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

Abstract

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.

Keywords

psychological mental well-being parent trauma childbirth post-traumatic stress disorder meta-analysis

Get full access to this article

View all access options for this article.

References

Abdollahpour

Keramat

Mousavi

S. A.

Khosravi

Motaghi

(2018). The effect of debriefing and brief cognitive-behavioral therapy on postpartum depression in traumatic childbirth: A randomized clinical trial. Journal of Midwifery & Reproductive Health, 6(1), 1122–1131. https://doi.org/10.22038/jmrh.2017.10000

Agius

Xuereb

R. B.

Carrick-Sen

Sultana

Rankin

(2016). The co-existence of depression, anxiety and post-traumatic stress symptoms in the perinatal period: A systematic review. Midwifery, 36, 70–79. https://doi.org/10.1016/j.midw.2016.02.013

Alcorn

K. L.

O’Donovan

Patrick

J. C.

Creedy

Devilly

G. J.

(2010). A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychological Medicine, 40(11), 1849–1859. https://doi.org/10.1017/S0033291709992224

Asadzadeh

Jafari

Kharaghani

Taremian

(2020). Effectiveness of midwife-led brief counseling intervention on post-traumatic stress disorder, depression, and anxiety symptoms of women experiencing a traumatic childbirth: a randomized controlled trial. BMC Pregnancy and Childbirth, 20(1), 142. https://doi.org/10.1186/s12884-020-2826-1

Ayers

Claypool

Eagle

(2006). What happens after a difficult birth? Postnatal debriefing services. British Journal of Midwifery, 14(3), 157–161. https://doi.org/10.12968/bjom.2006.14.3.20577

Baer

R. A.

(2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology (New York, N.Y.), 10(2), 125–143. https://doi.org/10.1093/clipsy.bpg015

Bastos

M. H.

Furuta

Small

McKenzie-McHarg

Bick

(2015). Debriefing interventions for the prevention of psychological trauma in women following childbirth. [The Cochrane Database of Systematic Reviews Electronic Resource], (4), Cd007194. https://doi.org/10.1002/14651858.CD007194.pub2

Bauer

Parsonage

Knapp

Iemmi

Adelaja

(2014). Costs of perinatal mental health problems. London School of Economics and Political Science.

Bavelier

Green

C. S.

(2003). Action video game modifies visual selective attention. Nature, 423(6939), 534–537. https://doi.org/10.1038/nature01647

10.

Beck

C. T.

(2016). Posttraumatic stress disorder after birth:Aa metaphor analysis. MCN, the American journal of maternal child nursing, 41(2), 76–83. https://doi.org/10.1097/NMC.0000000000000211

11.

Blasio

P. D.

Ionio

Confalonieri

(2009). Symptoms of postpartum PTSD and expressive writing: A prospective study. Journal of Prenatal & Perinatal Psychology & Health, 24(1), 49.

12.

Blom

E. A.

Jansen

P. W.

Verhulst

F. C.

Hofman

Raat

Jaddoe

V. W. V.

Coolman

Steegers

E. A. P.

Tiemeier

(2010). Perinatal complications increase the risk of postpartum depression. The generation R study: Perinatal risk factors of postpartum depression. BJOG : an International Journal of Obstetrics and Gynaecology, 117(11), 1390–1398. https://doi.org/10.1111/j.1471-0528.2010.02660.x

13.

Borg Cunen

McNeill

Murray

(2014). A systematic review of midwife-led interventions to address post partum post-traumatic stress. Midwifery, 30(2), 170–184. https://doi.org/10.1016/j.midw.2013.09.003

14.

Bryant

R. A.

(2007). Early intervention for post‐traumatic stress disorder. Early Intervention in Psychiatry, 1(1), 19–26. https://doi.org/10.1111/j.1751-7893.2007.00006.x

15.

Buckman

J. E. J.

Underwood

Clarke

Saunders

Hollon

S. D.

Fearon

Pilling

(2018). Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis. Clinical Psychology Review, 64, 13–38. https://doi.org/https://doi.org/10.1016/j.cpr.2018.07.005

16.

Cava-Tadik

Brown

G. L.

Mangelsdorf

S. C.

(2020). Fathers’ satisfaction with physical affection before and after the birth of a new baby: Cross-parent effects and associations with family dynamics. Journal of Family Issues, 41(4), 415–436. https://doi.org/10.1177/0192513X19875779

17.

de Bruijn

Stramrood

C. A.

Lambregtse-van den Berg

M. P.

Rius Ottenheim

(2020). Treatment of posttraumatic stress disorder following childbirth. Journal of Psychosomatic Obstetrics and Gynaecology, 41(1), 5–14. https://doi.org/10.1080/0167482x.2019.1593961

18.

de Graaff

L. F.

Honig

van Pampus

M. G.

Stramrood

C. A. I.

(2018). Preventing post-traumatic stress disorder following childbirth and traumatic birth experiences: A systematic review. Acta Obstetricia et Gynecologica Scandinavica, 97(6), 648–656. https://doi.org/10.1111/aogs.13291

19.

Dennis

C.-L.

(2010). Postpartum depression peer support: Maternal perceptions from a randomized controlled trial. Int J Nurs Stud, 47(5), 560–568. https://doi.org/https://doi.org/10.1016/j.ijnurstu.2009.10.015

20.

DEVOTION CA18211 . (2020). Birth trauma Research is a necessity. DEVOTION CA18211. https://www.ca18211.eu/why-this-research/ (accessed 22 February 2021).

21.

Dikmen-Yildiz

Ayers

Phillips

(2017). Depression, anxiety, PTSD and comorbidity in perinatal women in Turkey: A longitudinal population-based study. Midwifery, 55, 29–37. https://doi.org/10.1016/j.midw.2017.09.001

22.

Dikmen-Yildiz

Ayers

Phillips

(2018). Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors. J Affect Disord, 229, 377–385. https://doi.org/10.1016/j.jad.2017.12.074

23.

D’Souza

Waldie

K. E.

Waldie

K. E.

Peterson

E. R.

Peterson

E. R.

Underwood

Morton

S. M. B.

Morton

S. M. B.

(2019). Antenatal and postnatal determinants of behavioural difficulties in early childhood: Evidence from growing up in New Zealand. Child Psychiatry and Human Development, 50(1), 45–60. https://doi.org/10.1007/s10578-018-0816-6

24.

Eccleston

Fisher

Law

Bartlett

Palermo

T. M.

(2015). Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews. Advance online publication. https://doi.org/10.1002/14651858.CD009660.pub3

25.

Egger

Smith

G. D.

(1997). Meta-analysis: Potentials and promise. Bmj: British Medical Journal, 315(7119), 1371. https://doi.org/10.1136/bmj.315.7119.1371

26.

Eide

K. T.

Morken

N.-H.

Bærøe

(2019). Maternal reasons for requesting planned cesarean section in Norway: a qualitative study. BMC Pregnancy and Childbirth, 19(1), 102. https://doi.org/10.1186/s12884-019-2250-6

27.

Fairbrother

Thordarson

D. S.

Stoll

(2018). Fine tuning fear of childbirth: the relationship between childbirth fear questionnaire subscales and demographic and reproductive variables. Journal of Reproductive and Infant Psychology, 36(1), 15–29. https://doi.org/10.1080/02646838.2017.1396300

28.

Furuta

Horsch

E. S. W.

Bick

Spain

Sin

(2018). Effectiveness of trauma-focused psychological therapies for treating post-traumatic stress disorder symptoms in women following childbirth: A systematic review and meta-analysis. Front Psychiatry, 9, 591. https://doi.org/10.3389/fpsyt.2018.00591

29.

Furuta

Sandall

Bick

(2012). A systematic review of the relationship between severe maternal morbidity and post-traumatic stress disorder. BMC Pregnancy and Childbirth, 12, 125. https://doi.org/10.1186/1471-2393-12-125

30.

Gamble

J. A.

Creedy

D. K.

Webster

Moyle

(2002). A review of the literature on debriefing or non-directive counselling to prevent postpartum emotional distress. Midwifery, 18(1), 72–79. https://doi.org/10.1054/midw.2001.0287

31.

Giallo

Bahreinian

Brown

Cooklin

Kingston

Kozyrskyj

(2015). Maternal depressive symptoms across early childhood and asthma in school children: findings from a Longitudinal Australian Population Based Study. Plos One, 10(3), e0121459. https://doi.org/10.1371/journal.pone.0121459

32.

Glasheen

Richardson

G. A.

Richardson

G. A.

Fabio

(2010). A systematic review of the effects of postnatal maternal anxiety on children. Archives of Women's Mental Health, 13(1), 61–74. https://doi.org/10.1007/s00737-009-0109-y

33.

GRADEpro . (2015). GRADEpro. https://gradepro.org

34.

Grekin

O'Hara

M. W.

(2014). Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis. Clinical Psychology Review, 34(5), 389–401. https://doi.org/10.1016/j.cpr.2014.05.003

35.

Higgins

J. P.

Green

(2011). Cochrane handbook for systematic reviews of interventions. John Wiley & Sons.

36.

Hollon

S. D.

(2019). Treatment of Depression Versus Treatment of PTSD. American Journal of Psychiatry, 176(4), 259–261. https://doi.org/10.1176/appi.ajp.2019.19020173

37.

Holmes

E. A.

James

E. L.

Coode-Bate

Deeprose

(2009). Can playing the computer game “Tetris” reduce the build-up of flashbacks for trauma? A proposal from cognitive science. Plos One, 4(1), e4153. https://doi.org/10.1371/journal.pone.0004153

38.

Horsch

Schobinger

Stuijfzand

(2020). Acute and Post-traumatic Stress Disorder Symptoms in Mothers and Fathers Following Childbirth: A Prospective Cohort Study.(Clinical report). Front Psychiatry, 11, 562054. https://doi.org/10.3389/fpsyt.2020.562054

39.

Horsch

Vial

Favrod

Harari

M. M.

Blackwell

S. E.

Watson

Iyadurai

Bonsall

M. B.

Holmes

E. A.

(2017). Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study. Behaviour Research and Therapy, 94, 36–47. https://doi.org/10.1016/j.brat.2017.03.018

40.

Inglis

Sharman

Reed

(2016). Paternal mental health following perceived traumatic childbirth. Midwifery, 41, 125–131. https://doi.org/10.1016/j.midw.2016.08.008

41.

Jungari

Paswan

(2020). Supported motherhood? An examination of the cultural context of male participation in maternal health care among tribal communities in India. Journal of Biosocial Science, 52(3), 452–471. https://doi.org/10.1017/S0021932019000580

42.

Kempler

Sharpe

Miller

C. B.

Bartlett

D. J.

(2016). Do psychosocial sleep interventions improve infant sleep or maternal mood in the postnatal period? A systematic review and meta-analysis of randomised controlled trials. Sleep Medicine Reviews, 29, 15–22. https://doi.org/10.1016/j.smrv.2015.08.002

43.

Kershaw

Jolly

Bhabra

Ford

(2005). Randomised controlled trial of community debriefing following operative delivery. BJOG : an International Journal of Obstetrics and Gynaecology, 112(11), 1504–1509. https://doi.org/10.1111/j.1471-0528.2005.00723.x

44.

Lapp

L. K.

Agbokou

Peretti

C. S.

Ferreri

(2010). Management of post traumatic stress disorder after childbirth: a review. Journal of Psychosomatic Obstetrics and Gynaecology, 31(3), 113–122. https://doi.org/10.3109/0167482x.2010.503330

45.

Leach

L. S.

Poyser

Fairweather‐Schmidt

(2017). Maternal perinatal anxiety: A review of prevalence and correlates. Clinical Psychologist (Australian Psychological Society), 21(1), 4–19. https://doi.org/10.1111/cp.12058

46.

Luo

Wan

Liu

Tong

(2018). Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Statistical Methods in Medical Research, 27(6), 1785–1805. https://doi.org/10.1177/0962280216669183

47.

Meades

Pond

Ayers

Warren

(2011). Postnatal debriefing: Have we thrown the baby out with the bath water? Behaviour Research and Therapy, 49(5), 367–372. https://doi.org/10.1016/j.brat.2011.03.002

48.

Moher

Liberati

Tetzlaff

Altman

D. G.

(2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264–269. https://doi.org/10.1136/bmj.b2535

49.

National Collaborating Centre for Mental Health . (2005). National Institute for health and clinical excellence: Guidance (Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. Gaskell Copyright © 2005, The Royal College of Psychiatrists & The British Psychological Society.

50.

Nieminen

Berg

Frankenstein

Viita

Larsson

Persson

Spånberger

Wretman

Silfvernagel

Andersson

Wijma

(2016). Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth-a randomized controlled trial. Cognitive Behaviour Therapy, 45(4), 287–306. https://doi.org/10.1080/16506073.2016.1169626

51.

Nomaguchi

House

A. N.

(2013). Racial-ethnic disparities in maternal parenting stress: The role of structural disadvantages and parenting values. Journal of Health and Social Behavior, 54(3), 386–404. https://doi.org/10.1177/0022146513498511

52.

Oliveira

A. G. e. S. d.

Reichenheim

M. E.

Moraes

C. L.

Howard

L. M.

Lobato

(2017). Childhood sexual abuse, intimate partner violence during pregnancy, and posttraumatic stress symptoms following childbirth: a path analysis. Archives of Women's Mental Health, 20(2), 297–309. https://doi.org/10.1007/s00737-016-0705-6

53.

Peeler

Chung

M. C.

Stedmon

Skirton

(2013). A review assessing the current treatment strategies for postnatal psychological morbidity with a focus on post-traumatic stress disorder. Midwifery, 29(4), 377–388. https://doi.org/10.1016/j.midw.2012.03.004

54.

Poh

H. L.

Koh

S. S. L.

H. G.

(2014). An integrative review of fathers' experiences during pregnancy and childbirth. Int Nurs Rev, 61(4), 543–554. https://doi.org/10.1111/inr.12137

55.

Pour-Edalati

Moghadam

N. K.

Shahesmaeili

Salehi-Nejad

(2018). Exploring the effect of mindfulness-based stress reduction on childbirth fear among single-child mothers in the city of Kerman, Iran (2017): A clinical trial study. Medical-Surgical Nursing Journal, 7(4), 1–7. https://doi.org/10.5812/msnj.90247

56.

Qian

J. L.

Zhou

X. L.

Sun

X. S.

M. W.

Sun

S. W.

X. Y.

(2020). Effects of expressive writing intervention for women’s PTSD, depression, anxiety and stress related to pregnancy: A meta-analysis of randomized controlled trials. Psychiatry Research, 288, 293. https://doi.org/10.1016/j.psychres.2020.112933

57.

Regier

D. A.

Kuhl

E. A.

Kupfer

D. J.

(2013). The DSM‐5: Classification and criteria changes. World Psychiatry, 12(2), 92–98. https://doi.org/10.1002/wps.20050

58.

Rowan

Bick

Bastos

M. H.

(2007). Postnatal debriefing interventions to prevent maternal mental health problems after birth: exploring the gap between the evidence and UK policy and practice. Worldviews on Evidence-Based Nursing, 4(2), 97–105. https://doi.org/10.1111/j.1741-6787.2007.00088.x

59.

Rubin

(2020). Anxiety Symptoms and self-doubt. Lost Highway Blues. https://janerubinphd.com/anxiety-symptoms-and-self-doubt/ (accessed 26 January 2020).

60.

Ryding

E. L.

Wijma

(1998). Postpartum counselling after an emergency cesarean. Clinical Psychology & Psychotherapy, 5(4), 231–237. https://doi.org/10.1002/(sici)1099-0879(199812)5:4<231::Aid-cpp172>3.0.Co;2-9

61.

Sandstrom

Wiberg

Willman

A. K.

Wikman

Hogberg

(2008). A pilot study of eye movement desensitisation and reprocessing treatment (EMDR) for post-traumatic stress after childbirth. Midwifery, 24(1), 62–73. https://doi.org/10.1016/j.midw.2006.07.008

62.

Sawilowsky

S. S.

(2009). New effect size rules of thumb. Journal of Modern Applied Statistical Methods, 8(2), 597–599. https://doi.org/10.22237/jmasm/1257035100

63.

Sedgwick

(2013). Meta-analyses: heterogeneity and subgroup analysis. BMJ : British Medical Journal, 346, f4040. https://doi.org/10.1136/bmj.f4040

64.

Sheen

Slade

(2015). The efficacy of ‘debriefing’ after childbirth: Is there a case for targeted intervention? J Reprod Infant Psychol, 33(3), 308–320. https://doi.org/10.1080/02646838.2015.1009881

65.

Shi

Luo

Weng

Zeng

X.-T.

Lin

Chu

Tong

(2020). Optimally estimating the sample standard deviation from the five-number summary. Research Synthesis Methods, 11(5), 641–654. https://doi.org/10.1002/jrsm.1429

66.

Shorey

Ang

Goh

E. C. L.

Lopez

(2019). Paternal involvement of Singaporean fathers within six months postpartum: A follow-up qualitative study. Midwifery, 70, 7–14. https://doi.org/10.1016/j.midw.2018.12.003

67.

Shorey

E. D.

(2019). Evaluation of a technology-based peer-support intervention program for preventing postnatal depression (part 2): Qualitative study. Journal of Medical Internet Research, 21(8), e12915. https://doi.org/10.2196/12915

68.

Shorey

Wong

P. Z. E.

(2020). Traumatic childbirth experiences of new parents: A meta-synthesis. Trauma, Violence, & Abuse. Advance online publication. https://doi.org/10.1177/1524838020977161

69.

Shorey

Yang

Y. Y.

Ang

(2018). The impact of negative childbirth experience on future reproductive decisions: A quantitative systematic review. Journal of Advanced Nursing, 74(6), 1236–1244. https://doi.org/10.1111/jan.13534

70.

Slade

Molyneux

D. R.

Watt

D. A.

(2020b). A systematic review of clinical effectiveness of psychological interventions to reduce post traumatic stress symptoms following childbirth and a meta-synthesis of facilitators and barriers to uptake of psychological care. Journal of Affective Disorders. Advance online publication. https://doi.org/10.1016/j.jad.2020.11.092

71.

Slade

West

Thomson

Lane

Spiby

Edwards

R. T.

Charles

J. M.

Garrett

Flanagan

Treadwell

Hayden

Weeks

(2020a). STRAWB2 (stress and wellbeing after childbirth): A randomised controlled trial of targeted self-help materials to prevent post-traumatic stress disorder following childbirth. BJOG : an International Journal of Obstetrics and Gynaecology, 127(7), 886–896. https://doi.org/10.1111/1471-0528.16163

72.

Söderquist

Wijma

(2002). Traumatic stress after childbirth: the role of obstetric variables. Journal of Psychosomatic Obstetrics and Gynaecology, 23(1), 31–39. https://doi.org/10.3109/01674820209093413

73.

Söderquist

Wijma

(2006). The longitudinal course of post-traumatic stress after childbirth. Journal of Psychosomatic Obstetrics and Gynaecology, 27(2), 113–119. https://doi.org/10.1080/01674820600712172

74.

Sterne

J. A.

Sutton

A. J.

Ioannidis

J. P.

Terrin

Jones

D. R.

Lau

Carpenter

Rücker

Harbord

R. M.

Schmid

C. H.

(2011). Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. Bmj: British Medical Journal, 343, d4002. https://doi.org/10.1136/bmj.d4002

75.

Storksen

H. T.

Eberhard-Gran

Garthus-Niegel

Eskild

(2012). Fear of childbirth; the relation to anxiety and depression. Acta Obstetricia et Gynecologica Scandinavica, 91(2), 237–242. https://doi.org/10.1111/j.1600-0412.2011.01323.x

76.

Stramrood

C. A. I.

van der Velde

Doornbos

Marieke Paarlberg

Weijmar Schultz

W. C. M.

van Pampus

M. G.

(2012). The patient observer: Eye-movement desensitization and reprocessing for the treatment of posttraumatic stress following childbirth. Birth, 39(1), 70–76. https://doi.org/10.1111/j.1523-536X.2011.00517.x

77.

Teaford

McNiesh

Goyal

(2018). New mothers’ experiences with online postpartum forums. MCN, the American journal of maternal child nursing, 44(1), 40–45. https://doi.org/10.1097/NMC.0000000000000489

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.34 MB

0.28 MB