Effectiveness of Psychological Interventions to Improve the Mental Well-Being of Parents Who Have Experienced Traumatic Childbirth: A Systematic Review and Meta-Analysis

Considering the adverse impact that traumatic childbirth experiences can have on parental mental well-being, studies that have investigated the potential of providing postnatal psychological support for this group of parents require evaluation. This systematic review aimed to examine the effectiveness of psychological interventions at improving the mental well-being of parents who have experienced traumatic childbirth in terms of anxiety, depression, fear of childbirth, and post-traumatic stress disorder (PTSD) symptoms. Seven electronic databases were searched from their respective inception dates up to January 2021. Only quantitative studies that reported the effects of psychological interventions on anxiety, depression, fear of childbirth, and/or PTSD symptoms in selective (at risk of traumatic childbirth experience) or indicated (self-defined childbirth experience as traumatic for any reason) populations of parents (mothers and/or fathers) were included. Eight studies were included and meta-analyses were conducted using a random-effect model. All studies were conducted on mothers only, and one study had minimal father involvement. Results showed that psychological interventions were more effective in reducing fear of childbirth and improving PTSD symptoms compared to anxiety and depression. Greater improvement in depression was reported at 3–8 weeks’ follow-up than at immediate post-intervention. Subgroup analyses showed that technology-based interventions were feasible, and indicated interventions were more effective than selective interventions. Conducting future interventions in more geographical regions, engaging and including fathers more actively, incorporating both personalized professional therapy and informal peer support, striving for flexibility and convenience, as well as addressing topics on self-doubt and coping skills can improve current interventions.

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.

THE EXPERIENCE OF MIDWIVES WHO EXPERIENCED THE TRAUMATIC CHILDBIRTH

Background: The high rate of medicalization in a woman reduces her ability to give birth and negatively impacts labor. Negative birth emotion in a midwife affects the quality of care. METHOD: This research is a descriptive qualitative research. The sampling technique was purposive sampling consisting of 10 respondents based on inclusion and exclusion criteria setted by the researcher. Data was obtained by conducting in-depth interviews. Data was analysed by reducing data, presenting data, coding, categorizing, and drawing conclusions. RESULTS: Three themes that identified the causes of labor trauma to midwives in this study were complications, pain during labor and post sc, and the absence of a baby sitter. Besides being caused by having previous illnesses, providers who are impatient and prioritize their agendas cause women experience complications that make them traumatized. The attitude of providers and things around women can influence women's perceptions of women's pain. The absence of a baby sitter causes theintense stress for women during pregnancy. CONCLUSION: Providers should have good effective communication skills and pay attention to women's mental readiness during pregnancy and birth. The government ensures that the services provided during childbirth focus on the needs of women so as to reduce the number of trauma.

Clinical and functional features of rectal sphincter in patients with rectovaginal fistulas before and after split vaginal-rectal flap application

Dysfunction of the rectal sphincter is noted in more than 70 % of patients with rectovaginal fistulas (RVF), which require an extremely careful evaluation of the rectal sphincter function both by clinical and instrumental methods. Objective: to study the state of rectal sphincter in patients with rectovaginal fistulas before and after surgical treatment. Materials and methods: in the period from 2012 to 2021 198 patients (age from 20 to 73 years, Me = 35 (30; 45)) were included in the comprehensive study of the rectal sphincter functional state before and after surgical treatment. 106 (53,5 %) cases were recurrent. Traumatic childbirth was the most common cause of RVF (43,9 %). Results: dysfunction of the rectal sphincter is revealed in 154 (77,8 %) patients with rectovaginal fistulas. The etiology of the disease and the recurrent course do not affect the severity of the rectal sphincter functional disorders. Using of a split rectal-vaginal flap do not lead to a worsening of the rectal sphincter function. Conclusion: A significant mismatch between the obtained objective (sphincterometry) and subjective (Wexner scale) data of the rectal sphincter function in patients with rectovaginal fistulas proves the need for sphincterometry in this category of patients. Elimination of rectovaginal fistulas by using a split vaginal-rectal flap is a safe and low-traumatic surgical method.

The Effect of Labor Dance on Traumatic Childbirth Perception and Comfort: A Randomized Controlled Study

This study aims to evaluate the effect of labor dance on traumatic childbirth perception and comfort. This is a randomized controlled experimental study. The study was conducted with 120 primiparous pregnant women (60 in experiment group, 60 in control group). The pregnant women in the experiment group performed labor dance with the researcher midwife during the active phase of labor. The researcher implemented the Childbirth Comfort Questionnaire (CCQ) when the cervical dilation was 8 cm. The Postpartum Comfort Scale (PCS) and Traumatic Childbirth Perception Scale (TCPS) were implemented almost 2 hours after giving birth. The scores of the women in the experiment group in TCPS were significantly lower than those in the control group while their mean scores in CCQ and PCS were significantly higher. Labor dance contributed to the women’s more positive childbirth experiences, perceptions of childbirth as less traumatic, and increased their comfort levels.

Vicarious Trauma Experienced by Health Care Providers Involved in Traumatic Childbirths: A Meta-Synthesis

Health care providers are often “second victims” of traumatic childbirth events and should be adequately supported by their organizations to alleviate occupational stress and burnout. Therefore, this review aimed to explore and understand the vicarious traumatic childbirth experiences of health care providers, including obstetricians, midwives, nurses, and students. A systematic review of qualitative studies was conducted. Seven electronic databases, namely, PubMed, CINAHL, Embase, PsycINFO, Cochrane, Scopus, and Web of Science, were searched from each database’s inception to May 2020. In total, 1,575 studies were retrieved and screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen studies were included in this review and were meta-summarized and then meta-synthesized using the Sandelowski and Barroso approach. The overarching theme of “Tunneling through the trauma with a hope of finding an end” was derived, and four main themes along with 15 subthemes were identified. The four main themes were (1) “instantaneous response to the trauma,” (2) “finding hope in the midst of chaos,” (3) “dealing with the aftermath,” and (4) “resolution to move on.” Communication and teamwork among health care team members were identified as challenges contributed by professional hierarchy and lack of role clarity. Midwives and labor and delivery nurses expressed powerlessness in advocating for women on many occasions, and health care providers often had feelings of guilt and self-blame after adverse events. Health care providers also reported inadequate support from their colleagues and organizations, which influenced their ability to cope with the aftermath of trauma and their decision to stay in the profession.