Current Resources for Evidence‐Based Practice, September/October 2019

Abstract

MIXED-RESEARCH SYNTHESIS ON POSTTRAUMATIC BIRTH MAY POINT TO POTENTIAL INTERVENTIONSStudying the effects of traumatic birth on women and their lives can be difficult because birth trauma is defined by the person who experiences it. Perinatal care providers, who see a range of birth experiences daily, may not perceive a particular birth for a particular family as traumatic. It is clear that studying a complex phenomenon, such as traumatic birth stress, benefits from both qualitative and quantitative research methods.Additionally, an individual may experience posttraumatic stress symptoms that do not necessarily meet the criteria for posttraumatic stress disorder (PTSD), and, unfortunately, the 2 concepts may not be clearly differentiated in research studies. The prevalence of PTSD is around 4% in general community samples of postpartum women and is much greater (18%) in women at higher risk for PTSD, according to a recent meta-analysis of 25 studies. 1 Presumably, the number of women with posttraumatic stress symptoms is much higher.Beck and Casavant set out in this synthesis of studies using both quantitative and qualitative approaches to more deeply understand what we know about the effect of traumatic birth on women having term births. 2 They rigorously used mixedresearch synthesis methods with the aim of the narrative analysis of both quantitative and qualitative studies providing new theoretical insights to understanding the mechanisms of studied interventions. 3 For this synthesis, they identified 59 studies (55 quantitative and 4 qualitative) meeting their criteria (eg, participants had term births of living newborns not in the neonatal intensive care unit; studies were not focused on fathers' experiences or intimate partner violence). The synthesis focused on 4 questions: 1) prevalence of posttraumatic symptoms after a traumatic birth, 2) risk factors for posttraumatic stress symptoms, 3) the lived experience of women with symptoms, and 4) interventions that have been tested to decrease posttraumatic symptoms. The quality appraisal rating for the studies could range from 0 to 10 or 12, depending on study type; scores were mostly 9 to 11, with 2 studies rated as 7 and one as 8.There were 19 quantitative studies among 12 different countries examining prevalence and risk factors for posttraumatic stress after traumatic birth, of which 17 studies were among 7206 lower-risk women. It was difficult to identify a prevalence of posttraumatic stress symptoms because of the Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California.studies' use of 15 different instruments to measure stress and a wide range of timing of posttraumatic stress assessment, from 24 to 48 hours to 10 years later. Multiple studies in the United States, Belgium, and Japan found rates of around 20% measured at one week to one month postpartum. A smaller number of studies made the diagnosis of PTSD, which ranged between 2.4% at 4 weeks and 17% at 6 weeks postpartum.The pred...