Trauma, Stress, and Post-Traumatic Stress Disorder (PTSD) in perinatal period

This chapter provides an overview of trauma, stress, and post-traumatic stress symptoms during pregnancy and postpartum. Trauma-informed perinatal mental health care must consider the multifaceted strengths and vulnerabilities of each birthing person and seek to understand how what happened to an individual before, during, and after birth may impact her own health and the well-being of her family. In addition to a summary of the literature on perinatal PTSD, this chapter focuses on birth trauma, childhood maltreatment, and the COVID-19 pandemic as three critical traumatic stressors that may confer risk. Effects of these traumatic stressors on pregnancy and birth outcomes, perinatal mental health, and parenting outcomes are discussed. Given the potential intergenerational impact of untreated and unresolved trauma, this chapter ends with assessment and treatment recommendations for perinatal women and mothers of young children exposed to trauma or significant adversity, with an emphasis on the ways in which evidence-based dyadic interventions may help mitigate the intergenerational transmission of trauma and toxic stress. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

Trends and motivations for freebirth: A scoping review.

BACKGROUND: Even when maternity care facilities are available, some women will choose to give birth unassisted by a professional (freebirth). This became more apparent during the pandemic of coronavirus disease 2019 (COVID-19), as women were increasingly concerned they would contract the virus in health care facilities. Several studies have identified the factors that influence women to seek alternative places of birth to hospitals, but research focusing specifically on freebirth is limited. METHODS: Eight databases were searched from their respective inception dates to April 2022 for studies related to freebirth. Data from the studies were charted and a thematic analysis was subsequently conducted. RESULTS: Four themes were identified based on findings from the 25 included studies: (1) Geographical and socio-demographic determinants influencing freebirth, (2) Reasons for choosing freebirth, (3) Factors hindering freebirth, and (4) Preparation for and varied experiences of freebirth. DISCUSSION: More women chose to give birth unassisted in low- and middle-income countries (LMICs) compared with high-income countries (HICs). Overall, motivation for freebirth included previous negative birth experiences with health care professionals, a desire to adhere to their birth-related beliefs, and fear of contracting the COVID-19 virus. Included studies reported that study participants were often met with negative responses when they revealed that they were planning to freebirth. Most women in the included studies had positive freebirth experiences. Future research should explore the different motivators of freebirth present in LMICs or HICs to help inform effective policies that may improve birth experiences while maintaining safety.

Pregnant pause: Celebrity performance of pregnancy during the pandemic

This article explores how celebrity performance of pregnancy was disrupted in the United States during COVID-19. Celebrities had to renegotiate the public performance of pregnancy within a more complicated world filled with contradictions: giving birth while deaths surged, gaining access to hospitals overrun with COVID-19 patients and enjoying time at home while others were forced to stay home. This article explores how celebrities negotiated the balance of privacy and public revelation and the unexpected consequences of these shifts in the presentation of pregnancy. © 2023 Intellect Ltd Article. English language.

The impact of perinatal healthcare changes on birth trauma during COVID-19.

BACKGROUND: Since the onset of COVID-19, giving birth has involved navigating unprecedented healthcare changes that could significantly impact the psychological birth experience. AIM: Research has demonstrated increasing rates of birth trauma and birth plan alterations during the COVID-19 pandemic. This study specifically examined these intersecting experiences to understand how COVID-related healthcare changes have impacted birth trauma during the pandemic. METHODS: 269 people who gave birth in the U.S. during COVID-19 completed an online survey between November, 2020-May, 2021 which included questions about COVID-related perinatal healthcare changes and birth-related posttraumatic stress disorder (PTSD; The City Birth Trauma Scale). T-tests were run on birth demographics to assess for significant indicators of PTSD; variables having significant effects were used to build a hierarchical regression model to predict PTSD symptoms. FINDINGS: 5.9% of the sample met criteria for PTSD and 72.3% met partial criteria. The overall regression model predicted approximately 19% of variance in total PTSD symptoms. Labor and birth demographics were entered in Step 1 and predicted approximately 11% of variance: limited length of stay for support person, being allowed 1 support person who had to be the same, and mask requirements were significant predictors of PTSD. Variables related to birth plan changes were entered in Step 2 and predicted approximately 8% of variance: changes to support person(s) for labor and birth, breastfeeding plans, and birth location were significant predictors of PTSD. CONCLUSION: The present study demonstrates the importance of COVID-related perinatal healthcare changes to the development of trauma symptoms following childbirth.

The use of personal protective equipment as an independent factor for developing depressive and post-traumatic stress symptoms in the postpartum period.

BACKGROUND: New recommendations regarding the use of personal protective equipment (PPE) during delivery have changed the maternal birth experience. In this study, we investigated the mental perceived impact of PPE use during delivery on the development of maternal postpartum depression (PPD) and post-traumatic stress symptoms (PTSS). METHODS: This was a multicenter, retrospective cohort study concerning women who delivered during the COVID-19 pandemic first lockdown period in Israel. Postpartum women were approached and asked to complete a comprehensive online questionnaire. Impact of PPE was graded on a scale of 1-5, and Impact of PPE ≥4 was considered high. PPD and PTSS were assessed using the EPDS and City BiTS questionnaires. RESULTS: Of 421 parturients, 36 (9%) reported high Impact of PPE. Parturients with high Impact of PPE had significantly higher PPD and PTSS scores)EPDS 8.4 ± 5.8 vs. 5.7 ± 5.3; City BiTS 9.2 ± 10.3 vs. 5.8 ± 7.8, p < 0.05 for both). Following adjustment for socio-demographic and delivery confounders and fear of COVID-19 (using Fear of COVID19 scale), Impact of PPE remained positively correlated with PPD symptoms (ß = 0.103, 95% confidence intervals [CI] 0.029-1.006, p = 0.038). CONCLUSION: When examining the risk factors for developing postpartum PTSS-experiences during labor and PPE were found to be significant variables. As the use of PPE is crucial in this era of COVID-19 pandemic in order to protect both parturients and caregivers, creative measures should be taken in order to overcome the communication gap it poses.