When something goes
wrong…
Complications of
pregnancy and delivery,
miscarriage, prenatal
diagnosis, traumatic
delivery
When something goes
wrong…
Complications of
pregnancy and delivery,
miscarriage, prenatal
diagnosis, traumatic
delivery
Estimates of
reproductive problems
Estimated lifetime risk of
maternal death by geographic
region
Africa 1 in 21
Asia 1 in 54
South America
1 in 73
Caribbean
1 in 140
North America
1 in 6366
Northern Europe 1 in 9850
Reproductive statistics for
Poland
Women’s reactions to
complications in
pregnancy
Anxiety and fear
Worries over the course of pregnancy /
child’s health, one’s own health
Denial
Search for information / emotional support
Changes in lifestyle
Decision to undergo special diagnosis /
treatment
Prenatal diagnosis
WHEN
> 37, < 16
genetic diseases in
family
genetic disease in
previous children
malformed foetuses
in previous
pregnancies
2-3 miscarriages with
unknown reasons
WHAT
Ultrasound scan
Amniocentesis
Crionic villi
sampling
Psychological aspects of
ultrasound scan (C.Baillie,
1999)
Decreasing anxiety (artefact?)
No impact on lifestyle in pregnancy
Less stress
No changes in attitudes to pregnancy /
baby
No impact on prenatal bonding (in
normal)
More positive attitudes towards ultrasound
scan itself
How to persuade a patient to
go for amniocentesis ?
(T. Marteau,1993)
Offered to all 36 +
RISK of Down syndrome always mentioned
Not always info that the test reveals ONLY
50% of problems
No discussion - woman’s views ignored, not
attended to, directive communication
Wrong estimates of risk of Down syndrome
and of complications afterwards
Prenatal diagnosis -
feminist perspective (R.
Tong, 1997)
POSITIVE, if
possibility to
refrain from
procreation if
genetic risk
free decision to
undergo prenatal
tests
free decision to
deliver unhealthy
baby
NEGATIVE, if
not available for
every woman
Childbirth as an event
in autobiographical
memory
In autobiographical memory there
are events that …
… are experienced by an
individual
… are organised within a
sequence of other events
… are well placed in the time
frame
… make sense for an individual
Events evaluated less positively are
not remembered well (poorly
recalled)
Fear of labour in first and
second pregnancy - studies
in UŁ
Fear of labour in first and
second pregnancy - studies
in UŁ
FIRST
pregnancy
High in I and III
trimester, low in II
Fear mainly over
course of labour and
health of the child
Related to STAI-trait
scores (positively)
SECOND
pregnancy
Increases steadily
over the whole
pregnancy
Fear mainly over
maternal tasks and
well-being in
postpartum period
Related to STAI-trait
scores (positively)
Traumatic birth -
prevalence
Janet Menage (1993)
6 %
Suzanne Lyons
(1998)
9,5 %
Sarah Allen (1998)
13,7 %
Susan Ayers et al..
(2007)
5%
Childbirth as a traumatic
event
(Sarah Allen, 1998)
Harm to
a baby
Past
experiences
Pain
NOT IN CONRTOL
Attempt to access emotional
and practical support
Failure to
access support
Consequences of
traumatic birth
For a woman
development of PTDS syndrome
negative evaluation of a partner /
medical personnel
For her relations with a partner
less positive relationship with a
partner
disturbances in sexual life
Consequences of
traumatic birth
For the relationship with a baby
lack of close bonding
blaming a child
overprotectiveness
lack of confidence as a mother
For future procreation
no more pregnancies
Cesarean section preferred
Traumatic birth and PTSD in
men and women (Ayers et al.,
2007)
64 couples with babies 6-12 weeks of age
PTSD measured by the Impact of Events
Scale by Horowitz
The same intensity of symptoms of intrusions
and avoidance in men and women
PTSD not associated with couple’s
relationships or parent-baby bond
The best predictors of PTSD for men and
women: „something going wrong during
birth”, „delivery problems”, „emotions during
birth”
PTSD after delivery
studies in UŁ
SAMPLE
70 women (18 – 36
yrs)
M = 25,93
SD = 3,89
Labour 6 months
earlier
With a partner - 35
Without a partner - 35
Subgroups not
different according to
education, job,
duration of marriage
PROCEDURE
„Labour experience”
questionnaire
PTSD symptoms
from DSM-IV –
finally 15 items
Factor analysis
3 factors – 61,5%
variance explained
Arousal, avoidance,
re-experience
Other questionnaires
CISS
PTSD after delivery
studies in UŁ
PTSD after delivery
studies in UŁ
PTSD after delivery
studies in UŁ
PTSD after delivery
studies in UŁ
PTSD symptoms and coping
(Pearson’s r for women without a
partner)
*
*
*
*
*
*
*
** p <
0.01
* p <
0.05
Memories from childbirth –
studies in UŁ
SAMPLE
96 women
M = 27,73
SD = 4,46
Partner
Present at labour -
42
Partner absent -
54
Subgroups not different
according to education,
job, duration of
marriage
PROCEDURE
Descriptions of labour
and rating scales
Time 1 - prenatal ward
expectations related
to labour
Time 2 – in postnatal
ward
evaluation of the
birth expereince
Time 3 – 6 month after
evaluation of the
birth experience
Expectations and memories
Pearson’s r correlation
p <
0.001
Comments on
labour/delivery
Time 2 (just after)
Longer descriptions
More technical details
Staff – positive and negative remarks
Pain - more detailed description
Positive evaluation of a husband
being present
Comments on
labour/delivery
Time 3 (6 months after)
Shorter stories
Staff – negative remarks
More comments about the child
More comments about a woman’s well-
being
Pain - general description
Positive evaluation of a husband
being present
The presence
of the birth companion
General negative comments on
labour experience - less often
Less PTSD-like symptoms
Different opinions on a woman’s
own behaviour
WITH – stable opinion with time
WITHOUT – more negative with time
More negative evaluation of a
medical staff with time
The presence
of the birth
companion…
… is a source of possible support
emotional and practical
… helps a delivering woman to
maintain sense of control over the
event
a woman can rely on someone else
but the staff
… provides framework for a
woman’s own experiences
changes in evaluation of one’s
own behaviour and staff action
Prenatal attachment and
miscarriage
Intensity of
attachment
The level of
„psychological
investment” in
pregnacy
Intensity of
grief
Time
Pregnancy
loss
Depression after
miscarraige
Number of
miscarraiges
Maternal age
Duration of
pregnancy
Support from
medical staff
Number of
children
Poor
material
situation
Low perceived
social support
Low
resilience
No
pregnancy
/ delivery
within 1
year
The meaning
of
pregnancy
loss
Active
coping
Passive
coping
DEPRESSIO
N
Swanson, 2000
Experience of pregnancy
loss – theoretical model
(studies in UŁ)
Miscarriag
e
Circumstances
of pregnancy
loss
Attitude
towards
pregnancy
Coping / social
support
Woman’s
experience
after the loss
Present
experiences as
the result of loss
Partner’s
behaviour
after the loss
Support
for a
woman
Expression of
one’s own
reactions
Miscarriage – the effect on
a family
The replacement child syndrome (O’Leary,
2004)
The next child replaces the one who died during
miscarriage
The vulnerable child syndrome (O’Leary, 2004)
The next child needs a lot of support and care from
parents
Weaving babies lost in pregnancy into the
fabric of the family (Cote-Arsenault, 2003)
Other persons should be informed about the loss
Rituals commemorating the child lost in the miscarriage