NICU-Specific Stress Following Traumatic Childbirth and Its Relationship With Posttraumatic Stress

Abstract

This mixed-methods pilot study investigated maternal perceived stress specific to infant neonatal intensive care unit (NICU) hospitalization as a moderator of the relationship between traumatic childbirth appraisal and symptoms of posttraumatic stress disorder (PTSD). NICU mothers (N = 77) were recruited via social media 1 to 4 months postpartum for a cross-sectional survey about perinatal experiences. Measures included traumatic childbirth, PTSD Checklist for DSM-5, and Parental Stressor Scale (PSS): NICU. Quantitative results indicated that, only at high levels of stress, women who reported traumatic childbirth (68%) reported significantly higher PTSD symptoms [b = 18.00, standard error = 7.18, t = 2.51, P = .015, 95% confidence interval (3.65, 32.36)]. Qualitative analysis identified additional stressors: maternal emotional well-being, dissatisfaction with care, infant health problems, breastfeeding, and additional characteristics of the NICU environment. Results provide supportive evidence that NICU mothers are at high risk for childbirth-related trauma and PTSD. Perceived stress related to the NICU may be an important intervention target when developing trauma-informed patient care. In addition to the domains captured by the PSS: NICU, maternal emotional well-being, interpersonal relationships with NICU staff, and stress related to breastfeeding are additional areas for improvement in the family-centered NICU.

Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: A systematic review and meta-analysis

“…Eleven studies, published in 14 records, involved mothers and fathers; 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 one study involved fathers only [60] and the remaining 23 studies, reported in 26 records, involved mothers. 27 , 28 , 30 , 31 , 32 , 34 , 38 , 39 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 …”

“…Clinical interview was used in two studies, 46 , 54 clinical review of self-report scales was used in one study, published in three records, 38 , 39 , 62 and self-report scales were used in 32 studies, published in 36 records. 27 , 28 , 30 , 31 , 32 , 34 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 63 , 64 , 65 , 66 , 67 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 Seven different self-report scales were used, most commonly the Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ). Cut-off points varied across studies, even when the same measure was used.…”

The incidence of post-traumatic stress disorder (PTSD) following traumatic childbirth: a systematic review and meta-analysis

“…Of them, 56 studies were excluded according to the inclusion and exclusion criteria. A total of nine studies [22][23][24][25][26][27][28][29][30] were included in the final analysis (Figure 1).…”

“…This systematic review included one cohort study [22] and eight cross-sectional studies [23][24][25][26][27][28][29][30] with 3,821 postpartum women. A total of 1,823 with traumatic birth and 353 with postpartum PTSD were included in the final analysis.…”

“…A total of 1,823 with traumatic birth and 353 with postpartum PTSD were included in the final analysis. The included nine studies [22][23][24][25][26][27][28][29][30] were conducted in Turkey, the United Kingdom, Iran, Serbia, Australia and the United States and published between 2003 and 2020. The overall sample sizes ranged from 77 to 950, the number of traumatic childbirth and PTSD respectively from 15 to 675 and from 2 to 127.…”