Impact of Neonatal Outcome on Language Used to Describe Periviable Birth Experience

Motivation and Purpose: The experience of giving birth to a periviable neonate between 22-25 weeks gestation varies greatly among women depending on numerous factors. Studying periviable narrative experiences will allow us to isolate those factors that create a more positive experience, even in the instance of a negative neonatal outcome (infant death). Results may be used to advise future caregiving approaches so they may be tailored to the needs of women in these situations. This study aimed to qualitatively assess the extent of the relationship between neonatal outcome and the language used by women and their important others (IOs) to describe periviable birth experience three months postpartum. Method: A semi-structured interview guide was used to investigate participants’ perceptions of their delivery experience and subsequent NICU experience, if applicable, at three months postpartum. Interviews were transcribed verbatim and coded for themes by three investigators. Conventional content analysis was conducted using NVivo 12. Results: Twenty-three women and twelve IOs were recruited at two hospitals between 2016 and 2018. Women and IOs who experienced infant death negatively described their delivery experience if they also negatively described healthcare team (HCT) interactions, including providers’ communication, clinical judgement, and personality traits. Specifically, participants with overall negative birth experiences described not understanding various clinical decisions and felt uninformed on topics pertinent to their or their infant’s care. Alternatively, women and IOs who experienced infant death who positively described their delivery experience also positively described NICU care (including HCT interactions) and infant death experience (comfort care). These results highlight the impact of HCT interactions and communication on a patient’s perception of delivery despite a negative neonatal outcome. Conclusion: These findings could suggest that improvements in communication and information dissemination from the HCT may have the ability to improve a patient’s periviable birth experience despite a negative neonatal outcome.

Impact of Neonatal Outcome on Language Used to Describe Periviable Birth Experience

Motivation and Purpose: The experience of giving birth to a periviable neonate between 22-25 weeks gestation varies greatly among women depending on numerous factors. Studying periviable narrative experiences will allow us to isolate those factors that create a more positive experience, even in the instance of a negative neonatal outcome (infant death). Results may be used to advise future caregiving approaches so they may be tailored to the needs of women in these situations. This study aimed to qualitatively assess the extent of the relationship between neonatal outcome and the language used by women and their important others (IOs) to describe periviable birth experience three months postpartum. Method: A semi-structured interview guide was used to investigate participants’ perceptions of their delivery experience and subsequent NICU experience, if applicable, at three months postpartum. Interviews were transcribed verbatim and coded for themes by three investigators. Conventional content analysis was conducted using NVivo 12. Results: Twenty-three women and twelve IOs were recruited at two hospitals between 2016 and 2018. Women and IOs who experienced infant death negatively described their delivery experience if they also negatively described healthcare team (HCT) interactions, including providers’ communication, clinical judgement, and personality traits. Specifically, participants with overall negative birth experiences described not understanding various clinical decisions and felt uninformed on topics pertinent to their or their infant’s care. Alternatively, women and IOs who experienced infant death who positively described their delivery experience also positively described NICU care (including HCT interactions) and infant death experience (comfort care). These results highlight the impact of HCT interactions and communication on a patient’s perception of delivery despite a negative neonatal outcome. Conclusion: These findings could suggest that improvements in communication and information dissemination from the HCT may have the ability to improve a patient’s periviable birth experience despite a negative neonatal outcome.

Empowered or powerless? Contributing factors to women's appraisal of traumatic childbirth

Background Approximately one-third of women reflect on childbirth as a traumatic experience and the way women appraise their birth experience is significant to their postnatal wellbeing. This study aimed to identify and compare experiences of childbirth for mothers who reflect on birth as a traumatic or non-traumatic event. Methods Semi-structured interviews were conducted with 14 mothers in the postpartum period who appraised their birth as either traumatic or non-traumatic. The data were analysed using thematic analysis to elicit themes and subthemes. Results Thematic analysis revealed two contrasting themes relating to whether women felt empowered or powerless during birth. Empowerment was associated with women's trust in their maternity care, the sense of control they felt over their body and birth and the extent to which they felt informed of their options. Being powerless was associated with distrust towards healthcare services, feeling as though they lacked control over the process and feeling ‘in the dark’ about what was happening. Conclusions Women's sense of empowerment during birth is an important contributor to the appraisal of childbirth as a traumatic or non-traumatic experience. Empowerment is largely determined by the dynamic between a mother and the support around her.

Safe Deliveries?: a Review of New Zealand's Midwifery Regulation through the Lens of the Health and Disability Commissioner

<p>Although birth is a fundamental part of the life process, competing factions within the health profession struggle to agree on the best way to deliver maternity services. Despite this long-standing tension, the midwifery-led model has dominated New Zealand’s maternity system for more than two decades with the majority of consumers expressing satisfaction with the care provided. Unfortunately for a small number of mothers and babies the pregnancy and birth experience is not a positive one and families are left suffering life-long, and often tragic, consequences. As one of the main consumer watchdogs in New Zealand, the Health and Disability Commissioner is charged with investigating claims of poor quality healthcare. This paper examines the central themes in the Commissioner’s reports on substandard midwifery practice and proposes a number of regulatory solutions to the issues involved. Working in unison, these amendments have the potential to ease the pressure placed on midwives; enhance interprofessional relationships; improve practitioner competence; and increase overall compliance with the Code of Health and Disability Services Consumers’ Rights. By implementing these changes, the New Zealand Government could safeguard valuable midwifery-based principles whilst still ensuring that high quality maternity care is provided to all of the country’s mothers and babies.</p>

Safe Deliveries?: a Review of New Zealand's Midwifery Regulation through the Lens of the Health and Disability Commissioner

<p>Although birth is a fundamental part of the life process, competing factions within the health profession struggle to agree on the best way to deliver maternity services. Despite this long-standing tension, the midwifery-led model has dominated New Zealand’s maternity system for more than two decades with the majority of consumers expressing satisfaction with the care provided. Unfortunately for a small number of mothers and babies the pregnancy and birth experience is not a positive one and families are left suffering life-long, and often tragic, consequences. As one of the main consumer watchdogs in New Zealand, the Health and Disability Commissioner is charged with investigating claims of poor quality healthcare. This paper examines the central themes in the Commissioner’s reports on substandard midwifery practice and proposes a number of regulatory solutions to the issues involved. Working in unison, these amendments have the potential to ease the pressure placed on midwives; enhance interprofessional relationships; improve practitioner competence; and increase overall compliance with the Code of Health and Disability Services Consumers’ Rights. By implementing these changes, the New Zealand Government could safeguard valuable midwifery-based principles whilst still ensuring that high quality maternity care is provided to all of the country’s mothers and babies.</p>

Policy, service, and training provision for women following a traumatic birth: an international knowledge mapping exercise

Background High numbers of women experience a traumatic birth, which can lead to childbirth-related post-traumatic stress disorder (CB-PTSD) onset, and negative and pervasive impacts for women, infants, and families. Policies, suitable service provision, and training are needed to identify and treat psychological morbidity following a traumatic birth experience, but currently there is little insight into whether and what is provided in different contexts. The aim of this knowledge mapping exercise was to map policy, service and training provision for women following a traumatic birth experience in different European countries. Methods A survey was distributed as part of the COST Action “Perinatal mental health and birth-related trauma: Maximizing best practice and optimal outcomes”. Questions were designed to capture country level data; care provision (i.e., national policies or guidelines for the screening, treatment and/or prevention of a traumatic birth, service provision), and nationally mandated pre-registration and post-registration training for maternity professionals. Results Eighteen countries participated. Only one country (the Netherlands) had national policies regarding the screening, treatment, and prevention of a traumatic birth experience/CB-PTSD. Service provision was provided formally in six countries (33%), and informally in the majority (78%). In almost all countries (89%), women could be referred to specialist perinatal or mental health services. Services tended to be provided by midwives, although some multidisciplinary practice was apparent. Seven (39%) of the countries offered ‘a few hours’ professional/pre-registration training, but none offered nationally mandated post-registration training. Conclusions A traumatic birth experience is a key public health concern. Evidence highlights important gaps regarding formalized care provision and training for care providers.

Postpartum Early EMDR therapy Intervention (PERCEIVE) study for women after a traumatic birth experience: study protocol for a randomized controlled trial

Background Up to 33% of women develop symptoms of posttraumatic stress disorder (PTSD) after a traumatic birth experience. Negative and traumatic childbirth experiences can also lead to fear of childbirth, avoiding or negatively influencing a subsequent pregnancy, mother-infant bonding problems, problems with breastfeeding, depression and reduced quality of life. For PTSD in general, eye movement desensitization and reprocessing (EMDR) therapy has proven to be effective. However, little is known about the preventive effects of early intervention EMDR therapy in women after a traumatic birth experience. The purpose of this study is to determine the effectiveness of early intervention EMDR therapy in preventing PTSD and reducing PTSD symptoms in women with a traumatic birth experience. Methods The PERCEIVE study is a randomized controlled trial. Women suffering from the consequences of a traumatic birth experience will be randomly allocated at maximum 14 days postpartum to either EMDR therapy or ‘care-as-usual’. Patients in the EMDR group receive two sessions of therapy between 14 (T0) and 35 days postpartum. All participants will be assessed at T0 and at 9 weeks postpartum (T1). At T1, all participants will undergo a CAPS-5 interview about the presence and severity of PTSD symptoms. The primary outcome measure is the severity of PTSD symptoms, whereas the secondary outcomes pertain to fear of childbirth, mother-infant bonding, breastfeeding, depression and quality of life. The study will be conducted at a large city hospital and at multiple midwifery practices in Amsterdam, the Netherlands. Discussion It is to be expected that the results of this study will provide more insight about the safety and effectiveness of early intervention EMDR therapy in the prevention and reduction of PTSD (symptoms) in women with a traumatic birth experience. Trial registration Netherlands Trial Register NL73231.000.20. Registered on 21 August 2020.