Postpartum psychological distress after emergency team response during childbirth

Abstract

Purpose: To evaluate the feasibility and acceptability of a protocol determining the relationship between emergency team response (ETR) during childbirth and acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) symptoms.

Methods: In a prospective, observational, cohort design, women experiencing ETR during childbirth were approached and recruited on postpartum day-1 and followed for six weeks. Demographics, obstetric and birth characteristics, ASD scores and PTSD scores (by Impact of Events Scale, IES and PCL-civilian) were recorded. Recruitment and retention rates were recorded, and scores were compared to women who did not experience ETR.

Results: Three hundred sixty-nine were approached and 249 were enrolled (67.5% recruitment rate). One hundred twenty-five completed all procedures (50.2% retention). Twenty experienced ETR (3.5% event rate), 12 enrolled (60.0% recruitment rate) and 8 completed the study (66.7% retention). The ETR group had higher PCL and IES scores (PCL: ETR median 12, non-ETR median 2, p = .08; IES: ETR median 22.5, non-ETR median 20, p = .08). ASD scores were similar between groups.

Conclusions: Methodology investigating the link between ETR and postpartum psychological distress is feasible and acceptable. A relationship between ETR and PTSD symptoms appears to exist, with ETR being associated with higher PTSD scores compared to non-ETR childbirths. Methods that incorporate awareness of the unique concerns of vulnerable populations are needed.

KEYWORDS:

• Postpartum
• PTSD
• ASD
• trauma
• morbidity
• obstetric

Disclosure statement

No potential conflict of interest was reported by the authors.

Current knowledge on the subject

• Post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) can occur after perceived traumatic childbirth

• Risk factors include subjective distress during labor, emergency cesarean deliveries, instrumental vaginal deliveries, infant complications, lack of social support during labor and delivery, psychological difficulties in pregnancy, and previous traumatic experiences

• An emergency team response (ETR), the rapid assembly of a multidisciplinary team in response to an emergency can improve patient safety and reduce errors

What this study adds

• Research investigating the effect of ETR on postpartum PTSD and ASD is feasible, but methods that emphasize sensitivity to vulnerable populations are necessary

• Preliminary data suggests that there is a relationship between ETR and PTSD

• Identifying risk factors for postpartum PTSD is necessary so that risk-mitigating strategies can be pursued

Additional information

Funding

The project described was supported by the National Institutes of Health through Grant Numbers UL1TR001857 and K12HD043441.