Implementing an Eye Movement and Desensitization Reprocessing Treatment-Program for Women With Posttraumatic Stress Disorder After Childbirth.

PURPOSE: The purpose of this study is to describe the implementation and outcomes of an Eye Movement and Desensitization Reprocessing (EMDR) treatment-program for women with posttraumatic stress disorder (PTSD) after childbirth. METHODS: A prospective cohort-study with pre- and post-measurements was carried out in the setting of an academic hospital in the Netherland. Included were women who gave birth to a living child at least 4 weeks ago, with a diagnosis of PTSD, or severe symptoms of PTSD combined with another psychiatric diagnosis. All received up to 8 sessions of EMDR-therapy. The posttraumatic stress disorder Checklist for DSM-5 was administered before and after treatment. Trauma history was assessed before treatment with the Life Events Checklist for the DSM-5, the Childhood Trauma Questionnaire and the Childbirth Perception Scale. Descriptive statistics were used. RESULTS: Forty-four women were referred, 26 met the inclusion criteria. After treatment, none of the women met the criteria for diagnosis of PTSD after on average 5 weekly sessions of EMDR- therapy. These outcomes are promising, as they were achieved in women with relatively high levels of psychiatric comorbidity (64%) and high rates of previous mental health treatment (80%). CONCLUSION: Implementing an EMDR-treatment program for women with PTSD after childbirth in the setting of an academic hospital is feasible and effective. Key factors for success include a close collaboration between the relevant hospital departments and a thorough case conceptualization addressing the etiology of the PTSD.

[Planned location for delivery; no relationship with maternal or neonatal morbidity]. / Geplande locatie van bevalling.

OBJECTIVE: To compare maternal and neonatal outcomes of planned primary-care birth-centre deliveries with those of planned home deliveries and planned outpatient deliveries. DESIGN: Retrospective cohort study. METHOD: We used data collected in the period February 2009 to November 2013 from 4 community midwife practices attached to the Sophia birth centre (GCS), which is attached to the Erasmus MC academic hospital in Rotterdam, The Netherlands. We included women with low-risk pregnancies for whom primary-care midwives were responsible at the start of the delivery. Pregnant women were stratified according to planned location of delivery (home, outpatient or GCS). The most important outcome measures were: medical intervention during the delivery, and maternal or neonatal morbidity. We used 'propensity score matching' to correct for confounding factors. RESULTS: We included a total of 6185 pregnant women in our study. After propensity score matching, no statistically significant difference was seen in the total number of medical interventions during pregnancy, total maternal morbidity and total neonatal morbidity between pregnant women with planned home deliveries and those with planned GCS deliveries. (Medical interventions 13.6% and 12.4%, respectively; p-value 0.56. Maternal morbidity 4.9% and 5.7%, respectively; p-value 0.53. Neonatal morbidity 6.8% and 5.4%, respectively; p-value 0.31.) Similar results were seen when we compared pregnant women with planned outpatient deliveries with pregnant women with planned deliveries in the GCS. CONCLUSION: In women with low-risk pregnancies the planned location for delivery does not seem to be related to either the number of medical interventions during pregnancy or to maternal or neonatal morbidity. The GCS seems, therefore, to be an appropriate location for these women to deliver, but this should be confirmed by further studies.