2020 with 30 mothers who identified as women of color (37% Black, 40% Latina, and 23% Asian) who gave birth in the US and self-identified as having experienced a traumatic childbirth. Data were analyzed using qualitative content analysis. RESULTS: Mothers reported obstetric racism as core to their traumatic birth experiences. This racism manifested through practitioners' use of gendered and racialized stereotypes, denying and delegitimizing mothers' needs. Mothers shared key consequences of the obstetric racism they experienced, including postpartum anxiety and depression, increased medical mistrust, and decreased desire for future children. CONCLUSIONS: Mothers' reports suggest that obstetric racism played a role in their traumatic birth experiences. Particularly, practitioners' deployment of gendered and racialized stereotypes influenced mothers' treatment during birth. These findings point to opportunities to address obstetric racism during childbirth and improve patients' experiences through enhancing their agency and empowerment. The findings, in addition, highlight the need for increased practitioner training in anti-racist practice and cultural humility.

Screening for post-traumatic stress disorder following childbirth using the Peritraumatic Distress Inventory.

BACKGROUND: Post-traumatic stress disorder (PTSD) following traumatic childbirth may undermine maternal and infant health, but screening for maternal childbirth-related PTSD (CB-PTSD) remains lacking. Acute emotional distress in response to a traumatic experience strongly associates with PTSD. The Peritraumatic Distress Inventory (PDI) assesses acute distress in non-postpartum individuals, but its use to classify women likely to endorse CB-PTSD is unknown. METHODS: 3039 women provided information about their mental health and childbirth experience. They completed the PDI regarding their recent childbirth event, and a PTSD symptom screen to determine CB-PTSD. We employed Exploratory Graph Analysis and bootstrapping to reveal the PDI's factorial structure and optimal cutoff value for CB-PTSD classification. RESULTS: Factor analysis revealed two strongly correlated stable factors based on a modified version of the PDI: (1) negative emotions and (2) bodily arousal and threat appraisal. A score of 15+ on the modified PDI produced high sensitivity and specificity: 88 % with a positive CB-PTSD screen in the first postpartum months and 93 % with a negative screen. LIMITATIONS: In this cross-sectional study, the PDI was administered at different timepoints postpartum. Future work should examine the PDI's predictive utility for screening women as closely as possible to the time of childbirth, and establish clinical cutoffs in populations after complicated deliveries. CONCLUSIONS: Brief self-report screening concerning a woman's emotional reactions to childbirth using our modified PDI tool can detect those likely to endorse CB-PTSD in the early postpartum. This may serve as the initial step of managing symptoms to ultimately prevent chronic manifestations.

Maternal childbirth-related posttraumatic stress symptoms, bonding, and infant development: a prospective study.

BACKGROUND: Childbirth-related posttraumatic stress symptoms (CB-PTSS) including general symptoms (GS, i.e., mainly negative cognitions and mood and hyperarousal symptoms) and birth-related symptoms (BRS, i.e., mostly re-experiencing and avoidance symptoms) may disrupt mother-infant bonding and infant development. This study investigated prospective and cross-sectional associations between maternal CB-PTSS and mother-infant bonding or infant development (language, motor, and cognitive). METHOD: We analysed secondary data of the control group of a randomised control trial (NCT03576586) with full-term French-speaking mother-infant dyads (n = 55). Maternal CB-PTSS and mother-infant bonding were assessed via questionnaires at six weeks (T1) and six months (T2) postpartum: PTSD Checklist for DSM-5 (PCL-5) and Mother-Infant Bonding Scale (MIBS). Infant development was assessed with the Bayley Scales of Infant Development at T2. Sociodemographic and medical data were collected from questionnaires and medical records. Bivariate and multivariate regression were used. RESULTS: Maternal total CB-PTSS score at T1 was associated with poorer bonding at T2 in the unadjusted model (B = 0.064, p = 0.043). In the adjusted model, cross-sectional associations were found at T1 between a higher total CB-PTSS score and poorer bonding (B = 0.134, p = 0.017) and between higher GS and poorer bonding (B = 0.306, p = 0.002). Higher BRS at T1 was associated with better infant cognitive development at T2 in the unadjusted model (B = 0.748, p = 0.026). CONCLUSIONS: Results suggest that CB-PTSS were associated with mother-infant bonding difficulties, while CB-PTSS were not significantly associated with infant development. Additional studies are needed to increase our understanding of the intergenerational consequences of perinatal trauma.

Reducing the Adverse Effects of Birth Trauma Among Birth Companions.

Birth trauma affects the entire family, yet limited attention has been directed to how nurses influence the experiences of birth companions. Therefore, the purpose of this article is to increase awareness of birth trauma among birth companions and provide nursing strategies to reduce the adverse effects of traumatic childbirth among birth companions. I review background information describing birth companions' perceptions of childbirth as traumatic and the implications of birth trauma. I then present protective nursing strategies before, during, and after birth, followed by a discussion on implications. Lastly, I offer a summary of protective nursing strategies, an example of postnatal debriefing using the adapted ASSIST communication tool, and available online birth companion resources.

The impact on midwives and their practice after caring for women who have a traumatic childbirth: A systematic review.

BACKGROUND: Women's birth experiences can range from positive and satisfying to negative and traumatizing. Midwives caring for women can also be exposed to these traumatic childbirth experiences. There is a paucity of research on the impact these experiences have on midwives and their practice. The PEO framework guided the research review question. METHODS: Seven electronic databases were systematically searched. The quality of each included study was assessed using the tool appropriate to the study's methodological approach; Critical Appraisal Skills Program (CASP) criteria and the Mixed Methods Appraisal Tool (MMAT) Version 2018. The Consolidated Criteria for Reporting Qualitative Research (COREQ) tool was utilized to assess reported findings. Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to grade the confidence in the evidence of the qualitative research. Data were thematically analyzed to formalize the identification and development of themes. RESULTS: A total of 12 studies were included. Synthesis of the evidence generated one overarching theme, "Midwives, the forgotten victims", and three themes describing the essences of midwives' experiences: "Bruised and battered but still smiling"; "Wearing armour to protect my soul"; "Members of my team are holding me up, others are pulling me down". CONCLUSIONS: Midwives expressed feelings of shock, fear, responsibility, and powerlessness which may contribute to some experiencing serious mental illness. They reported a shaken belief in the normal physiologic birth process which consequently led to more defensive practice. Research is needed to identify high-quality interventions to support midwives after these events. This systematic review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO; Registration CRD42021252033).

Optimising maternity care for a subsequent pregnancy after a psychologically traumatic birth: A scoping review.

BACKGROUND: Psychological birth trauma is recognised as a significant and ubiquitous sequelae from childbirth, with the incidence reported as up to 44%. In a subsequent pregnancy, women have reported a range of psychological distress symptoms from anxiety, panic attacks, depression, sleep difficulties and suicidal thoughts. AIM: To summarise evidence on optimising a positive pregnancy and birth experience for a subsequent pregnancy following a psychologically traumatic pregnancy and identify research gaps. METHODS: This review followed the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR check list. Six databases were searched using key words relating to psychological birth trauma and subsequent pregnancy. Utilising agreed criteria, relevant papers were identified, and data were extracted and synthesised. RESULTS: A total of 22 papers met the inclusion criteria for this review. All papers addressed different aspects of what was important to women in this cohort, summarised as women wanting to be at the centre of their care. Pathways of care were diverse ranging from free birth to elective caesarean. There was no systematic process for identifying a previously traumatic birth experience and no education to enable clinicians to understand the importance of this. CONCLUSION: For women who have experienced a previous psychologically traumatic birth, being at the centre of their care, in their subsequent pregnancy, is a priority. Embedding woman-centred pathways of care for women with this experience, as well as multidisciplinary education on the recognition and prevention of birth trauma, should be a research priority.

A multilevel developmental psychopathology model of childbirth and the perinatal transition.

Despite recent applications of a developmental psychopathology perspective to the perinatal period, these conceptualizations have largely ignored the role that childbirth plays in the perinatal transition. Thus, we present a conceptual model of childbirth as a bridge between prenatal and postnatal health. We argue that biopsychosocial factors during pregnancy influence postnatal health trajectories both directly and indirectly through childbirth experiences, and we focus our review on those indirect effects. In order to frame our model within a developmental psychopathology lens, we first describe "typical" biopsychosocial aspects of pregnancy and childbirth. Then, we explore ways in which these processes may deviate from the norm to result in adverse or traumatic childbirth experiences. We briefly describe early postnatal health trajectories that may follow from these birth experiences, including those which are adaptive despite traumatic childbirth, and we conclude with implications for research and clinical practice. We intend for our model to illuminate the importance of including childbirth in multilevel perinatal research. This advancement is critical for reducing perinatal health disparities and promoting health and well-being among birthing parents and their children.

The incidence of post-traumatic stress disorder following traumatic childbirth: A systematic review and meta-analysis.

BACKGROUND: Although birth trauma may be a risk factor for postpartum post-traumatic stress disorder (PTSD), no systematic review regarding the incidence of postpartum PTSD in women with traumatic childbirth has been reported. OBJECTIVE: To estimate the incidence of PTSD in women following traumatic childbirth by systematically reviewing and synthesizing all available evidence. SEARCH STRATEGY: Six databases were searched using a combination of related terms for birth trauma and PTSD. SELECTION CRITERIA: Cohort and cross-sectional studies that were related to traumatic childbirth and PTSD were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened potentially relevant studies and extracted key data elements. A series of meta-analyses were conducted using STATA 17.0 software, with pooled incidence rates estimated using random effects models. MAIN RESULTS: A total of nine studies were included in this study. The pooled incidence of PTSD after traumatic childbirth was 19.4% (95% confidence interval 11.9%-26.5%). The incidence of PTSD varied with the scales used to assess traumatic birth and PTSD, evaluation times of PTSD after childbirth, and types of study participants. CONCLUSIONS: The incidence of PTSD in women with traumatic childbirth is about 19%, higher than the general obstetric population, suggesting that trauma-related care for them should be enhanced.

Cross-Sectional Study of the Frequency and Severity of Traumatic Childbirth Events and How They Affect Maternity Care Clinicians.

OBJECTIVE: To describe the frequency and severity of traumatic childbirth events (TCEs) and how they affected the professional practice and personal lives of maternity care clinicians, including registered nurses (RNs), certified nurse-midwives, attending physicians, and resident physicians. DESIGN: Descriptive cross-sectional study. SETTING: Maternity units across five hospitals in the Baltimore metropolitan area. PARTICIPANTS: Maternity care clinicians (N = 160) including RNs (n = 104), certified nurse-midwives (n = 17), attending physicians (n = 28), and resident physicians (n = 11). METHODS: Participants completed an online survey to measure the frequency and severity of TCEs and how they affect participants' professional practice and personal lives. We used descriptive statistics to characterize maternity care clinicians and bivariate analysis and linear regression to examine relationships. RESULTS: Most participants were women (92.5%), White (62.5%), between the ages of 21 and 54 years (89.4%), RNs (65.0%), and employed full-time (79.2%). Shoulder dystocia was the most frequently observed TCE (90.6%), and maternal death was the most severe TCE (M = 4.82, SD = 0.54). Attending physicians (50.0%) reported a significantly greater frequency of exposure to TCEs than the other participants, χ2(6) = 23.8 (n = 159), p <. 001. The frequency of TCEs had a significant medium correlation with perceived effect on professional practice, r(154) = 0.415, p < .001, and personal life, r(155) = 0.386, p < .001. Perception of severity was strongly associated with professional practice, ß = 0.52, p < .001, and personal life, ß = 0.46, p < .001. CONCLUSION: If severe, TCE exposure can affect the professional practice and personal life of maternity care clinicians.

Traumatic Childbirth and Birth-Related Post-Traumatic Stress Disorder in the Time of the COVID-19 Pandemic: A Prospective Cohort Study.

BACKGROUND: Birth-related post-traumatic stress disorder occurs in 4.7% of mothers. No previous study focusing precisely on the stress factors related to the COVID-19 pandemic regarding this important public mental health issue has been conducted. However, the stress load brought about by the COVID-19 pandemic could have influenced this risk. METHODS: We aimed to estimate the prevalence of traumatic childbirth and birth-related PTSD and to analyze the risk and protective factors involved, including the risk factors related to the COVID-19 pandemic. We conducted a prospective cohort study of women who delivered at the University Hospitals of Geneva between 25 January 2021 and 10 March 2022 with an assessment within 3 days of delivery and a clinical interview at one month post-partum. RESULTS: Among the 254 participants included, 35 (21.1%, 95% CI: 15.1-28.1%) experienced a traumatic childbirth and 15 (9.1%, 95% CI: 5.2-14.6%) developed a birth-related PTSD at one month post-partum according to DSM-5. Known risk factors of birth-related PTSD such as antenatal depression, previous traumatic events, neonatal complications, peritraumatic distress and peritraumatic dissociation were confirmed. Among the factors related to COVID-19, only limited access to prenatal care increased the risk of birth-related PTSD. CONCLUSIONS: This study highlights the challenges of early mental health screening during the maternity stay when seeking to provide an early intervention and reduce the risk of developing birth-related PTSD. We found a modest influence of stress factors directly related to the COVID-19 pandemic on this risk.

Experiencing Pregnancy during the COVID-19 Lockdown in Poland: A Cross-Sectional Study of the Mediating Effect of Resiliency on Prenatal Depression Symptoms.

The COVID-19 pandemic in Poland brought uncertainty, not only to the general population but also to women preparing for childbirth, which increased the risk of mental health illnesses during this special period of life. Resilience, which refers to positive adaptation or the ability to maintain good mental health, can be a protective factor against the development of psychiatric problems such as depressive symptoms. This study aimed to assess the protective role of resilience in the relationship of such risk factors as traumatic childbirth perception and pandemic-related pregnancy stress with prenatal depressive symptoms. The study was performed at the end of the first wave of the COVID-19 pandemic. A total of 80 pregnant women took part. A mediation analysis, an independent t-test, and a Pearson correlation analysis were conducted. The lower resilience group declared the inclusion of slightly more participants (n = 41; 51.2%); 39 women (48.8%) demonstrated a higher risk of prenatal depression. The analysis revealed a significant direct effect between pandemic-related stress and prenatal depression (ßc = 0.285, SE = 0.05, t = 2.63, p < 0.05) as well as between pandemic-related stress and resilience (ßa = −0.283, SE = 0.07, t = −2.61, p < 0.05) and between resilience and prenatal depression (ßb = −0.585, SE = 0.07, t = −6.34, p < 0.001). After the introduction of resilience as a mediator, the strength of the relationship not only decreased, but also ceased to be statistically significant (ßc' = 0.120, SE = 0.04, t = 1.29, p = 0.19), which indicates that it was in a full mediation state (R2 = 0.39, F = 25.31, p < 0.001; Z = 2.43, p < 0.05). The results indicate that in pregnant women, a high level of resilience protects them from the effects of pandemic-related stress on perinatal depression symptoms.

Comparison of pregnant women's anxiety, depression and birth satisfaction based, on their traumatic childbirth perceptions.

This study was conducted to identify and compare pregnant women's anxiety, depression, and birth satisfaction levels based on their traumatic childbirth perceptions. This study used a cross-sectional design. The data were collected at two stages, namely, the prenatal and postpartum stages. First, the Traumatic Childbirth Perception Scale, the Beck Anxiety Inventory, and the Beck Depression Inventory were applied to the pregnant women. Next, in the postpartum period, the Childbirth Information Form and the Birth Satisfaction Scale-Revised were applied. It was found that the participants with high levels of traumatic childbirth perception had higher mean anxiety and depressive symptom scores (26.13 ± 11.30 and 16.16 ± 9.02, respectively), whereas the participants with low levels of traumatic childbirth perception had a higher mean birth satisfaction score (17.50 ± 4.91). The findings indicated that high levels of traumatic childbirth perception may lead to have anxiety and depression, while low levels of traumatic childbirth perception may enhance their birth satisfaction. IMPACT STATEMENTWhat is already known on this subject? In the literature, it is stated that the perception of a traumatic birth can lead to permanent or long-term negative consequences in women's lives, negatively affecting their future health, subsequent birth experiences, and family relationships.What do the results of this study add? In this study, 37.7% of the participants were found to have high levels of traumatic childbirth perception. It was determined that the anxiety and depression levels of the participants with high levels of perception of traumatic birth were higher, and the levels of birth satisfaction were higher in the pregnant women with low levels of perception of traumatic birth. The results indicated that severe depressive symptoms, severe anxiety, and low levels of birth satisfaction were likely to raise traumatic childbirth perception levels in pregnant women.What are the implications of these findings for clinical practice and/or further research? The care to be given under the leadership of midwifery professionals is important in terms of reducing pregnant women's perceptions of a traumatic birth, anxiety, and depression levels and increasing their levels of birth satisfaction.

Disrespect and abuse during labour and birth amongst 12,239 women in the Netherlands: a national survey.

BACKGROUND: Women experience disrespect and abuse during labour and birth all over the world. While the gravity of many forms of disrespect and abuse is evident, some of its more subtle forms may not always be experienced as upsetting by women. This study examines (1) how often women experience disrespect and abuse during labour and birth in the Netherlands and (2) how frequently they consider such experiences upsetting. We also examine (3) which respondent characteristics (age, ethnicity, educational level and parity) are associated with those experiences of disrespect and abuse that are upsetting, and (4) the associations between upsetting experiences of disrespect and abuse, and women's labour and birth experiences. METHODS: Women who gave birth up to five years ago were recruited through social media platforms to participate in an online survey. The survey consisted of 37 questions about experiences of disrespect and abuse divided into seven categories, dichotomised in (1) not experienced, or experienced but not considered upsetting (2) experienced and considered upsetting. A multivariable logistic regression analysis was performed to examine associated characteristics with upsetting experiences of disrespect and abuse. A Chi-square test was used to investigate the association between upsetting experiences of disrespect and abuse and overall birth experience. RESULTS: 13,359 respondents started the questionnaire, of whom 12,239 met the inclusion and exclusion criteria. Disrespect and abuse in terms of 'lack of choices' (39.8%) was reported most, followed by 'lack of communication' (29.9%), 'lack of support' (21.3%) and 'harsh or rough treatment/physical violence' (21.1%). Large variation was found in how frequently certain types of disrespect and abuse were considered upsetting, with 36.3% of women experiencing at least one situation of disrespect and abuse as upsetting. Primiparity and a migrant background were risk factors for experiencing upsetting disrespect and abuse in all categories. Experiencing more categories of upsetting disrespect and abuse was found to be associated with a more negative birth experience. CONCLUSIONS: Disrespectful and abusive experiences during labour and birth are reported regularly in the Netherlands, and are often (but not always) experienced as upsetting. This emphasizes an urgent need to implement respectful maternity care, even in high income countries.

Disrespect and abuse during labour and birth is a globally recognized phenomenon and has been linked to traumatic birth experiences and PTSD. In our study, we investigated how often women experience disrespect and abuse during labour and birth in the Netherlands and what proportion of these experiences was found to be upsetting. We also looked at risk factors for experiencing upsetting disrespect and abuse and to what extent upsetting disrespect and abuse influences the overall labour and birth experience.We conducted an online survey, with 12,239 respondents included in the analysis. We found a large variation in how frequently certain types of disrespect and abuse were considered upsetting, with 36.3% of women experiencing at least one situation of disrespect and abuse as upsetting. More subtle forms of disrespect and abuse, such as lack of choice, communication or support, were most prevalent and often considered upsetting. Giving birth for the first time and having a migrant background were risk factors for experiencing upsetting disrespect and abuse. Upsetting disrespect and abuse was found to have a strong impact on the overall labour and birth experience; with every additional experienced category of upsetting disrespect and abuse, the number of (very) positive labour and birth experiences decreases and the number of very negative ones increases.Although disrespect and abuse is a complex issue and its measurement subjective, this study shows that there is still a long way to go before achieving optimal respectful maternity care for all women, even in high income countries.

Developing a woman-centered, inclusive definition of traumatic childbirth experiences: A discussion paper.

INTRODUCTION: Many women experience giving birth as traumatic. Although women's subjective experiences of trauma are considered the most important, currently there is no clear inclusive definition of a traumatic birth to help guide practice, education, and research. AIM: To formulate a woman-centered, inclusive definition of a traumatic childbirth experience. METHODS: After a rapid literature review, a five-step process was undertaken. First, a draft definition was created based on interdisciplinary experts' views. The definition was then discussed and reformulated with input from over 60 multidisciplinary clinicians and researchers during a perinatal mental health and birth trauma research meeting in Europe. A revised definition was then shared with consumer groups in eight countries to confirm its face validity and adjusted based on their feedback. RESULTS: The stepwise process confirmed that a woman-centered and inclusive definition was important. The final definition was: "A traumatic childbirth experience refers to a woman's experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/ or long-term negative impacts on a woman's health and wellbeing." CONCLUSIONS: This definition of a traumatic childbirth experience was developed through consultations with experts and consumer groups. The definition acknowledges that low-quality provider interactions and obstetric violence can traumatize individuals during childbirth. The women-centered and inclusive focus could help women to identify and validate their experiences of traumatic birth, offering benefits for practice, education, and research, as well as for policymaking and activism in the fields of perinatal mental health and respectful maternity care.

[Posttraumatic stress disorder and emergency cesarean delivery: Incidence and risk factors]. / Stress post traumatique et césarienne en extrême urgence : incidence et facteurs de risque.

BACKGROUND: Posttraumatic stress disorder (PTSD) is declared in 3 to 6 % of postpartum women (PP) and up to 18.5 % in cases of complications of pregnancy or childbirth. The objective of this study is to assess the prevalence of PTSD after a red code cesarean section and to identify the risk factors among the prenatal vulnerability factors, the birth alert factors and the maintenance factors in PP. METHOD: A phone or computerized questionnaire including an Questionnaire de stress immédiat and the Posttraumatic Stress Disorder Checklist for DSM-5 was offered to patients who had a red code cesarean section between 05/12/2015 and 02/28/2021 at the University South Hospital of Reunion Island. RESULTS: Among the 555 cesarean sections selected, 329 parturients responded. The prevalence of PTSD was 20.1 % and was stable over time. The 2 risk factors found were the negative experience of childbirth and the proven traumatic experience. Prenatal vunerability factors were not found to be statistically significant. Almost 3 in 4 women had not been informed of the risk of cesarean section and more than 1 in 2 women did not have an explanation in PP. CONCLUSION: Red code cesarean sections cause PTSD in 1 in 5 women. This lasting disorder can last up to 6 years after childbirth. This indicates the seriousness of this disorder and the need to prevent it. The risk of developing it is 4 times greater in the event of a traumatic experience proven in the Questionnaire de stress immédiat. Offering this questionnaire in the maternity could be an important element of secondary prevention. The role of health personnel remains essential.

The relationship of prenatal attachment level to traumatic childbirth perception and posttraumatic stress in pregnancy.

OBJECTIVE: This study aimed to investigate the relationship between the extent of prenatal attachment and traumatic childbirth perception (TCP) and posttraumatic stress. METHODS: A total of 308 pregnant women admitted to the Obstetrics and Gynecology Department during a period of 6 months were applied a Personal Information Form, the Prenatal Attachment Inventory, the Traumatic Childbirth Perception Scale, and the Posttraumatic Diagnostic Scale, Self-Report version. RESULTS: There was a negative correlation between TCP and posttraumatic stress disorder (PTSD). Traumatic stress decreased with increasing prenatal attachment. CONCLUSION: Consequently, a negative correlation was found between prenatal attachment and PTSD.

Vicarious Trauma Experienced by Health Care Providers Involved in Traumatic Childbirths: A Meta-Synthesis.

Health care providers are often "second victims" of traumatic childbirth events and should be adequately supported by their organizations to alleviate occupational stress and burnout. Therefore, this review aimed to explore and understand the vicarious traumatic childbirth experiences of health care providers, including obstetricians, midwives, nurses, and students. A systematic review of qualitative studies was conducted. Seven electronic databases, namely, PubMed, CINAHL, Embase, PsycINFO, Cochrane, Scopus, and Web of Science, were searched from each database's inception to May 2020. In total, 1,575 studies were retrieved and screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen studies were included in this review and were meta-summarized and then meta-synthesized using the Sandelowski and Barroso approach. The overarching theme of "Tunneling through the trauma with a hope of finding an end" was derived, and four main themes along with 15 subthemes were identified. The four main themes were (1) "instantaneous response to the trauma," (2) "finding hope in the midst of chaos," (3) "dealing with the aftermath," and (4) "resolution to move on." Communication and teamwork among health care team members were identified as challenges contributed by professional hierarchy and lack of role clarity. Midwives and labor and delivery nurses expressed powerlessness in advocating for women on many occasions, and health care providers often had feelings of guilt and self-blame after adverse events. Health care providers also reported inadequate support from their colleagues and organizations, which influenced their ability to cope with the aftermath of trauma and their decision to stay in the profession.