Construct Validity and Psychometric Properties of the Hebrew Version of the City Birth Trauma Scale

As many as third of the women perceive their childbirth as traumatic and although prevalence rates vary between studies, around 2–5% of women in community samples may develop childbirth-related postpartum post-traumatic stress disorder (PPTSD). The City Birth Trauma Scale (BiTS) was developed to address the need for a DSM-5-based instrument that assesses PPTSD. The BiTS is a self-report questionnaire, which covers all DSM-5 PTSD criteria, including the four symptom clusters – re-experiencing, avoidance, negative mood and cognitions and hyperarousal symptoms. The present study aimed to describe the psychometric properties and validate the Hebrew version of the BiTS. Five hundred and four mothers of 0- to 12-month-old infants were sampled using social media and the snowball method. Respondents completed an online survey consisting of a demographic questionnaire and the Hebrew versions of the BiTS, the impact of event scale-revised (IES-R), the Edinburgh postpartum depression scale (EPDS), and the Pittsburgh Sleep Quality Index (PSQI). The Hebrew BiTS demonstrated high internal consistency for the total scale (Cronbach α = 0.90) and good internal consistency (Cronbach’s α = 0.75–0.85) for the subscales. An exploratory factor (EFA) analysis yielded a two-factors solution, accounting for 45% of variance, with general symptoms loaded on Factor 1, and childbirth-related symptoms loaded on Factor 2, with both factors demonstrating high internal consistency (Cronbach’s α = 0.90, 0.85, respectively). High convergent validity for the symptom cluster subscales was demonstrated with the parallel IES-R subscales, EPDS and PSQI. A two-step cluster analysis indicated that dysphoric and hyperarousal symptoms best differentiated the severity of symptoms of respondents across measures. In sum, the Hebrew BiTS was psychometrically sound, indicating its utility for clinical and non-clinical research. The EFA and cluster analyses support the differentiation between symptoms of dysphoria and hyperarousal from trauma (i.e., childbirth) specific symptoms, suggesting that symptoms relating to specific aspects of the trauma differ qualitatively from general symptom in the phenomenology of PPTSD. Further research using clinical samples and comparing the BiTS to DSM-5 diagnosis using clinical interview is needed

Mother-infant bonding is not associated with feeding type: a community study sample

Abstract Background Bonding refers to emotions and cognitions towards one’s infant. Breastfeeding is believed to facilitate bonding, yet only a handful of studies have empirically tested this assertion. This study aimed to confirm whether a positive association between breastfeeding and bonding exists and whether breastfeeding may be protective against the negative consequences of mood and sleep disturbances on bonding. Method A cross-sectional survey was administered to a convenience sample of Israeli mothers of infants ages 1–9 months. The main outcome measures were breastfeeding history, bonding (Postpartum Bonding Questionnaire, PBQ), mood (Edinburgh Postnatal Depression Scale, EPDS) and sleep (Pittsburgh Sleep Quality Index, PSQI). Results Two hundred seventy-one mothers (21–46 years) completed the survey. 65.7% reported current breastfeeding, 22.1% past breastfeeding, 12.2% never nursed. The PBQ correlated with both the EPDS and PSQI. Breastfeeding was associated with greater daytime fatigue, but not with any other sleep problem, and was not associated with bonding. This negative result was confirmed with Bayesian analysis demonstrating that the probability for the null hypothesis was 4.5 times greater than the hypothesized effect. Further, hierarchical regression revealed a positive relationship between bonding, daytime fatigue and depression symptoms only among women who were currently breastfeeding. Conclusions These findings suggest that among healthy mothers, breastfeeding may not be a central factor in mother-infant bonding, nor is it protective against the negative impact of mood symptoms and bonding difficulties. Theoretical and methodological bases of these findings are discussed.https://deepblue.lib.umich.edu/bitstream/2027.42/148570/1/12884_2019_Article_2264.pd

Epidural analgesia associations with depression, PTSD, and bonding at 2 months postpartum

The research aim was to study the possible effect of epidural analgesia, as well as other possible demographic/obstetric variables and subjective birth experience on postpartum depression, PTSD, and impaired bonding. This was a longitudinal study of 254 women who gave birth at the maternity wards of a large tertiary health center and responded to questionnaires at T1 (Childbirth Experience Questionnaire and level of fatigue question; in person, 1–4 days postpartum) and at T2 (Postnatal Depression Scale, Postpartum Bonding Questionnaire, and the City Birth Trauma Scale; online-two months postpartum). Obstetric and demographic data were taken from medical files. Having a previous psychiatric diagnosis and higher levels of fatigue significantly predicted worse outcomes in all measures (level of fatigue was not associated with the City Birth Trauma birth-related symptoms factor). Having higher education, being primiparous, worse birth experience, and longer second stage of birth predicted worse outcomes in some measures. Although epidural administration had no effect on any of the outcome variables, special attention should be devoted to women who had long second-stage births and/or suffering from postpartum fatigue to prevent postpartum psychopathology. In addition, demographic variables, such as primiparity, education, and prior psychopathology diagnosis should be considered to treat women and prevent postpartum psychopathology

Self-Compassion Mediates the Relationship between Attachment Anxiety and Body Appreciation in Women and Men: Evidence from Israel

Previous work has suggested that self-compassion mediates the relationship between attachment anxiety and body appreciation but is limited by a reliance on college women from North America. To extend existing knowledge, we examined associations between peer and romantic partner attachment anxiety, self-compassion, and body appreciation in a community sample of women and men from Israel. A total of 597 adults (353 women, 244 men; age M = 29.45 years) completed Hebrew translations of measures of romantic partner and peer attachment anxiety, self-compassion, and body appreciation. Path analysis indicated that a model in which self-compassion mediated relationships between peer and romantic partner attachment anxiety – in parallel – and body appreciation had poor fit. However, mediation analysis indicated that self-compassion mediated relationships between peer and romantic partner attachment anxiety – in isolation – and body appreciation in isolation. These results highlight the importance of considering interpersonal dynamics in models of positive body image and point to possible interventionist routes for promoting greater body appreciation

An Examination of the Factor Structure and Preliminary Assessment of the Psychometric Properties of a Hebrew Translation of the Body Appreciation Scale-2 (BAS-2)

The Body Appreciation Scale-2 (BAS-2) is a widely-used, 10-item measure of a core facet of positive body image. To extend its use internationally, we examined the factor structure and conducted a preliminary assessment of the psychometric properties of a novel Hebrew translation of the BAS-2. A sample of 613 Israeli adults (362 women, 251 men; age M= 29.52, SD = 9.47) completed the BAS-2 alongside demographic items and previously-validated measures of life satisfaction, self-esteem, self-compassion, and body investment. Exploratory factor analyses with a semi-random split-half subsample (n = 377) indicated that BAS-2 scores reduced to a single dimension with all 10 items. This factor structure was equivalent across women and men. Confirmatory factor analysis (CFA) with a second split-half subsample (n = 235) showed the 1-dimensional factor structure had adequate fit following one modification and multi-group CFA showed that the model was invariant across sex. Men had significantly higher BAS-2 scores than women, but the effect size was small (d = 0.22). Evidence of construct validity was demonstrated through positive associations with indices of life satisfaction, self-esteem, self-compassion, and body investment. The availability of a validated BAS-2 Hebrew translation should advance future research of body appreciation in Israel

The associations between insecure attachment, rooming‐in, and postpartum depression: A 2 months’ longitudinal study

Postpartum depression (PPD) is the most common complication of childbearing, and recent studies have attempted to examine risk factors associated with it. The main study hypothesis was that a protective situational factor at a sensitive time period (full rooming‐in postpartum) would moderate the associations between insecure attachment dimensions and PPD. Three hundred twelve women, in either full or partial rooming‐in, participated in a longitudinal study at the maternity ward of a tertiary healthcare center. A Demographic questionnaire and the Experiences in Close Relationships Scale were administered at 1–4 days postpartum, and the Edinburgh Postnatal Depression scale at 2 months postpartum. PPD was significantly associated with both anxious and avoidant attachment dimensions, but not with rooming‐in conditions. In addition, women in partial rooming‐in showed a positive correlation between insecure attachment dimensions and PPD, whereas no such correlation was found for full rooming‐in women. A situational factor such as full rooming‐in, which occurs at a critical time point for the mother–infant relationship, can moderate the association between maternal avoidant or anxious attachment dimensions and the mother’s PPD levels. Postpartum practices, such as rooming‐in, can be personalized and thus beneficial in moderating personal risk factors for PPD.RESUMENLa depresión posterior al parto (PPD) es la complicación más común de dar a luz y estudios recientes han intentado examinar los factores de riesgo asociados con el parto. La hipótesis del principal estudio fue que un factor situacional de protección en un período temporal sensible (permitirle a la madre mantener a su bebé con ella en el mismo cuarto después del parto) moderaría las asociaciones entre las dimensiones de afectividad insegura y PPD. Trescientas doce mujeres, en situación completa o parcial de tener a su bebé en el mismo cuarto, participaron en un estudio longitudinal en la sala de partos de un centro terciario de cuidado de salud. Del primer al cuarto día después del parto, se administró un cuestionario demográfico y la Escala de Experiencias en Relaciones Cercanas; la Escala de Edimburgo de Depresión Postnatal se administró a los dos meses posteriores al parto. Significativamente se asoció la PPD tanto con las dimensiones de afectividad de tipo ansiosas como las evasivas, pero no con las condiciones de compartir el mismo cuarto. Adicionalmente, las mujeres en situaciones parciales de compartir el mismo cuarto mostraron una correlación positiva entre las dimensiones de afectividad insegura y PPD, mientras que tal correlación no se encontró en el caso de las mujeres en situaciones de compartir el cuarto completamente. Un factor situacional tal como el compartir el cuarto completamente, lo cual ocurre en un punto temporal crítico para la relación madre‐infante, puede moderar la asociación entre las dimensiones de afectividad maternas evasivas o ansiosas y los niveles de PPD de la madre. Las prácticas del período posterior al parto, tales como el compartir el cuarto, pueden ser personalizadas y por tanto beneficiosas en cuanto a moderar los factores personales de riesgo de PPD.RÉSUMÉLa dépression postpartum (DPP) est la complication la plus commune de la maternité et les études récentes ont essayé d’examiner les facteurs de risque qui y sont liés. L’hypothèse principale de cette étude était qu’un facteur protecteur situationnel à une période sensible (rooming‐in total postpartum) modérerait les liens entre les dimensions d’attachement insécure et la DPP. Trois cent douze femmes, soit en rooming‐in partiel ou total, ont participé à une étude longitudinale à la maternité d’un centre de santé tertiaire. Un questionnaire démographique et l’Echelle d’Expériences dans les Relations Proches ont été donnés à 1–4 jours postpartum, l’Echelle de Dépression Postnatale d’Edinbourg à deux mois postpartum. La DPP a été liée de manière importante à des dimensions d’attachement à la fois anxieux et évitant, mais pas avec les conditions de rooming‐in. De plus, les femmes en rooming‐in partiel ont fait preuve d’une corrélation positive entre les dimensions de l’attachement insécure et la DPP, alors qu’aucune corrélation n’a été trouvée pour les femmes du groupe rooming‐in. Un facteur situationnel telle que le rooming‐in total, qui se passe à un moment critique pour la relation mère‐bébé, peut modérer le lien entre les dimensions d’attachement évitant maternel et de l’attachement anxieux et les niveaux de DPP de la mère. Les pratiques postpartum, tel que le rooming‐in, peuvent être personnalisées et donc s’avérer être un bénéfice pour la modération de facteurs de risque personnel pour la DPP.ZUSAMMENFASSUNGDie Zusammenhänge zwischen unsicherer Bindung, Rooming‐in und postpartaler Depression: Eine zweimonatige LängsschnittstudiePostpartale Depression (PPD) ist die häufigste Komplikation, die im Zusammenhang mit Geburten von Kindern auftritt. Neuere Studien haben versucht, die damit verbundenen Risikofaktoren zu untersuchen. Die Hypothese der Hauptstudie war, dass ein protektiver Situationsfaktor innerhalb eines kritischen Zeitraums (vollständiges Rooming‐in, d.h. die Möglichkeit, das Neugeborene nach der Geburt im Zimmer zu haben) den Zusammenhang zwischen unsicheren Bindungsdimensionen und PPD abschwächen kann. 312 Frauen, mit einem entweder vollständigen oder teilweisen Rooming‐in, nahmen an einer Längsschnittstudie auf der Entbindungsstation eines tertiären Gesundheitszentrums teil. Ein bis vier Tage nach der Geburt wurde ein demografischer Fragebogen und die Skala für Erfahrungen in engen Beziehungen ausgeteilt. 2 Monate nach der Geburt erfolgte eine Befragung mit der Edinburgh Skala für postnatale Depression. PPD war sowohl mit ängstlichen als auch mit vermeidenden Bindungsdimensionen signifikant assoziiert, jedoch nicht mit Bedingungen des Rooming‐ins. Frauen mit teilweisem Rooming‐in zeigten eine positive Korrelation zwischen unsicheren Bindungsdimensionen und PPD, während für Frauen mit vollständigem Rooming‐in keine solche Korrelation gefunden wurde. Ein Situationsfaktor wie das vollständige Rooming‐in, der zu einem kritischen Zeitpunkt für die Mutter‐Kind‐Beziehung auftritt, kann den Zusammenhang zwischen mütterlichen vermeidenden oder ängstlichen Bindungsdimensionen und den PPD‐Werten der Mutter abschwächen. Postpartale Praktiken wie das Rooming‐In können personalisiert werden und somit zur Minderung persönlicher PPD‐Risikofaktoren beitragen.抄録不安定型アタッチメント、母子同室、産後うつ病の間の関連性:2ヶ月の縦断研 究産後うつ病(PPD)は、出産によって起こる最も一般的な合併症で、最近では、そ れに関連した危険因子を探究しようと試みている研究が複数ある。本研究の主な 仮説は、繊細な時期での1つの予防的状況要因 (産後の完全母子同室) は、不安 定型アタッチメントとPPD間の関連性を抑えるのではないかということである。 完全あるいは一部母子同室の312人の女性が、三次保健センターの産科病棟での 縦断研究に参加した。人口統計学的質問紙と成人アタッチメントスタイル尺度( ECR)を産後1～4日に行い、エジンバラ産後うつ病質問票を産後2か月に行なった。 PPDは、 不安型アタッチメントと回避型アタッチメントの両方と有意に関連があ ったが、母子同室の状況とは関連がなかった。さらに、一部母子同室の女性は、 不安定型アタッチメントとPPD間に正の相関がみられた。一方、完全母子同室の 女性にはそのような相関は見られなかった。母子関係にとって重要な時点で起こ る、完全母子同室のような状況要因は、母親の回避型あるいは不安型アタッチメ ントの程度と母親のPPDのレベルとの間の関連性を抑えることができる。母子同 室のような産後の実践は、個人対象にすることが可能であろう。そして、それは PPDに関する個人的な危険因子を抑えるのに有益であると思われる。摘要产后抑郁症 (PPD) 是最常见的分娩并发症, 最近的研究试图探讨与之相关的危险因素。主要的研究假设是在一个敏感的时间段 (完整产后同住) 的保护性情境因素会缓和不安全型依恋维度与PPD之间的关联。312名女性, 无论是完整还是部分同住, 都参加了在三级保健中心产科病房进行的纵向研究。产后1–4天使用“人口统计调查问卷”和“亲密关系经历量表”测量, 产后2个月使用“爱丁堡产后抑郁量表”测量。PPD与焦虑型、回避型依恋维度显著相关, 但与同住条件无关。此外, 部分同住的女性在不安全型依恋维度和PPD之间显示出正相关, 而完整同住的女性则没有这种相关性。在母婴关系的关键时间点发生的情境因素 (例如完整同住) 可以缓和母亲回避型或焦虑型依恋维度与母亲PPD水平之间的关联。产后的做法 (例如同住) 可以是个性化的, 从而有利于降低PPD的个人风险因素。ملخصالعلاقة بين التعلق الغير الآمن، والإقامة في غرفة الولادة والاكتئاب ما بعد الولادة: دراسة طولية لمدة شهرين.الاكتئاب بعد الولادة (PPD) يعتبر من المضاعفات الأكثر شيوعا لما بعد الإنجاب، وقد حاولت الدراسات الحديثة تناول عوامل الخطر المرتبطة به. كانت فرضية الدراسة الرئيسية هي أن عاملًا وقائيًا في فترة زمنية حساسة (الإقامة الكاملة في غرفة بعد الولادة) من شأنه أن يتوسط العلاقة بين أبعاد التعلق الغير آمن واكتئاب ما بعد الولادة. اشترك في الدراسة ثلاثمائة واثنتي عشرة امرأة، في إقامة كاملة أو جزئية، وأقيمت هذه الدراسة الطولية في جناح الأمومة في مركز فرعي للرعاية الصحية. تم إدارة استبيان ديموغرافي ومقياس التجارب في العلاقات الوثيقة عند 1–4 أيام بعد الولادة، ومقياس أدنبرة لاكتئاب ما بعد الولادة عند شهرين بعد الولادة. ارتبط اكتئاب ما بعد الولادة بشكل كبير مع كل من أبعاد التعلق القلق والمتجنب ، ولكن ليس مع ظروف إقامة الغرفة. وبالإضافة إلى ذلك، أظهرت النساء في الإقامة الجزئية وجود ارتباط إيجابي بين أبعاد التعلق غير الآمن واكتئاب ما بعد الولادة، في حين لم يتم إيجاد مثل هذا الارتباط للنساء في مجموعة الإقامة الكاملة. وبذلك فإن العوامل الظرفية مثل الإقامة الكاملة في فترة زمنية حرجة في العلاقة بين الأم والرضيع يمكن أن تتوسط الارتباط بين أبعاد التعلق الأمومي القلق أو المتجنب ومستويات اكتئاب ما بعد الولادة. ويمكن أن تتخذ ممارسات ما بعد الولادة، مثل الإقامة في غرفة الولادة، طابعا شخصيا وبالتالي تكون مفيدة في تخفيف عوامل المخاطرة الشخصية لاكتئاب ما بعد الولادة.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166287/1/imhj21895_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166287/2/imhj21895.pd

Indications for Emergency Intervention, Mode of Delivery, and the Childbirth Experience.

Although the impact of emergency procedures on the childbirth experience has been studied extensively, a possible association of childbirth experience with indications for emergency interventions has not been reported.To compare the impacts on childbirth experience of 'planned' delivery (elective cesarean section and vaginal delivery) versus 'unplanned' delivery (vacuum extraction or emergency cesarean section); the intervention itself (vacuum extraction versus emergency cesarean section); and indications for intervention (arrest of labor versus risk to the mother or fetus).A total of 469 women, up to 72 hours post-partum, in the maternity ward of one tertiary health care institute completed the Subjective Childbirth Experience Questionnaire (score: 0-4, a higher score indicated a more negative experience) and a Personal Information Questionnaire. Intra-partum information was retrieved from the medical records. One-way analysis of variance and two-way analysis of variance, followed by analysis of covariance, to test the unique contribution of variables, were used to examine differences between groups in outcome. Tukey's Post-Hoc analysis was used when appropriate.Planned delivery, either vaginal or elective cesarean section, was associated with a more positive experience than unplanned delivery, either vacuum or emergency cesarean section (mean respective Subjective Childbirth Experience scores: 1.58 and 1.49 vs. 2.02 and 2.07, P <0.01). The difference in mean Subjective Childbirth Experience scores following elective cesarean section and vaginal delivery was not significant; nor was the difference following vacuum extraction and emergency cesarean section. Interventions due to immediate risk to mother or fetus resulted in a more positive birth experience than interventions due to arrest of labor (Subjective Childbirth Experience: 1.9 vs. 2.2, P <0.01).Compared to planned interventions, unplanned interventions were shown to be associated with a more negative maternal childbirth experience. However, the indication for unplanned intervention appears to have a greater effect than the nature of the intervention on the birth experience. Women who underwent emergency interventions due to delay of birth (arrest of labor) perceived their birth experience more negatively than those who underwent interventions due to risk for the mother or fetus, regardless of the nature of the intervention (vacuum or emergency cesarean section). The results indicate the importance of follow-up after unexpected emergency interventions, especially following arrest of labor, as negative birth experience may have repercussions in a woman's psychosocial life and well-being