Emotions and support needs following a distressing birth: Scoping study with pregnant multigravida women in North-West England

Abstract

Emotions and support needs following a distressing birth: Scoping study with pregnant multigravida women in North-West England AbstractObjective: To identify the emotional and support needs of pregnant multigravida women who have experienced adverse responses associated with a previous childbirth experience.Setting: Four maternity hospitals in North-West England.Design: 100 surveys were distributed at an anomaly scan clinic in each of four maternity hospitals (total n=400). The survey included an adapted version of a Post-Traumatic Stress Disorder Symptom Scale to explore trauma responses at two broad time points: a) following a previous birth and b) during the current pregnancy. Participants were also asked about the optimal time to receive support post-birth, and the type and provider of support they had accessed/would have liked to access. Descriptive and inferential statistics were undertaken on the quantitative data. The qualitative data was analysed using a basic thematic approach.Participants: Multigravida pregnant women aged 18+ years. Findings:The overall response rate was 28% (n=112); 43% (n=46) of these had experienced negative/trauma responses associated with a previous birth, 74% of whom (n=34) continued/reexperienced adverse responses in their current pregnancy. Most commonly reported trauma responses were difficulties in recalling the previous birth(s), avoiding memories associated with it, and the distress associated with these memories when they were recalled.Approximately 54% (n=25) had received some form of support post-birth, and variations in preferred timing of postnatal support provision were reported. Information on available support and opportunities to discuss the birth with a maternity professional were identified most frequently as preferred support options. Conclusion & Implications for Practice:Women's views about what might work should form the basis for effectiveness studies in this area. Among the participants in this study there was evidence of unmet support needs relating to negative or traumatic responses to a previous birth.The range of preferred timing and types of support indicate that flexible needs-based support options should be provided. Further research should assess if these findings are reinforced in a more diverse sample with a higher response rate.

Afterbirth support provision for women following a traumatic/distressing birth: Survey of NHS hospital trusts in England

“…All completed surveys were uploaded into SPSS v.24 and quantitative data were analysed using descriptive statistics. All the narrative comments collected via open text boxes were extracted, combined with the descriptive statistics, and analysed using a basic thematic approach, similar to other survey-based studies (Downe et al, 2012;Redshaw and Henderson, 2012;Thomson and Downe, 2016). This involved an iterative process of line by line coding, with data mapped into sub-themes and then final themes.…”

“…Survey questions were developed based on literature into women's support needs following a traumatic/distressing birth (Gamble et al, 2004;Thomson and Downe, 2016) and previous surveys in this area (Ayers et al, 2006;Steel et al, 2003). We obtained initial feedback on the survey design to assess for comprehension and completeness from three maternity professionals and a clinical psychologist with a background in this area.…”

“…However, for many women, their experience may be more mixed or, indeed, negative. Recent research reports that between 20-40% of women perceive their birth to have been a traumatic and/or distressing event (Alcorn et al, 2010;Ayers et al, 2009;Polachek et al, 2012;Thomson and Downe, 2016) and ~3% of women in general community samples develop Post-Traumatic Stress Disorder (PTSD) following childbirth (Ayers et al, 2017). Birth trauma/PTSD onset can occur irrespective of how the baby was delivered (i.e.…”

“…While the lack of evidence, or clarity as to what postnatal debriefing should comprise is disconcerting, it is important to note that such opportunities reflect what women want. A recent study identified that while ~46% of women did not seek out support following a distressing/traumatic birth, the most preferred support option was to discuss the birth with a maternity professional (Thomson and Downe, 2016). A recent critical meta-ethnographic review of women's experiences of postnatal debriefing reports that women valued opportunities to understand what happened and why during the birth, and to have their birth experience validated (Baxter et al, 2014).…”

A meta‐ethnographic synthesis of midwives’ and nurses’ experiences of adverse labour and birth events

“…While birth in most instances is a joyous event, some women may experience complications during labour or birth predisposing them to symptoms of post‐traumatic stress disorder (PTSD). While the effects of adverse birth outcomes leading to trauma for women have been researched (Beck, ,b; Elmir, Schmied, Wilkes, & Jackson, ; Thomson & Downe, ), it is important to consider the impact of witnessing or being involved in adverse birth events that are potentially traumatic on midwives and nurses. In this study, we report on the findings of a meta‐ethnographic study of the impact of adverse labour and birth events on midwives and nurses caring for women.…”