Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors

Background Although longitudinal trajectories of post-traumatic stress disorder (PTSD) are well-established in general trauma populations, very little is known about the trajectories of birth-related PTSD. This study aimed to identify trajectories of birth-related PTSD; determine factors associated with each trajectory; and identify women more likely to develop birth-related PTSD. Method 226 women who had traumatic childbirth according to DSM-IV criterion A were drawn from a community sample of 950 women. Measures were taken of PTSD, affective symptoms, fear of childbirth and social support in pregnancy, 4–6 weeks and 6-months postpartum. Information on some obstetric and psychosocial factors were also prospectively obtained. Results Four trajectories were identified: resilience (61.9%), recovery (18.5%), chronic-PTSD (13.7%) and delayed-PTSD (5.8%). Resilience was consistently distinguished from other PTSD trajectories by less affective symptoms at 4–6 weeks postpartum. Poor satisfaction with health professionals was associated with chronic-PTSD and delayed-PTSD. When affective symptoms at 4–6 weeks postpartum were removed from the model, less social support and higher fear of childbirth 4–6 weeks after birth predicted chronic and recovery trajectories; whereas experience of further trauma and low levels of satisfaction with health professionals were predictive of chronic-PTSD and delayed-PTSD, compared to resilience. Additional variables associated with different trajectories included antenatal affective symptoms, caesarean-section, preterm birth and receiving professional help. Limitations Use of self-report measures, use of DSM-IV criteria for PTSD diagnosis, and no follow-up beyond six months are the main limitations of this study. Conclusion Identified factors may inform preventive and treatment interventions for women with traumatic birth experiences

“Living each week as unique” : maternal fears in Assisted Reproductive Technology pregnancies

Objective: to explore women's fears during pregnancy following conception via assisted reproductive technology (ART). Methods: 19 expectant first-time mothers were interviewed during the third trimester of pregnancy using a semi-structured schedule. Perceptions of and feelings about pregnancy were assessed. Content analysis was used to identify themes and subthemes. Findings: four overarching themes emerged: the baby's survival, the health of the baby, the efficacy of the mother and childbirth. Of these, the most commonly reported fears were related to miscarriage or fetal death, and the baby being born with an abnormality. Conclusions and implications: in addition to fears that are experienced by some women who conceived spontaneously, the women in this study who conceived via ART reported other fears, such as miscarriage or fetal death, that are more specific to this context. This suggests that these concerns should be taken into consideration when providing psychological support for ART mothers

Factors associated with post-traumatic stress symptoms (PTSS) 4-6 weeks and 6 months after birth: A longitudinal population-based study

BACKGROUND: Identifying factors that precipitate and maintain post-traumatic stress symptoms (PTSS) after birth is important to inform clinical and research practice; yet, prospective longitudinal studies on the predictors of PTSS are limited. This study aimed to determine the pregnancy and postpartum factors associated with PTSS at 4-6 weeks and 6-months postpartum. METHOD: A systematic sample of 950 pregnant women were recruited from three maternity hospitals in Turkey. Participants completed assessments of depression, anxiety, PTSS and social support in pregnancy, 4-6 weeks and 6-months postpartum. Fear of childbirth was assessed in pregnancy and 4-6 weeks after birth. RESULTS: Regression models showed that PTSS six months after birth were associated with anxiety and PTSS in pregnancy, complications during birth, satisfaction with health professionals, fear of childbirth 4-6 weeks after birth, PTSS and depression 4-6 weeks after birth, social support 4-6 weeks after birth, traumatic events after birth, need for psychological help, and social support 6-months after birth. PTSS was highly comorbid with depression and anxiety at all-time points. The most robust predictor of PTSS at 6-months postpartum was PTSS at 4-6 weeks postpartum. Intra-partum complications were not associated with PTSS 4-6 weeks after birth. No socio-demographic variables were correlated with PTSS postpartum. LIMITATIONS: Self-report questionnaires were used to measure outcomes. This study is based on sampling from public hospitals so may not represent women treated in private hospitals. CONCLUSIONS: Associated risk factors may help to identify women at risk of PTSS after birth and to inform targeted early intervention

The quality of childbirth care in China: women’s voices: a qualitative study

BACKGROUND: In the context of improved utilisation of health care and outcomes, rapid socio-economic development and health system reform in China, it is timely to consider the quality of services. Data on quality of maternal health care as experienced by women is limited. This study explores women's expectations and experiences of the quality of childbirth care in rural China. METHODS: Thirty five semi-structured interviews and five focus group discussions were conducted with 69 women who had delivered in the past 12 months in hospitals in a rural County in Anhui Province. Data were transcribed, translated and analysed using the framework approach. RESULTS: Hospital delivery was preferred because it was considered safe. Home delivery was uncommon and unsupported by the health system. Expectations such as having skilled providers and privacy during childbirth were met. However, most women reported lack of cleanliness, companionship during labour, pain relief, and opportunity to participate in decision making as poor aspects of care. Absence of pain relief is one reason why women may opt for a caesarean section. CONCLUSIONS: These findings illustrate that to improve quality of care it is crucial to build accountability and communication between providers, women and their families. Ensuring women's participation in decision making needs to be addressed

Health care to immigrant and Portuguese pregnant women in Portugal

This study aimed to assess the care received and the barriers faced by immigrants and Portuguese pregnant women in Portugal. This is an exploratory qualitative study, resorting to applying semi-structured interviews to 60 immigrant and 22 Portuguese women. Content analysis supported by QSR Nvivo10 program was used. The study was approved by an Ethics Committee. The results showed four categories related to affective dimensions-relational, cognitive, technical-instrumental and health care policy for pregnant women. As for the barriers in health care, these were mentioned by some of the expectant mothers, especially immigrant women. Almost all, both immigrant and Portuguese, pregnant women were satisfied with the health care

Intervention for Fear of Childbirth: HypnoBirthing

Fear of childbirth was a common problem among pregnant women. Fear of childbirth cause both many important problems at childbirth and maternal request for cesarean section and gradually increase in cesarean section rate. It was known that childbirth education classses were effective way in order to decrease fear. HypnoBirthing, which was one of the methods used at childbirth education classes, was effective approach for decreasing childbirth fear. As in the world, in Turkey, widespreading education classses used HypnoBirthing method with other methods, can increase achievement of that classses’ lessen fear of childbirth. [TAF Prev Med Bull 2011; 10(2.000): 239-242

Investigation of Active Birth Method with Evidence Based Practice

Active birth was one of the prenatal education methods which hasn’t been common in our country, yet. The aim of this article was to clarify the approach to the active birth method and to investigation thi method by means of evidence based practice perspective. Active birth was important method, because of focusing on the normal birth, encouraging women to activity during labor and emphasizing the importance of pregnancy exercises and birth ward. It was seen that practices recommended in this method effect labor positively, by the investigation of evidence based studies and evidence based guidelines. For this reason, to widespread this method in our contry will be useful. [TAF Prev Med Bull 2012; 11(1.000): 97-102

self-efficacy and parental attachment

Objective: to examine the effects of antenatal education on fear of childbirth, maternal self-efficacy, and maternal and paternal attachment.Design: quasi-experimental study, comparing an antenatal education group and a control group.Participants: 63 pregnant women and their husbands.Measurements: demographic data forms, the Wijma Delivery Expectancy/Experience Questionnaire, the Childbirth Self-Efficacy Inventory, the Maternal Attachment Inventory and the Postnatal Paternal-Infant Attachment Questionnaire were used for data collection.Findings: antenatal education was found to reduce the fear of childbirth and to increase childbirth related maternal self-efficacy. However, antenatal education was found to have no effect on parental attachment.Key conclusions: it is recommended that widespread antenatal education programmes should be provided in developing countries, and the content of the education programme about parental attachment should be increased. Implications for practice: this study found that antenatal education has no influence on maternal and paternal attachment. As such, there is a need to increase the content of the education programme about parental attachment. (C) 2015 Elsevier Ltd. All rights reserved

Turkey

Clinical education has a vital role in nursing curriculum. Clinical education environment can be enhanced by feedbacks provided by students. The purpose of this research was to search factors that affect the clinical learning environment. A qualitative approach was used. 36 nursing students were recruited from school of nursing in Turkey. It was found that students are negatively affected by communication errors and feedbacks given in the presence of patients by instructors. The constant presence of instructors may be the source of stress for some students. Besides peer support and favourable communication with peers have a positive impact on student learning. Communication with hospital staff and instructors are important. The study revealed that student learning is affected by the level of confidence and support displayed by patients. In order to ensure the most favourable learning environment for students, it is essential that cooperation should be increased between school staff and clinical staff, instructor skills should be developed, and students should be supported in the clinical environment. (C) 2015 Elsevier Ltd. All rights reserved