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Counseling for Traumatic Births

From The Thinking Parent newsletter

Some birth experiences can be traumatic for the mother. Brief counseling after birth may help the mother psychologically recover faster following a traumatic birth.

What the researchers did
Women in their last trimester of pregnancy in Australia were recruited. There were 348 women interviewed within 72 hours of birth. Only a group of 103 women identified as having a post-traumatic stress reaction following childbirth were of interest in this study. They essentially were fearful for their life or their baby’s life or feared serious injury or permanent damage during labor or delivery. The women were randomly assigned to either the intervention group (50) or to the control group (53). The women completed questionnaires in their last trimester, at four to six weeks postpartum and at three months postpartum.

The women in the intervention group received 40 to 60 minutes of counseling from a midwife within 72 hours of birth on the maternity ward and again by phone at four to six weeks postpartum. The control group did not receive any counseling. A problem with the study is that the counselor was also a researcher. A followup interview was performed three months postpartum.

What the researchers found
The average age of the woman was 28 years old and most were white. Post-traumatic symptoms were the same for both groups at four to six weeks postpartum but were lower in the intervention group at three months. At three months postpartum, significantly fewer women in the intervention group continued to have scored suggestive of postnatal depression as compared to the control group.

Additional benefits of the intervention were found. The women in the intervention group had lower levels of self-blame about the birth and greater confidence about a future pregnancy than did women in the control group.

What this means for you
In this study, a midwife without specialized training in counseling essentially provided emotional support and gave women the opportunity to discuss the birth experience, work through any issues regarding the birth and offered information. If you experience a difficult or traumatic birth, you may benefit from gaining support and discussing the birth experience with ahealth professional familiar with the birth process (midwife, obstetrician, lactation consultant, labor and delivery nurse). For more severe levels of post-traumatic stress and postpartum depressions, more specialized care (e.g. a psychologist and/or psychiatrist) may be needed instead or in addition.

The intervention in this study was not helpful in the short term (at four to six weeks postpartum) but was found to have an effect by three months. The brief counseling may have helped symptoms resolve more quickly than in the control group. One problem with the study is that the second counseling sessions by phone was performed around the same time as the second assessment of symptoms (four to six weeks postpartum). It is possible that the cumulative effect of two sessions of counseling was responsible for the changes at three months. If so, then this suggests that more frequent sessions are of greater benefit.

Source: Gamble, J., et al., March 2005, Effectiveness of a counseling intervention after a traumatic childbirth: A randomized controlled trial. Birth, 32, 11-19.

© Jennifer Hahn

NFO contributor Dr. Jennifer Hahn is the editor of The Thinking Parent, a quarterly publication reviewing research of interest to parents: child development and parenting, pregnancy and childbirth, physical health, mental health and education. With more than 12 years of experience in research at the Johns Hopkins School of Medicine, Dr. Hahn received her Ph.D. from the University of Maryland Baltimore County and completed her residency at the University of Virginia Health Sciences Center. She is the mother of two daughters.

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