Childbirth and criteria for traumatic events
Introduction
Recent research in Australia found that 45.5% of women giving birth are likely to report childbearing as traumatic (Alcorn et al., 2010), leading to a projected 135,000 Australian women each year self-rating childbirth as traumatic. Experiencing a traumatic birth can negatively impact on a woman's emotional well-being, her relationship with her new baby and her spouse (Beck, 2004a, Ayers et al., 2006, Parfitt and Ayers, 2009), extinguish her desire for more children (Allen, 1998), and increase her likelihood of requesting a surgical delivery for future births (McCourt et al., 2007). Traumatic birth may lead to the development of Posttraumatic Stress Disorder (PTSD), with estimated prevalence rates ranging from 1% to 6% at four to six weeks post partum (Creedy et al., 2000, Soet et al., 2003, Adewuya et al., 2006, Soderquist et al., 2006, Edworthy et al., 2008, Alcorn et al., 2010).
The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV: American Psychiatric Association, 1994) defines a traumatic event as ‘where the person experienced, witnessed, or was confronted with event or events that involved actual or threatened death or serious injury, or a threat to physical integrity of self or others’ (Criterion A1) and where the same person experienced an intense emotional response of fear, horror, or helplessness (Criterion A2). Both criteria must be endorsed to meet the guidelines for a traumatic event (as opposed to self-describing an event as ‘traumatic’). In the development of the fifth edition of the diagnostic manual, it is proposed that Criterion A2, the emotional response, be removed (American Psychiatric Association, 2010).
A recent study of women's experience of childbirth found that almost half (45.8%) of women who met Criteria A1 of threat did not report fear, horror or helplessness (Alcorn et al., 2010). A better understanding of how Criteria A1 and A2 relate to emotional pathology, and each other, would inform the design of successful resilience interventions for women most at risk of developing PTSD following a traumatic childbirth. This study examines the prevalence and associated factors of a traumatic birthing experience, and its immediate effect on emotional well-being of new mothers. First we gauged the prevalence and tested the relationship between Criteria A1, A2 and overall experiencing of a traumatic birth (A1 and A2 together). We then tested if each criterion was related to adverse emotional reactions in women. As interventions to prevent such reactions are desirable, we then tested which pre-existing characteristics of the mother and her birth predict traumatic childbirth.
Section snippets
Method
The present study was part of a larger randomised control trial evaluating the efficacy of a counselling intervention on mental health outcomes of emotionally distressed postpartum women (Fenwick et al., 2011). Measures used in this study were collected prior to intervention.
Findings
PASW Statistics (IBM SPSS Inc., 2010) and ClinTools Software (Devilly, 2005) were used for analysis. Hypothesis testing was non-directional (i.e. two-tailed testing), and alpha was set at .05.
Prevalence of the traumatic event
At 14.3%, this study found a lower prevalence rate of Criterion A traumatic births than comparative childbirth studies. The difference may be related to measurement variation. Alcorn et al. (2010) and Soet et al. (2003) reported rates of 45.5% and 34% respectively and used adapted Criterion A wording to include elements reflective of childbirth. Alcorn et al. did, however, use the Posttraumatic Diagnostic Scale. This study's finding is closer to the 19.7% prevalence rate reported by Ayers et
Conflict of interest
The authors declare that there are no conflicts of interest.
Author contribution
All authors meet the criteria for authorship, have approved the final article and all entitled to authorship are listed as authors.
Acknowledgements
This research was supported by a National Health & Medical Research Project Grant (ID: 481900).
References (45)
- et al.
Women's experiences of the PRIME midwifery counselling intervention: promoting resilience in mothers emotions
Women and Birth
(2011) - et al.
Does fear of childbirth during pregnancy predict emergency caesarean section?
BJOG: An International Journal of Obstetrics & Gynaecology
(2002) - et al.
Childhood sexual abuse as a predictor of birth-related stress and postpartum posttraumatic stress
Child Abuse & Neglect
(2009) - et al.
Posttraumatic stress following childbirth: a review
Clinical Psychology Review
(2006) - et al.
Post-traumatic stress disorder after childbirth in Nigerian women: prevalence and risk factors
BJOG: An International Journal of Obstetrics & Gynaecology
(2006) - et al.
A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events
Pyschological Medicine
(2010) A qualitative analysis of the process, mediating variables and impact of traumatic childbirth
Journal of Reproductive and Infant Psychology
(1998)Diagnostic and Statistical Manual of Mental Disorders
(1994)- American Psychiatric Association, 2010. DSM-5 Development. http://www.dsm5.org/Pages/Default.aspx (retrieved 17 August...
- Australian Bureau of Statistics (ABS), 2010. Births, Australia, cat. no. 3301.0. ABS,...
Delivery as a traumatic event: prevalence, risk factors, and treatment for postnatal posttraumatic stress disorder
Clinical Obstetrics and Gynecology
The effects of childbirth-related post-traumatic stress disorder on women and their relationships: a qualitative study
Psychology, Health & Medicine
Posttraumatic stress disorder after childbirth: analysis of symptom presentation and sampling
Journal of Affective Disorders
Post-traumatic stress disorder due to childbirth: the aftermath
Nursing Research
Birth trauma: in the eye of the beholder
Nursing Research January/February
The development of a clinician-administered PTSD scale
Journal of Traumatic Stress
Review of screening instruments for postpartum depression
Archives of Women's Mental Health
Heart rate after trauma and the specificity of fear circuitry disorders
Psychological Medicine
The psychatric sequelae of traumatic injury
The American Journal of Psychiatry
Detection of postnatal depression: development of the 10-item Edinburgh postnatal depression scale
British Journal of Psychiatry
Posttraumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-Being
Psychological Medicine
Childbirth and the development of acute trauma symptoms: incidence and contributing factors
Birth
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