Choices made by women in pregnancy, birth and the early postnatal period, after a previous traumatic birth

Greenfield, Anne-Mari

Health studies
March 2017

Thesis or dissertation

© 2017 Anne-Mari Greenfield. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

[From the introduction]:
Experiencing childbirth as a traumatic event is a factor that has been highlighted as contributing to poorer psychological outcomes. Up to 30% of women in the UK experience childbirth as a traumatic event, with many consequently going on to experience some form of anxiety, depression, or post-traumatic stress disorder (PTSD) following childbirth (Slade, 2006; Ayers, 2014). When childbirth presents as a traumatic experience it can impose a profound effect on the lives of mothers, fathers (Nicholls & Ayers, 2007), their children (Allen, 1998) and family and friends (Beck, 2004a; Ayers, Eagle & Waring, 2006). If left untreated the effects can last many years (Forssen, 2012). Consequences of traumatic birth include enduring mental health problems (Forssen, 2012; Beck, 2004a), compromised maternal infant relationships (Nicholls & Ayers, 2007), poorer quality marital relationships (Ayers, Eagle & Waring, 2006) concomitant depression in partners (Nicholls & Ayers, 2007) and can present a challenge to future reproductive decisions (Fenech & Thomson, 2014). This is therefore an important area to research, in order to alleviate some of these difficulties.

The causes of traumatic birth are complex and multi-faceted (Simpson & Catling, 2016). Predisposing factors include pre-existing psychological issues (Grekin & O’Hara, 2014) or prior traumatic experiences, such as rape and sexual abuse (Ford & Ayers, 2011). Other risk factors include obstetric emergencies and neonatal complications (Grekin & O’Hara, 2014). Poor care during labour can compound these experiences, or be traumatic in its own right (Ford & Ayers, 2011; Elmir, Schmied, Wilkes & Jackson, 2010; Beck, 2004a). Attachment styles and relationships with partners can influence the likelihood of developing psychological disorders following a traumatic birth, and may influence whether a birth is experienced as traumatic too (Iles, Slade & Spiby, 2011).

Women who have experienced a traumatic birth are less likely to have a subsequent pregnancy (Fenech & Thomson, 2014; Gottvall & Waldenstrom, 2002). If these women do become pregnant, they are more likely to request a non-medically indicated caesarean section (Kottmel, Hoesli, Traub, Urech, Huang, Leeners & Tschudin, 2012; Gamble & Creedy, 2001). What is less well known is what other choices women make about pregnancy and birth following a previous traumatic birth.

Department of Health Studies, The University of Hull
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