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      Two are better than one? The impact of lay birth companions on childbirth experiences and PTSD

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          Abstract

          Although continuous support during childbirth is recommended by the World Health Organization (WHO) and has well-established benefits, the practice is still not routinely implemented in all maternity settings. We studied the possible effect of an additional lay companion (other than the partner) on childbirth experience and postpartum post-traumatic stress disorder (PTSD). Two hundred and forty-six women, who gave birth in maternity wards of a large tertiary health center in Israel, responded to questionnaires in person at 1–4 days (Demographic questions and the childbirth experience questionnaire) and on-line at 8–10 weeks postpartum (City Birth Trauma Scale). Obstetric data were taken from the medical files. Women who were accompanied by their partners and an additional companion were lower in birth-related PTSD symptoms (M = 1.17, SD = 2.61) than women accompanied by only their partner (M = 1.53, SD = 2.79) (F(2, 240) = 4.0, p < 0.05). Women who had a single companion (M = 1.44, SD = 2.61) showed more birth-related PTSD symptoms than women who had two or more companions (M = 1.17, SD = 2.52) (F(1, 241) = 6.4, p < 0.05). In addition, women who had a single companion were higher in general PTSD symptoms (M = 3.91, SD = 4.73) than women who had two or more companions (M = 2.31, SD = 4.29) (F(1, 241) = 4.2, p < 0.05). No differences were found in childbirth experiences of women with single or multiple companions. Allowing more than one lay companion (other than the partner) may be a simple cost-effective way of providing beneficial support in all birth settings, promoting respectful maternity care and reducing childbirth-related PTSD levels and by that future psychopathology sequela.

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          The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework.

          There is evidence that 3.17% of women report post-traumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its aetiology. Systematic searches were carried out on PsycINFO, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least 1 month after birth. In all, 50 studies (n = 21 429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (r = 0.51), fear of childbirth (r = 0.41), poor health or complications in pregnancy (r = 0.38), and a history of PTSD (r = 0.39) and counselling for pregnancy or birth (r = 0.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (r = 0.59), having an operative birth (assisted vaginal or caesarean, r = 0.48), lack of support (r = -0.38) and dissociation (r = 0.32). After birth, PTSD was associated with poor coping and stress (r = 0.30), and was highly co-morbid with depression (r = 0.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the aetiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care.
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            What matters to women during childbirth: A systematic qualitative review

            Introduction Design and provision of good quality maternity care should incorporate what matters to childbearing women. This qualitative systematic review was undertaken to inform WHO intrapartum guidelines. Methods Using a pre-determined search strategy, we searched Medline, CINAHL, PsycINFO, AMED, EMBASE, LILACS, AJOL, and reference lists of eligible studies published 1996-August 2016 (updated to January 2018), reporting qualitative data on womens’ childbirth beliefs, expectations, and values. Studies including specific interventions or health conditions were excluded. PRISMA guidelines were followed. Data collection and analysis Authors’ findings were extracted, logged on a study-specific data form, and synthesised using meta-ethnographic techniques. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting themes was assessed using GRADE-CERQual. A line of argument synthesis was developed. Results 35 studies (19 countries) were included in the primary search, and 2 in the update. Confidence in most results was moderate to high. What mattered to most women was a positive experience that fulfilled or exceeded their prior personal and socio-cultural beliefs and expectations. This included giving birth to a healthy baby in a clinically and psychologically safe environment with practical and emotional support from birth companions, and competent, reassuring, kind clinical staff. Most wanted a physiological labour and birth, while acknowledging that birth can be unpredictable and frightening, and that they may need to ‘go with the flow’. If intervention was needed or wanted, women wanted to retain a sense of personal achievement and control through active decision-making. These values and expectations were mediated through womens’ embodied (physical and psychosocial) experience of pregnancy and birth; local familial and sociocultural norms; and encounters with local maternity services and staff. Conclusions Most healthy childbearing women want a positive birth experience. Safety and psychosocial wellbeing are equally valued. Maternity care should be designed to fulfil or exceed womens’ personal and socio-cultural beliefs and expectations.
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              Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review

              Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal period (from conception until one year postpartum) on child outcomes has not been systematically examined.
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                Author and article information

                Contributors
                jhandelzalts@gmail.com
                Journal
                Arch Womens Ment Health
                Arch Womens Ment Health
                Archives of Women's Mental Health
                Springer Vienna (Vienna )
                1434-1816
                1435-1102
                13 June 2022
                : 1-9
                Affiliations
                [1 ]GRID grid.430432.2, ISNI 0000 0004 0604 7651, School of Behavioral Sciences, , Academic College of Tel-Aviv-Yafo, ; 68114 Tel-Aviv, Israel
                [2 ]GRID grid.214458.e, ISNI 0000000086837370, Department of Psychiatry, , University of Michigan, ; Ann Arbor, MI USA
                [3 ]GRID grid.28577.3f, ISNI 0000 0004 1936 8497, Centre for Maternal and Child Health Research, School of Health Sciences, , City, University of London, ; London, UK
                [4 ]GRID grid.413156.4, ISNI 0000 0004 0575 344X, The Helen Schneider Hospital for Women, , Rabin Medical Center, ; Petach-Tikva, Israel
                [5 ]GRID grid.12136.37, ISNI 0000 0004 1937 0546, Sackler Faculty of Medicine, , Tel-Aviv University, ; Tel-Aviv, Israel
                Author information
                http://orcid.org/0000-0002-9045-6057
                Article
                1243
                10.1007/s00737-022-01243-7
                9191546
                35697941
                14e3e33b-7473-405e-ab37-a53ce1775582
                © The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature 2022

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 6 April 2022
                : 5 June 2022
                Categories
                Original Article

                Clinical Psychology & Psychiatry
                lay companion,childbirth,postpartum, ptsd,birth experience
                Clinical Psychology & Psychiatry
                lay companion, childbirth, postpartum, ptsd, birth experience

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