Study Results
Results pending
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Basic Information
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Recruitment Status
COMPLETED
Clinical Phase
NA
Total Enrollment
30 participants
Study Classification
INTERVENTIONAL
Study Start Date
2018-11-10
Study Completion Date
2022-10-31
Brief Summary
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The study is a part of a PhD thesis. The study aims to develop a specific midwifery intervention consisting of two components; women writing about the birth experience and reviewing their experience with a known midwife. Women´s birth experience has received research attention worldwide, showing a prevalence of negative birth experience ranging from 5-34%. Considerable knowledge of predictors and impacts of negative birth experience exists, but less is known about effective interventions although women report that reviewing birth experiences is beneficial. Six to eight midwives, providing antenatal care at the high-risk maternity clinic at Landspitali University Hospital, provide the intervention after completing a special training program. Thirty women who had their antenatal care provided at the clinic, after 28 weeks of pregnancy, will be invited to write about their birth experience and review it with the midwife who provided their antenatal care, four to six weeks after birth. The study is based on a mixed method design where quantitative and qualitative data will be collected. Data including traumatic symptoms, birth outcomes, birth experience and experience of the intervention, will be collected from women before the intervention and then six weeks later. The participating midwives´ diaries and focus group interviews will be used to explore their experience of providing the intervention. Descriptive and thematic analysis will be used.
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Detailed Description
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The purpose of the study is to develop and explore the feasibility and acceptability of an intervention, involving writing about and reviewing birth experience with a known midwife from antenatal care.
Studies in developed countries indicate that between 5-16.5% of women perceive their births to be negative. The perception of birth experience seems to be consistent over time, suggesting that time alone does not have a healing effect. Adverse consequences of negative birth experience can be profound and have an impact on different aspects of woman´s life. Among well-known consequences are development of fear of childbirth, a tendency to delay pregnancy and longer interval between children, an increase in request for elective caesarean section without health indications and mental health problems like depression, anxiety and post-traumatic stress disorder (PTSD). Around 1-6% of women develop PTSD in response to pregnancy, birth and post-partum events. Negative birth experience may have long-term and negative consequences on the women´s self-identity and relationships with their infants and partners. This is of concern as there is a growing body of literature showing negative consequences of maternal mental distress on the mother-infant bonding and attachment process, and relationships with partner. Improvement in bonding could take as long as one to five years - which needs attention because a delay in bonding can have detrimental effects on the child's long-term development.
Risk factors for a negative birth experience are multifaceted and associations have been found between negative birth experience and instrumental or caesarean births, intrapartum complications, maternal complications or hospitalisation in pregnancy and prolonged labour. Furthermore, fear of childbirth, negative thoughts about the upcoming birth, prior negative birth experience, feelings of not being in control, and powerlessness during birth have been associated with negative birth experiences as well as history of mental health problems. Furthermore, perceived lack of professional support during pregnancy or birth has been associated with negative experience of birth.
Evidence for useful methods to assist women with negative childbirth experience is limited. Interventions aimed to assist women with negative birth experience have been explored but the effectiveness remains inconsistent, with five comparative studies showing improvements on psychological measures while six of them did not. In recent studies a method of writing about the experience was explored with promising results, where one of them showed a reduction in depressive and traumatic symptoms and the other one showed emotional benefits like clarifying thoughts and feelings of empowerment.
It is worth considering that in many of the above comparative studies, the need to review the birth experience was based on the view of health professionals. Also, the interviews were limited to women who experienced an operative birth or unexpected events during birth but none of these were effective in psychological improvements. Likewise, the time between the negative birth experience until the intervention was provided ranged from the first week after birth up to seven years after birth. Similarly, the structure, content and quantity of interview interventions varied. Each study´s design and outcome measures used, varied significantly making it difficult to determine which components of the interventions women considered most effective. Despite failure in these studies to show significant changes in psychological measures, women reported that it was helpful to participate in the intervention.
The results from authors´ recent study in Iceland provide important insights into women´s views about the process of reviewing negative birth experience and reconciling difficult emotions, at a special midwifery clinic Ljáðu mér eyra (LME) at Landspítali. The women prefer their negative birth experiences to be detected by professionals and consequently have opportunity to review their birth experience in a tailored conversation on their terms. Many of them revealed preferences of talking to a known midwife who had provided care during pregnancy or birth, suggesting a request for some form of continuity of care. Reviewing the birth experience provided an opportunity for many women to relieve the burden of difficult emotions, enhance well-being and gain strength to move on with their lives.
The ideological background of the study is affected by the international ideology of midwifery and models of care. According to the International Confederation of midwives' philosophy and model of midwifery care (2014), birth is not only … a normal and physiological process… but also … a profound experience, which carries significant meaning to the woman and her family. Midwifery care combines art and science and is holistic in nature, grounded in an understanding of the social, emotional, cultural, spiritual, psychological experiences of women and based upon the best available evidence. Furthermore, in International Confederation of midwives' code of ethics (2014) is stated that midwives should … respond to the psychological, physical, emotional and spiritual needs of women…,requiring midwives to react to women´s needs following childbirth from a holistic perspective. This philosophy of care is extended in Renfrew´s et. al. framework for childbirth care and a midwifery model of woman-centred childbirth care, developed in Swedish and Icelandic settings. Good quality midwifery care includes continuity of care, information, communication and understanding of women's needs. According to the above, interventions need to be tailored to women's circumstances and needs and provided in partnership with them.
Thirty women who had their antenatal care provided at the clinic, after 28 weeks of pregnancy, will be invited to write about their birth experience and review it with the midwife who provided their antenatal care, four to six weeks after birth. Six to eight midwives will provide the intervention after completing a 12-hour training program. The study is based on a mixed method design where quantitative and qualitative data will be collected. Data including traumatic symptoms, traumatic life events, birth outcomes and birth experience will be collected from women before the intervention. Four to six weeks after the intervention, data about birth experience, traumatic symptoms and experience of the intervention will be collected. The participating midwives´ diaries and focus group interviews will be used to explore their experience of providing the intervention. Descriptive and thematic analysis will be used.
Studies in developed countries indicate that between 5-16.5% of women perceive their births to be negative. The perception of birth experience seems to be consistent over time, suggesting that time alone does not have a healing effect. Adverse consequences of negative birth experience can be profound and have an impact on different aspects of woman´s life. Among well-known consequences are development of fear of childbirth, a tendency to delay pregnancy and longer interval between children, an increase in request for elective caesarean section without health indications and mental health problems like depression, anxiety and post-traumatic stress disorder (PTSD). Around 1-6% of women develop PTSD in response to pregnancy, birth and post-partum events. Negative birth experience may have long-term and negative consequences on the women´s self-identity and relationships with their infants and partners. This is of concern as there is a growing body of literature showing negative consequences of maternal mental distress on the mother-infant bonding and attachment process, and relationships with partner. Improvement in bonding could take as long as one to five years - which needs attention because a delay in bonding can have detrimental effects on the child's long-term development.
Risk factors for a negative birth experience are multifaceted and associations have been found between negative birth experience and instrumental or caesarean births, intrapartum complications, maternal complications or hospitalisation in pregnancy and prolonged labour. Furthermore, fear of childbirth, negative thoughts about the upcoming birth, prior negative birth experience, feelings of not being in control, and powerlessness during birth have been associated with negative birth experiences as well as history of mental health problems. Furthermore, perceived lack of professional support during pregnancy or birth has been associated with negative experience of birth.
Evidence for useful methods to assist women with negative childbirth experience is limited. Interventions aimed to assist women with negative birth experience have been explored but the effectiveness remains inconsistent, with five comparative studies showing improvements on psychological measures while six of them did not. In recent studies a method of writing about the experience was explored with promising results, where one of them showed a reduction in depressive and traumatic symptoms and the other one showed emotional benefits like clarifying thoughts and feelings of empowerment.
It is worth considering that in many of the above comparative studies, the need to review the birth experience was based on the view of health professionals. Also, the interviews were limited to women who experienced an operative birth or unexpected events during birth but none of these were effective in psychological improvements. Likewise, the time between the negative birth experience until the intervention was provided ranged from the first week after birth up to seven years after birth. Similarly, the structure, content and quantity of interview interventions varied. Each study´s design and outcome measures used, varied significantly making it difficult to determine which components of the interventions women considered most effective. Despite failure in these studies to show significant changes in psychological measures, women reported that it was helpful to participate in the intervention.
The results from authors´ recent study in Iceland provide important insights into women´s views about the process of reviewing negative birth experience and reconciling difficult emotions, at a special midwifery clinic Ljáðu mér eyra (LME) at Landspítali. The women prefer their negative birth experiences to be detected by professionals and consequently have opportunity to review their birth experience in a tailored conversation on their terms. Many of them revealed preferences of talking to a known midwife who had provided care during pregnancy or birth, suggesting a request for some form of continuity of care. Reviewing the birth experience provided an opportunity for many women to relieve the burden of difficult emotions, enhance well-being and gain strength to move on with their lives.
The ideological background of the study is affected by the international ideology of midwifery and models of care. According to the International Confederation of midwives' philosophy and model of midwifery care (2014), birth is not only … a normal and physiological process… but also … a profound experience, which carries significant meaning to the woman and her family. Midwifery care combines art and science and is holistic in nature, grounded in an understanding of the social, emotional, cultural, spiritual, psychological experiences of women and based upon the best available evidence. Furthermore, in International Confederation of midwives' code of ethics (2014) is stated that midwives should … respond to the psychological, physical, emotional and spiritual needs of women…,requiring midwives to react to women´s needs following childbirth from a holistic perspective. This philosophy of care is extended in Renfrew´s et. al. framework for childbirth care and a midwifery model of woman-centred childbirth care, developed in Swedish and Icelandic settings. Good quality midwifery care includes continuity of care, information, communication and understanding of women's needs. According to the above, interventions need to be tailored to women's circumstances and needs and provided in partnership with them.
Thirty women who had their antenatal care provided at the clinic, after 28 weeks of pregnancy, will be invited to write about their birth experience and review it with the midwife who provided their antenatal care, four to six weeks after birth. Six to eight midwives will provide the intervention after completing a 12-hour training program. The study is based on a mixed method design where quantitative and qualitative data will be collected. Data including traumatic symptoms, traumatic life events, birth outcomes and birth experience will be collected from women before the intervention. Four to six weeks after the intervention, data about birth experience, traumatic symptoms and experience of the intervention will be collected. The participating midwives´ diaries and focus group interviews will be used to explore their experience of providing the intervention. Descriptive and thematic analysis will be used.
Conditions
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Childbirth
Study Design
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Allocation Method
NA
Intervention Model
SINGLE_GROUP
The study is a pilot feasibility study, exploring a new type of intervention after birth, for women who had their antenatal care provided at a high-risk maternity clinic. The intervention involves women writing about and reviewing their birth experience, six to eight weeks after birth, with the midwife who provided antenatal care.
Primary Study Purpose
TREATMENT
Blinding Strategy
NONE
Study Groups
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Women reviewing birth experience
Women who had their antenatal care provided at a high-risk antenatal clinic, will be offered to write about and review their birth experience about 6 weeks post-partum with a known midwife from antenatal care.
Group Type
EXPERIMENTAL
Writing about and reviewing birth experience
Intervention Type
OTHER
Writing about and reviewing birth experience with a known midwife from antenatal care about 6 weeks post-partum.
Interventions
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Writing about and reviewing birth experience
Writing about and reviewing birth experience with a known midwife from antenatal care about 6 weeks post-partum.
Intervention Type
OTHER
Eligibility Criteria
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Inclusion Criteria
* Women aged ≥ 18 years old, having their antenatal care provided at the clinic after 28 weeks of pregnancy and planned a vaginal birth.
Exclusion Criteria
* Women \< 18 years old, referred to the clinic after 28 weeks of pregnancy, not reading Icelandic or planned elective caesarean section.
Minimum Eligible Age
18 Years
Eligible Sex
FEMALE
Accepts Healthy Volunteers
No
Sponsors
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University of Iceland
OTHER
Sponsor Role
lead
Responsible Party
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Responsibility Role
SPONSOR
Principal Investigators
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Helga Gottfredsdottir
Role: STUDY_DIRECTOR
University of Iceland
Locations
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Valgerdur Lisa Sigurdardottir
Reykjavik, , Iceland
Site Status
Countries
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Iceland
References
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Sigurdardottir VL, Gamble J, Gudmundsdottir B, Kristjansdottir H, Sveinsdottir H, Gottfredsdottir H. The predictive role of support in the birth experience: A longitudinal cohort study. Women Birth. 2017 Dec;30(6):450-459. doi: 10.1016/j.wombi.2017.04.003. Epub 2017 May 3.
Reference Type
BACKGROUND
Sigurethardottir VL, Gamble J, Guethmundsdottir B, Sveinsdottir H, Gottfreethsdottir H. Processing birth experiences: A content analysis of women's preferences. Midwifery. 2019 Feb;69:29-38. doi: 10.1016/j.midw.2018.10.016. Epub 2018 Oct 27.
Reference Type
BACKGROUND
Rijnders M, Baston H, Schonbeck Y, van der Pal K, Prins M, Green J, Buitendijk S. Perinatal factors related to negative or positive recall of birth experience in women 3 years postpartum in the Netherlands. Birth. 2008 Jun;35(2):107-16. doi: 10.1111/j.1523-536X.2008.00223.x.
Reference Type
BACKGROUND
Waldenstrom U, Hildingsson I, Rubertsson C, Radestad I. A negative birth experience: prevalence and risk factors in a national sample. Birth. 2004 Mar;31(1):17-27. doi: 10.1111/j.0730-7659.2004.0270.x.
Reference Type
BACKGROUND
Ayers S, Eagle A, Waring H. The effects of childbirth-related post-traumatic stress disorder on women and their relationships: a qualitative study. Psychol Health Med. 2006 Nov;11(4):389-98. doi: 10.1080/13548500600708409.
Reference Type
BACKGROUND
Fenech G, Thomson G. Tormented by ghosts from their past': a meta-synthesis to explore the psychosocial implications of a traumatic birth on maternal well-being. Midwifery. 2014 Feb;30(2):185-93. doi: 10.1016/j.midw.2013.12.004. Epub 2013 Dec 13.
Reference Type
BACKGROUND
Waldenstrom U. Why do some women change their opinion about childbirth over time? Birth. 2004 Jun;31(2):102-7. doi: 10.1111/j.0730-7659.2004.00287.x.
Reference Type
BACKGROUND
Baxter JD, McCourt C, Jarrett PM. What is current practice in offering debriefing services to post partum women and what are the perceptions of women in accessing these services: a critical review of the literature. Midwifery. 2014 Feb;30(2):194-219. doi: 10.1016/j.midw.2013.12.013. Epub 2013 Dec 27.
Reference Type
BACKGROUND
Borg Cunen N, McNeill J, Murray K. A systematic review of midwife-led interventions to address post partum post-traumatic stress. Midwifery. 2014 Feb;30(2):170-84. doi: 10.1016/j.midw.2013.09.003. Epub 2013 Sep 21.
Reference Type
BACKGROUND
Gamble J, Creedy D, Moyle W, Webster J, McAllister M, Dickson P. Effectiveness of a counseling intervention after a traumatic childbirth: a randomized controlled trial. Birth. 2005 Mar;32(1):11-9. doi: 10.1111/j.0730-7659.2005.00340.x.
Reference Type
BACKGROUND
Lavender T, Walkinshaw SA. Can midwives reduce postpartum psychological morbidity? A randomized trial. Birth. 1998 Dec;25(4):215-9. doi: 10.1046/j.1523-536x.1998.00215.x.
Reference Type
BACKGROUND
Ryding EL, Wiren E, Johansson G, Ceder B, Dahlstrom AM. Group counseling for mothers after emergency cesarean section: a randomized controlled trial of intervention. Birth. 2004 Dec;31(4):247-53. doi: 10.1111/j.0730-7659.2004.00316.x.
Reference Type
BACKGROUND
Meades R, Pond C, Ayers S, Warren F. Postnatal debriefing: have we thrown the baby out with the bath water? Behav Res Ther. 2011 May;49(5):367-72. doi: 10.1016/j.brat.2011.03.002. Epub 2011 Mar 12.
Reference Type
BACKGROUND
Blasio PD, Camisasca E, Caravita SC, Ionio C, Milani L, Valtolina GG. THE EFFECTS OF EXPRESSIVE WRITING ON POSTPARTUM DEPRESSION AND POSTTRAUMATIC STRESS SYMPTOMS. Psychol Rep. 2015 Dec;117(3):856-82. doi: 10.2466/02.13.PR0.117c29z3. Epub 2015 Nov 23.
Reference Type
BACKGROUND
Blainey SH, Slade P. Exploring the process of writing about and sharing traumatic birth experiences online. Br J Health Psychol. 2015 May;20(2):243-60. doi: 10.1111/bjhp.12093. Epub 2014 Mar 12.
Reference Type
BACKGROUND
Park CL. Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events. Psychol Bull. 2010 Mar;136(2):257-301. doi: 10.1037/a0018301.
Reference Type
BACKGROUND
Bastos MH, Furuta M, Small R, McKenzie-McHarg K, Bick D. Debriefing interventions for the prevention of psychological trauma in women following childbirth. Cochrane Database Syst Rev. 2015 Apr 10;2015(4):CD007194. doi: 10.1002/14651858.CD007194.pub2.
Reference Type
BACKGROUND
Thomson G, Downe S. Emotions and support needs following a distressing birth: Scoping study with pregnant multigravida women in North-West England. Midwifery. 2016 Sep;40:32-9. doi: 10.1016/j.midw.2016.06.010. Epub 2016 Jun 8.
Reference Type
BACKGROUND
Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, Silva DR, Downe S, Kennedy HP, Malata A, McCormick F, Wick L, Declercq E. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet. 2014 Sep 20;384(9948):1129-45. doi: 10.1016/S0140-6736(14)60789-3. Epub 2014 Jun 22.
Reference Type
BACKGROUND
Berg M, Asta Olafsdottir O, Lundgren I. A midwifery model of woman-centred childbirth care--in Swedish and Icelandic settings. Sex Reprod Healthc. 2012 Jun;3(2):79-87. doi: 10.1016/j.srhc.2012.03.001. Epub 2012 Mar 16.
Reference Type
BACKGROUND
Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q. 2001;79(2):281-315. doi: 10.1111/1468-0009.00206.
Reference Type
BACKGROUND
Turkstra E, Mihala G, Scuffham PA, Creedy DK, Gamble J, Toohill J, Fenwick J. An economic evaluation alongside a randomised controlled trial on psycho-education counselling intervention offered by midwives to address women's fear of childbirth in Australia. Sex Reprod Healthc. 2017 Mar;11:1-6. doi: 10.1016/j.srhc.2016.08.003. Epub 2016 Aug 29.
Reference Type
BACKGROUND
Gamble J, Creedy DK. A counselling model for postpartum women after distressing birth experiences. Midwifery. 2009 Apr;25(2):e21-30. doi: 10.1016/j.midw.2007.04.004. Epub 2007 Jul 27.
Reference Type
BACKGROUND
Bell AF, Rubin LH, Davis JM, Golding J, Adejumo OA, Carter CS. The birth experience and subsequent maternal caregiving attitudes and behavior: a birth cohort study. Arch Womens Ment Health. 2019 Oct;22(5):613-620. doi: 10.1007/s00737-018-0921-3. Epub 2018 Oct 23.
Reference Type
BACKGROUND
Other Identifiers
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UIceland
Identifier Type: -
Identifier Source: org_study_id
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