Academic journal article European Journal of Psychotraumatology

The OptiMUM-Study: EMDR Therapy in Pregnant Women with Posttraumatic Stress Disorder after Previous Childbirth and Pregnant Women with Fear of Childbirth: Design of a Multicentre Randomized Controlled Trial

Academic journal article European Journal of Psychotraumatology

The OptiMUM-Study: EMDR Therapy in Pregnant Women with Posttraumatic Stress Disorder after Previous Childbirth and Pregnant Women with Fear of Childbirth: Design of a Multicentre Randomized Controlled Trial

Article excerpt

1.Posttraumatic stress disorder after childbirth, and fear of childbirth

Although pregnancy and childbirth are supposed to be joyful times, 25% of pregnant women report having psychological problems (Vesga-López et al., 2008). Research indicates that up to 43% of women experience childbirth as traumatic (Alcorn, O'Donovan, Patrick, Creedy, & Devilly, 2010), and it is estimated that 3% of women will develop posttraumatic stress disorder (PTSD) following childbirth (Grekin & O'Hara, 2014). The main symptoms of PTSD, according to DSM-5, are re-experiencing, avoidance and numbing, negative cognitions and mood, and hyperarousal. These symptoms last more than one month and result in significant dysfunction (American Psychiatric Association, 2013). By definition, PTSD after previous childbirth refers to PTSD with childbirth itself being the index trauma. The distinction with non-childbirth related PTSD that is ongoing or retriggered in the postpartum period is not always made correctly (Grekin & O'Hara, 2014). PTSD following other traumatic events is beyond the scope of this study; however, a history of trauma or psychiatric disorders such as PTSD are risk factors for childbirth-related PTSD. Childbirth-related PTSD can occur in the absence of medical complications, but prevalence has been found to be higher among women with complicated pregnancies (Ayers, Bond, Bertullies, & Wijma, 2016). For example, it appears that 14% of women with preterm birth due to preeclampsia or premature preterm rupture of membranes develop PTSD (Stramrood et al., 2011). Posttraumatic stress symptoms after childbirth are not always self-limiting, leading to a chronic disorder (Söderquist, Wijma, & Wijma, 2006). Because the prospect of giving birth may trigger both memories of a previous distressing delivery as well as traumatic events such as sexual violence or previous medical trauma, pregnancy can be accompanied by severe childbirth-related anxiety and a disproportional fear of the upcoming delivery. In addition, avoidance symptoms of PTSD often manifest themselves as avoiding future pregnancy, avoiding prenatal care in a subsequent pregnancy, or demanding an elective caesarean section (Fuglenes, Aas, Botten, Øian, & Kristiansen, 2011; Gottvall & Waldenström, 2002). Moreover, (psychotraumatic) stress during pregnancy appears to be related to negative outcomes for the mother and the foetus (Alder, Fink, Bitzer, Hösli, & Holzgreve, 2007; Seng, Low, Sperlich, Ronis, & Liberzon, 2011; Seng et al., 2001), such as preterm birth (Shaw et al., 2014; Yonkers et al., 2014).

Women who are pregnant for the first time may also experience anxiety symptoms during pregnancy. Overall, about 7.5% of pregnant women experience a pathological fear of childbirth (FoC) (Adams, Eberhard-Gran, & Eskild, 2012; Söderquist, Wijma, Thorbert, & Wijma, 2009). FoC has been found in both nulliparous women who have not experienced childbirth before (primary FoC), as well as in multiparous women (women with a previous birth, whether one or more) in whom a negative or traumatic previous childbirth experience often plays a role (secondary FoC) (Hofberg & Ward, 2003; Størksen, GarthusNiegel, Vangen, & Eberhard-Gran, 2013). Therefore, it is to be expected that (subclinical) PTSD is accompanied by FoC. FoC appears to be more common in nulliparous women compared to multiparous women (Rouhe, Salmela-Aro, Halmesmäki, & Saisto, 2009). Several studies found that the concept of FoC is multifaceted, including - but not limited to - fear of pain, the baby dying or being handicapped, loneliness, lack of support, or being concerned, or embarrassed about, one's own appearance while giving birth (GarthusNiegel, Størksen, Torgersen, Von Soest, & EberhardGran, 2011; Huizink, Mulder, Robies De Medina, Visser, & Buitelaar, 2004). Women with FoC may attempt to avoid pregnancy or even decide to terminate the pregnancy, or request (and receive) a caesarean section (Rai'sanen et al. …

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