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BACKGROUND: Fear of childbirth (FOC) may affect family planning in lesbian, bisexual and transgender (LBT) couples with two potential carriers of a pregnancy. FOC has previously been researched in heterosexual women, while experiences of LBT people have remained unattended. The choice of birth-giving partner in same-sex couples has gained some attention in previous research, but the potential complexities of the decision have not been studied. AIM: The aim is to explore how LBT people negotiate the question of who gives birth, in couples with two potential birth parents, and where one or both partners have a pronounced FOC. METHODS: Seventeen self-identified LBT people were interviewed about their expectancies and experiences of pregnancy and childbirth. Data were analysed following a six-step thematic analysis. RESULTS: FOC was negotiated as one of many aspects that contributed to the decision of who would be the birth-giving partner. Several participants decided to become pregnant despite their fears, due to a desire to be the genetic parent. Others negotiated with their partner about who was least vulnerable, which led some of them to become pregnant despite FOC. Still other participants decided to refrain from pregnancy, due to FOC, and were delighted that their partner would give birth. Several participants described their partner's birth-giving as a traumatic experience for them, sometimes also when the birth did not require any obstetric interventions. The partner's experience was in some cases not addressed in postnatal care. CONCLUSIONS: It is important that healthcare staff address both partners' prenatal expectancies and postnatal experiences. Funding: Royal Swedish Academy of Sciences [AM2017-0005]

OBJECTIVE In this study, the effect of high-risk pregnancies on pregnant women's perception of anxiety and traumatic birth was examined. DESIGN AND METHODS Data in a comparative descriptive study involving 156 pregnant women, collected by pregnant information form, State and Trait Anxiety, and Traumatic Birth Perception Scale. RESULTS It was found that 44.9% of the pregnant women in the study were between the ages of 24-29, 79.5% wanted to give birth normally, and 62.8% feared vaginal delivery. There was a low level of positive correlation between traumatic anxiety and perception of traumatic delivery in high-risk pregnant women, and a moderate positive relationship between traumatic anxiety and traumatic delivery perception in low risk pregnant women (p

Background: Many trans and non-binary people wish to be parents. However, few countries record figures for trans and non-binary people becoming pregnant/impregnating their partners. Pregnant non-binary people and trans men may be growing populations, with heightened vulnerabilities to traumatic birth and perinatal mental health difficulties (i.e. pregnancy-one year postpartum). Aim: To conduct a scoping review on traumatic birth and perinatal mental health in trans and non-binary people to identify research evidence, summarize findings, and identify gaps. Methods: Electronic databases were searched to identify published English-language evidence. Eligibility was not restricted by type of study, country, or date. Findings: All studies were from the Global North and most participants were white. The literature focuses on structural and psychological barriers faced by non-binary people and trans men and on the lack of reliable medical information available. There is a lack of empirical research and, to date, no research into trans and non-binary parents’ experiences has focused on traumatic birth or perinatal mental health. However, common themes of dysphoria, visibility, isolation, and the importance of individualized respectful care indicate potential vulnerability factors. Trans women’s and non-binary people’s experiences are particularly under-researched. Discussion: The themes of dysphoria, visibility, and isolation present a series of challenges to pregnant non-binary people and trans men. These coalesce with external events and internal choices, creating the potential to make the individual feel not man enough, not trans enough, not pregnant enough, and not safe enough during pregnancy, birth, and the postpartum. Further research involving trans people is needed to inform future services.

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.

The researchers aimed to investigate the relationship between the health literacy levels of pregnant women and their perceptions of traumatic childbirth. The sample consisted of 384 pregnant women. The data were collected using the 'Pregnancy Information Form", the "Health Literacy-32 Scale," and the "Traumatic Birth Perception Scale." Health literacy levels of pregnant women were found to be inadequate (44%) and limited (43.5%). 56.8% of pregnant women had moderate, and 27.1% had a high perception of traumatic birth. A negative correlation was determined between the total score and sub-dimensions of the Health Literacy Scale of pregnant women (i.e. access to health information, understanding health information, protection from diseases, and health promotion) and their perceptions of traumatic birth (p

Vitamin D supplementation is essential for the entire population, especially during pregnancy and in the pediatric period. We report two case studies of full-term newborns who presented long-bone fractures associated with severe vitamin D deficiency transmitted to them by their mothers, even though maternal supplementation had been implemented according to the existing recommendations. These observations encourage the investigation of neonatal vitamin D deficiency in the presence of long-bone fractures in the absence of traumatic birth and the necessity of reenforcing the means of prevention and the selection of risk groups in order to adjust vitamin D supplementation during pregnancy individually.

ZusammenfassungWir berichten einen Fall von isolierter Kongenitaler Radiusköpfchenluxation (kRKL) bei einem Neugeborenen nach vaginaler Geburt aus Beckenendlage. Die Assoziationen dieser Geburtsmodalität führten zu der Fehldiagnose einer Ellbogenluxation. Die Ellbogenluxation ist eine häufige Fehldiagnose der kRKL, obwohl sie insbesondere bei Kindern unter einem Jahr bisher nicht berichtet wurde. Für den erfahrenen Kliniker führen jedoch die wiederholte klinische Untersuchung zusammen mit der geeigneten Bildgebung zum Ausschluß dieser Diagnose. Die kRKL kann bis in das Jugendalter asymptomatisch bleiben. Sofern keine Schmerzen oder funktionelle Beeinträchtigung vorliegen ist keine Therapie notwendig. Wir nahmen diesen Fall zum Anlass, neonatale Ellbogen-Auffälligkeiten in diesem Bericht zusammenzufassen.

Traumatic birth has various effects on women, and postpartum depression is one of them. The present study had two aims: 1) to determine the level of traumatic childbirth perception and postpartum depression in women and the factors affecting them and 2) to reveal the relationship between traumatic childbirth perception and postpartum depression. Five hundred fifty women, recruited between March 2018 and February 2019, completed the following form and scales one month after delivery: the general and obstetric information form, the Perception of Traumatic Childbirth Scale (PTCS), and the Edinburgh Postnatal Depression Scale (EPDS). The mean PTCS scores of the women included in the study were 63.45 ± 28.116 with a median value of 65, and the prevalence of traumatic childbirth was 33.8%. The risk of postpartum depression was determined in 25.3% of the women. There was a significant relationship between the participants' traumatic childbirth perception and their EPDS scores (

Background: Traumatic birth experiences may lead to serious psychological impairment. Recent studies show that a considerable number of women can develop post-traumatic stress disorder (PTSD). Objectives: The aim of this study was to investigate the effect of cognitive-behavioral therapy (CBT) on PTSD in pregnant women with a history of traumatic childbirth. Methods: This quasi-experimental study was conducted on 80 pregnant women with a history of traumatic childbirth, referring to health centers in Zahedan in 2020. The mothers were selected by a convenience sampling method and divided into two groups (40 mothers in each group) according to the random allocation method. The data were collected using the PTSD questionnaire administered before the intervention and five weeks after the final training session. The intervention group received four sessions of CBT during four weeks, and the control group received only routine pregnancy care. Data analysis was performed by SPSS 22 software using the independent t-test, chi-square test, and paired sample t-test at a significant level of < 0.05. Results: The results of the study showed that the mean post-traumatic stress score of pregnant women before CBT in the intervention and control groups was 27.90 ± 10.91 and 24.97 ± 14.85, respectively, and it changed to 15.25 ± 4.08 and 26.25 ± 11.56, respectively, after the intervention. Independent t-test showed that the mean scores of post-traumatic stress of pregnant women in the two groups were not significant before education (P = 0.31), but it was significant after it (P = 0.0001). Conclusions: CBT can have significant effects on reducing the severity of PTSD in pregnant women with a history of traumatic childbirth. Thus, it is recommended to include this type of educational intervention in the care program of pregnant women with a history of traumatic childbirth.

Purpose: To evaluate whether severe postpartum hemorrhage (PPH) is a risk factor for posttraumatic stress disorder (PTSD). Severe PPH can be experienced as a traumatic event. PTSD leads to negative mental health effects. Knowing risk factors for PTSD during childbirth offers opportunities for early interventions, which may prevent the development of PTSD.Materials and methods: In this prospective study, we compared two groups of participants; women with ≥2000 mL of blood loss (severe PPH, patients) and women with ≤500 mL of blood loss (controls). Participants were screened for PTSD using the PCL-5 four to six weeks after delivery. Positive screening was followed by the CAPS-5 to diagnose PTSD.Results: We included 187 PPH patients and 121 controls. Median PCL-5 scores were higher for PPH patients (5.0) than controls (4.0, p = 0.005). Thirteen PPH patients (7.0%) and two controls (1.7%) scored ≥32 on the PCL-5, indicative of probable PTSD (OR 4.45, 95% CI 0.99-20.06, p = 0.035). Significant more PPH patients than controls met criteria for a clinical diagnosis of PTSD on the CAPS-5 (n = 10, 5.6% vs n = 0, 0.0%; p = 0.007).Conclusions: There is a significant and clinically relevant increased risk for developing PTSD after severe PPH. Gynecologists and midwives are advised to screen for PTSD at postpartum follow-up visits to prevent long-term negative mental health effects. Clinical Trial Registration: NL50273.100.14.

Background After a traumatic childbirth experience, women are often afraid of future pregnancies, and may be at risk for also experiencing their subsequent childbirth as traumatic. Aims Two questions were investigated regarding women's experience of their subsequent childbirth after a previous traumatic birth: (1) which factors in the previous traumatic birth are associated with the subsequent childbirth experience, and (2) fear of childbirth and coping behaviour during the subsequent pregnancy associated with the subsequent birth experience. Methods A total 474 Dutch women (mean age during traumatic childbirth=28.9 years; SD=3.9) answered an online survey about their previous traumatic and subsequent birth experience. Findings Making a birth plan, choosing a home birth in a high-risk pregnancy, and having a planned caesarean section emerged as statistically significant correlates of positive subsequent birth experience. Conclusion Experiencing control over the subsequent birth might underlie practices associated with more positive subsequent childbirth experience among women with a traumatic childbirth history.

ZusammenfassungInsbesondere sexuelle aber auch körperliche oder emotionale Gewalterfahrungen in der Biografie oder Gegenwart stellen einen Hochrisikofaktor für pathologische Schwangerschafts- und Geburtsverläufe mit Entwicklung von Traumafolgestörungen nach der Geburt sowie eine erschwerte Mutter-Kind-Bindung dar. Eine Geburt kann aber auch primär traumatisch erlebt werden, ohne dass es vorher Traumaerfahrungen gab. Schwierige und traumatisch erlebte Geburtsverläufe beeinträchtigen auch Geburtshelfer. Der vorliegende Beitrag gibt einen Überblick über Prävalenz und Risikofaktoren einer traumatisch erlebten Geburt sowie Verläufe, Auswirkungen und Interventionsmöglichkeiten.

Introduction: Between 9 and 44% of women experience giving birth as traumatic, and 3% of women develop a post-traumatic stress disorder following childbirth. Knowledge on risk factors is abundant, but studies on treatment are limited. This study aimed to present an overview of means to prevent traumatic birth experiences and childbirth-related post-traumatic stress disorder. Material and methods: Major databases [Cochrane; Embase; PsycINFO; PubMed (Medline)] were searched using combinations of the key words and their synonyms. Results: After screening titles and abstracts and reading 135 full-text articles, 13 studies were included. All evaluated secondary prevention, and none primary prevention. Interventions included debriefing, structured psychological interventions, expressive writing interventions, encouraging skin-to-skin contact with healthy newborns immediately postpartum and holding or seeing the newborn after stillbirth. The large heterogeneity of study characteristics precluded pooling of data. The writing interventions to express feelings appeared to be effective in prevention. A psychological intervention including elements of exposure and psycho-education seemed to lead to fewer post-traumatic stress disorder symptoms in women who delivered via emergency cesarean section. Conclusions: No research has been done on primary prevention of traumatic childbirth. Research on secondary prevention of traumatic childbirth and post-traumatic stress disorder following delivery provides insufficient evidence that the described interventions are effective in unselected groups of women. In certain subgroups, results are inhomogeneous.

Birth trauma has been a central theme in all the preceding chapters as a main driver leading women to choose to birth outside the system. We end Part 1: Listening to the canary by looking specifically at birth trauma and PTSD. In this chapter, Maddy reports on the research into birth trauma and post-traumatic stress disorder (PTSD) following birth and shows how multiple factors, such as a previous history of trauma or mental illness, can make women vulnerable to being traumatised during birth. It is not just what is done to women or the intervention they experience that creates birth trauma. It is also about how women are treated and spoken to that has a negative influence. Agy tells the story of her traumatic birth and how she had to battle her midwives and obstetrician every step of the way to have her choices met and how this led to birth trauma that has still not been resolved. The emerging evidence of the protective effect of continuity of midwifery care and homebirth make it clear that women who seek to freebirth after a traumatic birth are trying to protect themselves from a repeat of the same experience. Birth trauma is the noxious by-product of a system that fails women.

Background Traumatic birth experience has undesirable effects on the life of the mother, child, family, and society. The identification of predictive factors can be useful in improving birth experiences among women. This study aimed to assess the prevalence of a traumatic birth experience and identify its predictors among a group primiparous women. Methods A cross-sectional study was conducted among 64 health centres in Tabriz, the second largest city in Iran. Cluster sampling was used to recruit 800 eligible women at one to 4 months postpartum. The Persian version of the Childbirth Experience Questionnaire was used to measure the womens’ birth experiences. Data were collected through face to face interviews and analysed mainly by multivariable logistic regression. Results The prevalence of traumatic birth experience was 37% in the study group. The independent predictors of the traumatic birth experience were related to antenatal and intrapartum factors. The antenatal predictor was the lack of exercise during pregnancy (OR = 2.81, CI 1.40–5.63, P = .003) and the intrapartum predictors were the absence of pain relief during labour and birth (OR = 4.24, CI 2.12–8.50, P

Background: A significant number of women experience childbirth as traumatic. These experiences are often characterized by a loss of control coupled with a perceived lack of support and inadequate communication with health care providers. Little is known about the choices women make in subsequent pregnancy(s) and birth(s), or why they make these choices. This study aimed to understand these choices and explore the reasons behind them. Methods: A longitudinal grounded theory methods study involving nine women was conducted. Over half of the participants had a formal diagnosis of post-traumatic stress disorder (PTSD) and/or PND related to the previous birth. Interviews were carried out at three timepoints perinatally. These findings are from the first interviews at 12–20 weeks. Results: From the first days of pregnancy, this cohort of women were focused on concerns that this birth would be a repeated traumatic experience. The women were deliberately searching out and analyzing information about their choices in this pregnancy and birth, and making plans which had two aims; firstly to avoid a repeat of their previous birth experience and secondly to avoid a loss of control to other people during the birth. The women considered a range of birth choices, from elective cesareans to freebirth. Some women felt well supported by those around them, including care providers, partners, friends, and family. Others did not feel supported and were anticipating conflict in trying to assert their birth choices. Many early relationships with healthcare professionals were characterized by fear and mistrust. Discussion: If women who have previously experienced a traumatic birth become pregnant again, they have a strong desire to avoid a repeat experience and to feel in control of their birth choices. Access to robust information appears to help reduce uncertainty and arm women in their discussions with professionals. Similarly making plans and seeking to have them agreed with care providers at an early stage is used a way to reduce the risk of having a further traumatic experience. Implications for practice include supporting women in formulating and confirming pregnancy and birth plans at an early stage to reduce uncertainty and foster a sense of control.

Delayed subaponeurotic fluid collections (DSFCs) are a recently described cause of idiopathic scalp swelling in young infants. Associated with traumatic birth and the use of vacuum-assisted devices or fetal scalp electrodes, DSFCs can be differentiated from similar causes of neonatal scalp swelling based on characteristic history and physical examination findings. In this article, we highlight 2 cases of young infants presenting to a pediatric emergency department with large, fluctuant scalp swellings, which were appropriately diagnosed as DSFCs; clinical data on an additional eight cases are presented in table format. In cases of isolated DSFCs in otherwise well-appearing infants, further laboratory work, imaging, subspecialty consultation, and child abuse investigation is not necessary. Recommendations for the diagnosis and management of DSFCs presented reflect the clinical experience of the authors in conjunction with a review of the available medical literature on this topic.

The rate of operative vaginal births (OVBs) is stable in the UK running at approximately 12% of all deliveries. OVB is in the main a safe practice when performed in the correct setting by an appropriately trained operator, producing good outcomes for the majority of mothers and babies. There should be a balance of risk. Instrumental delivery is safer than a caesarean section at full dilatation for the mother and causes less impact on future pregnancies, as most women will achieve a vaginal birth in a subsequent pregnancy. A caesarean section at full dilatation, however, shows reduced rates of traumatic birth injury to the baby. Despite the fact that in most cases the outcomes are good for forceps and vacuum assisted deliveries, these births still generate a considerable cost in terms of litigation when they are performed sub optimally, or when the baby is born in poor condition. All obstetricians require appropriate training and supervision to ensure these deliveries are performed safely in line with national guidance.

Objectives: Major obstetric hemorrhage (MOH) is the leading cause of severe maternal morbidity and mortality, and can have a significant impact on a woman's life. This study aims to gain insight into the patients reported experiences (PREs) and outcomes (PROs) after a major obstetric hemorrhage, and to investigate which patients are most at risk for negative experiences. Material and methods: A Consumer Assessment of Healthcare Providers and Systems (CAHPS) based questionnaire was developed covering items on the PREs and PROs, and send to all patients with blood loss exceeding 2500 ml in six hospitals over the period of 2008-2012. A regression analysis was performed to find determinants for negative experiences. Results: In total 372 of the 570 questionnaires were returned. Women scored the overall care before, during and after the MOH with a mean of 7.67, 7.62 and 7.28, respectively. However, most PRE items individually were scored suboptimal, with items regarding information supply scoring the lowest. Our results on the PROs showed 81% of the women (362) sustaining extreme fatigue, whereas problems with concentration (53% of 373 women), memory (49% of 353), or reliving (49% of 356) and irritability (51 % of 355) were also frequently endured. Negative long term effects were observed in 28% of the women (106 of 372). We found 'year of the MOH longer ago', 'a lower total blood loss' and 'a large location of birth' to be determinants for negative experiences. Conclusions: Women frequently reported negative experiences and outcomes following a MOH. Information supply after an MOH concerning both physical and psychological complaints is essential for the improvement of care. (C) 2018 Elsevier B.V. All rights reserved.

Post Traumatic Stress Disorder-Post Childbirth (PTSD-PC) is a powerful pathophysiological reaction that occurs in response to experiencing a traumatic birth and affects between1-6% of women. Regardless of its trigger, PTSD-PC causes significant impairment to women’s social interactions, capacity to work, and daily life. A key symptom of PTSD-PC is re-experiencing the birth in the form of nightmares, flashbacks, continual replay, intrusive thoughts, and images. When these symptoms persist beyond ‘one month’ (DSM-V definition), a diagnosis of PTSD-PC should be considered. In full awareness that there are additional mental health problems that a childbearing woman could encounter, we have elected to focus on two of the more commonly experienced diagnoses; specifically PTSD and Post Natal Depression (PND). It is important for midwives to be able to differentiate between PTSD-PC and Post Natal Depression (PND), because diagnoses and treatments differ. Generally PND is treated with antidepressants and Cognitive Behavioural Therapy (CBT), whilst PTSD is treated with Eye Movement Desensitisation and Reprocessing (EMDR) therapy or Emotional Freedom Technique (EFT). Also, there is potential for a women to develop a dual diagnosis, with partner and family affected also. Clarity surrounding the differences between PND and PTSD are key to accessing appropriate diagnosis, referral, and treatment.

Planning to promote the health of mothers in postpartum is important in all countries. This study aimed to determine the effectiveness of two counseling method on prevention of post-traumatic stress after childbirth. In this clinical trial, 193 of mothers who had experienced a traumatic birth were randomly assigned to three groups. Participants were assessed using IES_R questionnaire at 4–6 weeks and 3 months after delivery. Debriefing and brief cognitive behavioral counseling (CBC) significantly improved the symptoms of postpartum traumatic stress disorder. After 3 months, CBC had a significant effect on the symptoms. Screening of traumatic childbirth, implementation of supportive care, and early counseling prior to the initiation of post-traumatic stress are recommended. IRCT2015072522396N2. http://en.search.irct.ir/view/24735 .

Background\ud Although longitudinal trajectories of post-traumatic stress disorder (PTSD) are well-established in general trauma populations, very little is known about the trajectories of birth-related PTSD. This study aimed to identify trajectories of birth-related PTSD; determine factors associated with each trajectory; and identify women more likely to develop birth-related PTSD.\ud \ud Method\ud 226 women who had traumatic childbirth according to DSM-IV criterion A were drawn from a community sample of 950 women. Measures were taken of PTSD, affective symptoms, fear of childbirth and social support in pregnancy, 4–6 weeks and 6-months postpartum. Information on some obstetric and psychosocial factors were also prospectively obtained.\ud \ud Results\ud Four trajectories were identified: resilience (61.9%), recovery (18.5%), chronic-PTSD (13.7%) and delayed-PTSD (5.8%). Resilience was consistently distinguished from other PTSD trajectories by less affective symptoms at 4–6 weeks postpartum. Poor satisfaction with health professionals was associated with chronic-PTSD and delayed-PTSD. When affective symptoms at 4–6 weeks postpartum were removed from the model, less social support and higher fear of childbirth 4–6 weeks after birth predicted chronic and recovery trajectories; whereas experience of further trauma and low levels of satisfaction with health professionals were predictive of chronic-PTSD and delayed-PTSD, compared to resilience. Additional variables associated with different trajectories included antenatal affective symptoms, caesarean-section, preterm birth and receiving professional help.\ud \ud Limitations\ud Use of self-report measures, use of DSM-IV criteria for PTSD diagnosis, and no follow-up beyond six months are the main limitations of this study.\ud \ud Conclusion\ud Identified factors may inform preventive and treatment interventions for women with traumatic birth experiences.

Relatively little is known about the extent of trauma and birth-related fear in midwives and how this might affect practice.(1) Determine prevalence of birth related trauma and fear in midwives and associations with midwives' confidence to advise women during pregnancy of their birth options and to provide care in labour. (2) Describe midwives' experiences of birth related trauma and/or fear.A mixed methods design. A convenience sample of midwives (n=249) completed an anonymous online survey. Descriptive and inferential statistics were used to analyse the quantitative data. Latent content analysis was used to extrapolate meaning from the 170 midwives who wrote about their experiences of personal and/or professional trauma.The majority of midwives (93.6%) reported professional (n=199, 85.4%) and/or personal (n=97, 41.6%) traumatic birth experiences. Eight percent (n=20) reported being highly fearful of birth. Trauma was not associated with practice concerns but fear was. Midwives categorised as having 'high fear' reported more practice concerns (Med 23.5, n=20) than midwives with 'low fear' (Med 8, n=212) (U=1396, z=-3.79, p0.001, r=0.24). Reasons for personal trauma included experiencing assault, intervention and stillbirth. Professional trauma related to both witnessing and experiencing disrespectful care and subsequently feeling complicit in the provision of poor care. Feeling unsupported in the workplace and fearing litigation intensified trauma.High fear was associated with lower confidence to support childbearing women. Fear and trauma in midwives warrants further investigation to better understand the impact on professional practice.

Subgaleal hemorrhage is an uncommon but often fatal complication of a traumatic birth. Careful assessment and monitoring of the infant following birth are necessary to ensure prompt intervention, referral, and improved outcomes. Additional care, planning, and communication are especially important in the transport environment.

Background: Post-traumatic stress disorder is a Trauma- and Stressor-Related Disorder resulting from exposure to an event that is considered as traumatic. It is recognized in relation to traumatic childbirth that both patient, partner and health-care provider can develop a post-traumatic stress disorder. The most important risk factors in women are depression during the pregnancy, fear of childbirth, severe pre-eclampsia, preterm premature rupture of membranes, and severe neonatal complications. The prevalence rate in women in Western countries is estimated between 1 and 3%. The prevalence in partners witnessing childbirth is unknown. Post-traumatic stress disorder in relation to severe post-partum haemorrhage, in either women or partners, has not been extensively researched yet. Methods/design: This is a prospective cohort study in a hospital setting, with the objective to evaluate whether women and their partners have a higher risk to develop a post-traumatic stress disorder or symptoms, following a severe post-partum hemorrhage of 2.0 l or more, compared to a control group. The primary outcome variable is diagnosis of post-traumatic stress disorder. Secondary outcome variables are post-traumatic symptoms according to the post-traumatic stress disorder criteria, psychiatric co-morbidities and seeking psychological help. A total of at least 130 women and 130 partners, must be included according to power calculations. Patients, partners and controls are selected in eight hospitals through complication registers. They are asked to complete a digital questionnaire four to six weeks after delivery, to screen for a post-traumatic stress disorder or symptoms. Participants with scores above cut off values are asked to participate in a telephone interview. For secondary outcomes, risk factors will be evaluated by multivariable analysis. Discussion: This study is designed to give insight into the frequency of post-traumatic stress disorder and post-traumatic stress symptoms following a severe post-partum hemorrhage, both in patients and their partners. We strive to minimize the non-response bias, a common problem in this type or research, through early and active participant recruitment. Trial registration: NL50273.100.14.

The childbirth experience can be a wonderful event, or one of horror. One in 3 adult mothers appraises her childbirth experience as traumatic, with up to 10% of women reporting a severe traumatic stress response post-delivery. The impact of the birth experience on adolescents is unknown.Eighty-five Latinas ages 13 to 19 appraised their childbirth experience and reported symptoms of trauma impact as measured via the Impact of Event Scale (IES) within 72 hours of delivery. Descriptive statistics included demographic, obstetrical, and personal factors, and trauma scores. ANOVAs were used to examine differences in birth appraisal and trauma impact by demographic, obstetrical, and personal factors. Spearman rho and Pearson's r was used to compute correlations between birth appraisal, depression, and trauma impact.One-third of adolescents appraised their childbirth as traumatic; one-half displayed symptoms of trauma impact. Items influencing appraisal of the birth experience included marital status, fear of dying, fear of loss of control, and partner violence. Birth appraisal and symptoms of depression were found to influence trauma impact.One-third of teens appraised childbirth as traumatic with 50% displaying symptoms suggestive of acute trauma at immediate postpartum. Nursing recommendations focus on providing a non-traumatic birth experience and follow-up by mental health professionals for assessment of potential chronic trauma, posttraumatic stress and depression. Teens can enter labor and delivery with stressors, depression, and past traumas; collaboration of care between maternal-child and mental health professionals is encouraged.

The birth is an individual and also important expression for women life. This experience can be perceived in a different way by each woman that can be defined by different feelings such as positive, negative or mixed. Some women perceive birth experience as a traumatic event. Traumatically perceived birth is considered an event that may trigger Posttraumatic Stress Disorder (PTSD) reaction. It is stated that traumatic birth experience may cause permanent or long-term negative consequences in women's life, may negatively affect future health, subsequent birth experiences and family relations. It is reported that birth is part of the continuity from past to future and the effects are not limited to the woman giving birth, but also that the subsequent generations, and even the other women around it, can influence the birth perceptions and experiences. There are many studies shows that the effects of traumatic events are transmitted to the next generation. This genetic transmission suggests that traumatic birth is a serious problem not only affecting the women who will give birth to nowadays but also having long-term consequences. From today's women to future generations, obstetrics and gynecology nurses have important responsibilities to prevent of reaching traumatic experience of birth, is a natural part of women's life. In this article, it was aimed to investigate the importance of traumatic birth concept, risk factors, existing effects and future generations in the context of literature and to draw attention to the responsibilities of the obstetrics and gynecology nurses.Extended English summary is in the end of Full Text PDF (TURKISH) file. ÖzetDoğum bireyseldir ve kadın için çok yönlü önemli bir yaşam deyimidir. Bu deneyim her bir kadın tarafından farklı algılanabilmekte, olumlu, olumsuz ya da karışık farklı duygularla tanımlanabilmektedir. Bazı kadınlar ise doğum deneyimini travmatik bir olay olarak algılayabilmektedir. Travmatik olarak algılanan doğum, Posttravmatik Stres Bozukluğu (PTSB) reaksiyonunu tetikleyebilecek bir olay olarak kabul edilmektedir. Travmatik doğum deneyiminin kadının hayatında kalıcı veya uzun vadeli olumsuz sonuçlar doğurabileceği, gelecekteki sağlığını, sonraki doğum deneyimlerini ve aile içi ilişkilerini olumsuz etkileyebileceği belirtilmektedir. Doğumun geçmişten geleceğe giden devamlılığın bir parçası olduğu belirtilmekte ve etkilerinin doğum yapan kadınla sınırlı kalmayıp, onunla birlikte çevresindeki diğer kadınların ve hatta sonraki nesillerin doğum algılarını ve deneyimlerini de etkileyebildiği bildirilmektedir. Travmatik olayların etkilerinin sonraki nesillere aktarıldığını gösteren pek çok çalışma bulunmaktadır. Bu genetik aktarım travmatik doğumun da sadece günümüzde doğum yapacak kadınları etkilemeyip daha uzun vadeli sonuçları olabilecek ciddi bir sorun olduğunu göstermektedir. Kadın hayatının doğal bir parçası olan doğum eylemini günümüz kadınlarının ve gelecek nesillerin travmatik bir deneyim olarak hatırlamalarının önlenmesinde kadın doğum hemşirelerine önemli sorumluluklar düşmektedir. Bu makalede travmatik doğum kavramı, risk faktörleri, ortaya çıkan mevcut etkileri ve gelecek nesiller açısından önemini literatür bağlamında irdelemek, konuya ve kadın doğum hemşiresinin sorumluluklarına dikkat çekmek amaçlanmıştır.

The dislocation of a shoulder joint in infancy is extremely rare and is usually the result of traumatic birth injuries, a sequel to brachial plexus injury, or a true congenital dislocation of shoulder. With more advanced obstetric care, the incidence of first two types has drastically decreased. We report a case of true congenital dislocation of shoulder, second of its kind, in a child who was delivered by cesarean section thereby negating any influence of trauma. We report the case because of its rarity, and review the available literature on this topic. We also discuss the management options when encountered with such a rare case scenario.

Objective: To determine if there were any consistent factor(s) in the case histories and/or examination findings in a small case series of dyslexic children who had presented to chiropractors. Method: A questionnaire was completed by the mother in each case, eliciting information regarding the history of the labour and delivery; particular regard to any pre- or peri-natal trauma; the child’s developmental pattern and dietary and lifestyle details. Conclusion: It was noted that all three children had had a traumatic birth; all three presented with co-morbidity; two of the three children had a parent who had been diagnosed as dyslexic and the other had a parent with dyslexic tendencies. A larger study is called for to determine whether or not pre- or peri-natal trauma is a persistent trend in children with dyslexia.

In this study, researchers explored mothers' coping strategies in dealing with birth by unplanned Caesarean section. Mothers' experiences of a traumatic birth could be influenced by perceived strengths when coping with the stress related to the incident. Coping strategies resulted in reassessment of the birth process and were associated with a more positive and memorable experience. In-depth interviews with 10 women explored their lived experiences of childbirth. Data were analyzed thematically. Phenomenological theory served as a framework for the structuring, organizing, and categorizing of data. Mothers described several factors and coping strategies that they perceived to be effective in reducing the impact of their traumatic birth experiences.

By Abraham Verghese. Published by Chatto & Windus London 2009 9780701173838 Samuel Johnson wrote one of the world’s best books and set it in Ethiopia. His History of Rasselas, Prince of Abissinia is peppered with insightful and pithy commentary on the foibles of humans who, for example, believe happiness possessed by others to keep alive the hope of obtaining it for themselves.1 To say that Abraham Verghese’s entertaining novel, Cutting for Stone , about two generations of surgeons in Ethiopia and the USA, has better characterisation and plot structure than Dr Johnson’s smaller work but fails to rise to the same stature, does neither an injustice. Abraham Verghese is a professor of medicine at Stanford University California and a writer of books, essays and short stories, who was born and brought up by Indian parents in Ethiopia. This is a well-crafted novel and Verghese is meticulous in acknowledging his sources, including those for some of the work’s best lines: “I owe you the sight of morning” for instance, and “squared her shoulders to the unloveliness”. Verghese draws on surgical emergencies with which he is obviously familiar to create dramatic pivot points in his narrative. The first is the traumatic birth, at the Ethiopian Missing (sic) Hospital, of the conjoined male twins Shiva and Marion …

Objective for some women childbirth is physically and psychologically traumatic and meets Criterion A1 (threat) and A2 (intense emotional response) for Posttraumatic Stress Disorder of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV).This study differentiates Criterion A1 and A2 to explore their individual relationship to prevalence rates for posttraumatic stress, each other, and associated factors for childbirth trauma. Design and setting women were recruited at three hospitals from October 2008 to October 2009. Questionnaires were completed at recruitment and at 14 days post partum. Participants women in the third trimester of pregnancy (n=890) were recruited by a research midwife while waiting for their antenatal clinic appointment. Participants were over 17 years of age, expected to give birth to a live infant, not undergoing psychological treatment, and able to complete questionnaires in English. Findings this study found 14.3% of women met criteria for a traumatic childbirth. When the condition of A2 was removed, the prevalence rate doubled to 29.4%. Approximately half the women who perceived threat in childbirth did not have an intense negative emotional response. Predictors of finding childbirth traumatic were pre-existing psychiatric morbidity, being a first time mother and experiencing an emergency caesarean section. Key conclusions the fear response is an important diagnostic criterion for assessing psychologically traumatic childbirth. The identification of risk factors may inform maternity service delivery to prevent traumatic birth and postpartum approaches to care to address long-term negative consequences. Implications for practice prevention and treatment of traumatic childbirth are improved through knowledge of potential risk factors and understanding the woman's subjective experience.

Endothelial keratoplasty, particularly Descemet’s stripping automated endothelial keratoplasty (DSAEK), has quickly become the standard of care for adult endothelial dysfunction [1–4]. As long-term follow-up data becomes available and surgeon comfort with the procedure increases, DSAEK is continually being applied to new diseases. Pediatric cases of endothelial dysfunction treated by DSAEK have already been reported for the treatment of bullous keratopathy following cataract surgery and Descemet’s membrane damage due to traumatic birth injury [5, 6]. Pineda et al. [7] reported a single case of attempted DSAEK in a 7-year-old boy with congenital hereditary endothelial dystrophy (CHED) which was converted to penetrating keratoplasty due to poor visualization and difficulty stripping the host Descemet’s membrane. The authors questioned whether DSAEK could be successfully performed for CHED. Mittal et al. [8] recently reported the first successful case of DSAEK in a 19-year-old male with CHED. To date, no successful reports of DSAEK as treatment for CHED in the pediatric age group have been published. In this paper, we report our successful technique and results in performing DSAEK for each eye of an eight-yearold child with CHED.

In this column, Kimmelin Hull, community manager ofScience & Sensibility, Lamaze International’s research blog, reprints and discusses a recent blog post series by acclaimed writer, lecturer, doula, and normal birth advocate Penny Simkin. Examined here is the fruitful dialog that ensued—including testimonies from blog readers about their own experiences with traumatic birth and subsequent posttraumatic stress disorder. Hull further highlights the impact traumatic birth has not only on the birthing woman but also on the labor team—including doulas and childbirth educators—and the implied need for debriefing processes for birth workers. Succinct tools for assessing a laboring woman’s experience of pain versus suffering are offered by Simkin, along with Hull’s added suggestions for application during the labor and birth process.

Though birth injury is common, neonatal perineal injuries are rare. They may be associated with high morbidity and mortality if not identified and adequately managed. Few reports of neonatal perineal birth injuries are found in literature. No neonate with this condition to our knowledge has been reported following caesarean section in our setting. We report our experience of a neonate with severe anterior perineal laceration managed in our centre with good outcome.

Women who have traumatic birth experiences, and even those who merely perceive their experiences as traumatic, may be at risk for PTSD. This article explains the condition and the role nurses can play in identifying patients at risk.

Objective it is widely acknowledged that caring can cause emotional suffering in health-care professionals. The concepts of compassion fatigue, post-traumatic stress disorder and secondary traumatic stress are used to describe the potential consequences of caring for people who are or have experienced trauma. Empathy between the professional and patient or client is a key feature in the development of secondary traumatic stress. The aim of this paper is to contribute to the conceptual development of theory about dynamics in the midwife–woman relationship in the context of traumatic birth events, and to stimulate debate and research into the potential for traumatic stress in midwives who provide care in and through relationships with women. Method the relevant literature addressing secondary traumatic stress in health-care professionals was reviewed. Findings it is argued that the high degree of empathic identification which characterises the midwife–woman relationship in midwifery practice places midwives at risk of experiencing secondary traumatic stress when caring for women experiencing traumatic birth. It is suggested that this has harmful consequences for midwives' own mental health and for their capacity to provide care in their relationships with women, threatening the distinct nature of midwifery care. Conclusions opportunities for research to establish the existence of this phenomenon, and the potential implications for midwifery practice are identified.

There is increasing pressure to improve maternity services and provide postnatal services for women who have a difficult birth experience. However, there is little information about services currently offered. This survey aimed to establish the type and availability of postnatal services in the UK for women who have a difficult or traumatic birth. A telephone survey was carried out of a quarter of UK hospitals randomly chosen from the Department of Health listing. Seventy-one hospitals took part (76% of eligible hospitals). Results showed that 94% (CI 86% to 98%) of hospitals provide postnatal services for women who have difficult births. Most of these are debriefing services (78%: CI 67% to 86%) that were implemented in response to need; only 5% (CI 2% to 13%) were reportedly started on the basis of research evidence. Results are discussed in relation to the relative lack of awareness that such services exist and the controversy over the use of debriefing after trauma.

J Obstet Gynaecol Can 2013;35(9):864 L month, we described the traumatic birth of Asclepius, the Greek god of medicine. This month’s picture is very different, a refined portrait rather than a crude woodcut, but it does contain a visual reference to one of Asclepius’ medical daughters: the goddess Hygeia. Her spirit is personified in the maid, pouring (hopefully warm) water behind the parturient woman, the illuminated focus of this intense painting.

Objective To compare the indications for elective lower segment caesarean section (ElLSCS) in a tertiary centre (TC) and a district general hospital (DGH) over six months. To determine the proportion of women having ElLSCS with previous traumatic birth experiences. Design A retrospective study comparing the number of women choosing ElLSCS in a TC and a DGH after previous traumatic birth. Traumatic birth was defined as: previous early neonatal death/stillbirth, previous complicated vaginal delivery 3 rd /4 th degree tear, instrumental delivery, shoulder dystocia. Methods ElLSCS indications were retrieved from both hospitals9 ElLSCS diaries (May–October 2011), and compared. In the TC, documented indications for traumatic births were compared to annual rates. Data on annual DGH rates was not available. Results 669 deliveries were recorded (TC=463, DGH=206). 42% of all ElLSCS in the TC and 50% in the DGH were for “Previous CS”. 14% of ElLSCS in the TC, and 8% in the DGH were for ‘traumatic birth’. The TC (10%) had five times more CS for maternal request than the DGH (2%). In the TC: 79%(23/29 women) of women chose ElLSCS after a neonatal death/stillbirth, 16% (18/115 women) after a 3 rd /4 th degree tear, 2% (11/562 women) after an instrumental delivery, 10% (3/30 women) after a shoulder dystocia. Conclusions The data suggests the poorer the obstetric outcome, the more likely women are to choose future ElLSCS. The best mode of delivery is that chosen by women who have been offered counselling after a traumatic birth to assist them in making an informed decision.

Background A proportion of women requesting Caesarean section (CS) do so due to a previous traumatic birth experience with the expectation that a CS will improve their next birth experience. Obstetricians involved the care of these women have little evidence as to whether a CS does in fact improve women9s satisfaction and it is a controversial indication. This qualitative study provides information about why these women request CS, whether they are satisfied and thus may help inform obstetric management. Methods Nine women who requested CS following a traumatic birth and 10 obstetricians were interviewed. The women were asked about their previous birth experience, their satisfaction with CS, and what factors could have influenced their decision. Obstetricians were asked about maternal request for CS following traumatic birth and their management of these women. Analysis Framework approach, key themes identified. Results Key themes Women: reasons why their birth was traumatic (loss of control, pain, poor communication); suggestions as to how the birth experience could be improved, (debriefing consistently suggested); overall women were satisfied with their decision. Obstetricians : previous traumatic birth perceived as a valid indication for CS, sub themes were what was considered traumatic and whether it improved satisfaction; conviction that if the initial birth experience was improved this would reduce such CS requests (debriefing consistently suggested). Conclusion Women were satisfied with planned CS following a previous traumatic birth but both groups interviewed were keen to prevent the initial traumatic birth with debriefing being a consistent key theme.

Sternoclavicular (SC) dislocation is an injury that is very rare in the newborn. Thus far there have been no reports describing this in neonates after a traumatic birth injury. This condition can be difficult to differentiate from epiphyseal separation, which occurs more often in older children. For successful treatment, early diagnosis is essential. Timely surgical reposition and fixation with following immobilization is recommended in instances of complete (SC) dislocation. We report a trauma-induced case of SC dislocation in a neonate successfully managed by polydioxanon cord fixation.