Specialist Perinatal Mental Health Service, Rotunda Hospital, Dublin 1, Dublin D01 P5W9, Ireland.
Specialist Perinatal Mental Health Service, Rotunda Hospital, Dublin 1, Dublin D01 P5W9, Ireland.
Midwifery. 2022 Oct;113:103419. doi: 10.1016/j.midw.2022.103419. Epub 2022 Jul 9.
To establish the prevalence and correlates of a subjectively traumatic birth experience in an Irish maternity sample.
A questionnaire routinely provided to all women prior to hospital discharge post-birth was amended for data collection for this study. Two additional questions seeking information about women's perceptions of their birth were added and analysed. Women who described their birth as traumatic and agreed to follow-up, received a City Birth Trauma Scale (Ayers et al., 2018) at subsequent follow-up (6 to 12 weeks postpartum). Demographic, obstetric, neonatal variables and factors associated with birth trauma were collected from electronic maternity records retrospectively.
A postnatal ward in an Irish maternity hospital which provides postnatal care for public maternity patients.
Postpartum women (N=1154) between 1 and 5 days postpartum.
MEASUREMENTS & FINDINGS: Participants completed the Edinburgh Postnatal Depression Scale (EPDS) (Cox et al., 1987) with two additional questions about birth trauma. Eighteen percent (n=209) of women reported their birth as traumatic. Factors associated with reporting birth as traumatic included a history of depression, raised EPDS scores (>12), induction of labour, combined ventouse/forceps birth, and postpartum haemorrhage. Of these 209 women, 134 went on to complete the City Birth Trauma Scale (Ayers et al., 2018). The average score was 3.84 and 6 of this sample (4%) reached the threshold for postpartum post-traumatic stress disorder (PTSD).
This study identified a prevalence of 18% of women experiencing birth as traumatic and the potentially important role of a current and past history of depression, postpartum haemorrhage, induction of labour and operative vaginal birth in defining a traumatic birth experience. The majority of women were resilient to birth trauma, few developed PTSD , but a larger cohort had significant functional impairment associated with sub-clinical postpartum PTSD symptoms.
Maternity care providers should be aware of the risk factors for traumatic birth. Introducing a trauma-informed approach amongst midwives and maternity care providers in the postnatal period may help to detect emerging or established persisting trauma-related symptoms. For women with sub-clinical postpartum PTSD symptoms a detailed enquiry may be more effective in identifying postpartum PTSD at a later postnatal stage e.g., at six weeks postpartum. Maternity services should provide ongoing supports for women who have experienced birth trauma.
在爱尔兰产妇样本中确定主观创伤性分娩经历的流行率和相关性。
对分娩后在医院出院前提供给所有女性的问卷进行了修改，以便为这项研究收集数据。增加了两个额外的问题，以获取有关女性对分娩看法的信息，并对其进行了分析。描述分娩经历为创伤性的并同意随访的女性，在随后的随访（产后 6 至 12 周）中接受城市分娩创伤量表（Ayers 等人，2018 年）。从电子产妇记录中回顾性收集人口统计学、产科、新生儿变量以及与分娩创伤相关的因素。
爱尔兰一家产科医院的产后病房，为公共产妇提供产后护理。
产后 1 至 5 天的产妇（N=1154）。
参与者完成了爱丁堡产后抑郁量表（EPDS）（Cox 等人，1987 年），并增加了两个关于分娩创伤的问题。18%（n=209）的女性报告分娩经历为创伤性。报告分娩经历为创伤性的因素包括抑郁症病史、EPDS 评分升高（>12）、引产、联合使用产钳和吸引器分娩以及产后出血。在这 209 名女性中，有 134 名继续完成城市分娩创伤量表（Ayers 等人，2018 年）。平均得分为 3.84，其中 6 名（4%）达到产后创伤后应激障碍（PTSD）的阈值。
本研究确定了 18%的女性经历过创伤性分娩，目前和过去的抑郁症、产后出血、引产和阴道分娩等因素在定义创伤性分娩经历方面具有重要作用。大多数女性对分娩创伤具有弹性，很少发展为 PTSD，但较大的队列与亚临床产后 PTSD 症状相关的功能障碍显著。
产妇护理提供者应该意识到创伤性分娩的风险因素。在产后期间，向助产士和产妇护理提供者引入创伤知情方法可能有助于发现新出现或持续存在的与创伤相关的症状。对于有亚临床产后 PTSD 症状的女性，详细询问可能更有效地在产后六周后等以后的阶段识别产后 PTSD。产妇服务应向经历过分娩创伤的女性提供持续支持。
