„Hilflosigkeit, das Abgeben jeglicher Selbstverantwortung und Selbstbestimmtheit“ – eine qualitative Auswertung von traumatisierenden Geburtserlebnissen in Relation zum Geburtsmodus

 

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Zusammenfassung

Hintergrund Eine Geburt verbindet emotionale Herausforderungen mit individuellen Ängsten. Unerwartete Geburtsverläufe können Stressreaktionen bis hin zu posttraumatischen Belastungsstörungen auslösen.Ziel der Studie Das Ziel der Studie war die qualitative Beschreibung von belastend wahrgenommenen Geburtserlebnissen und gewünschten Maßnahmen nach traumatisierenden Geburtserlebnisse.Methodik Es wurde eine inhaltsanalytische Auswertung von 117 Freitextantworten zu belastenden Geburtserlebnissen und gewünschten Maßnahmen anhand von Kategorien und Häufigkeiten in Relation zum Geburtsmodus vorgenommen.Ergebnisse Fünf Themen wurden herausgearbeitet: (1) Belastende Erfahrungen aufgrund von Ängsten um das Kind und die Trennung vom Kind vor allem nach einer Notsectio, (2) als unzulänglich erfahrene Kommunikation nach operativ vaginalen Geburten und sekundären Sectiones, (3) Gefühle von Versagen und Schuld nach allen ungeplanten Geburtsmodi, (4) Hilflosigkeit aufgrund des erlebten Kontrollverlustes und Ausgeliefertsein nach einer Notsectio sowie (5) Subjektiv ungünstige Versorgung durch mangelnde Empathie oder fehlende Betreuung. Als gewünschte Maßnahmen wurden genannt: unmittelbare Nachbesprechungen des Geburtserlebens mit dem beteiligten Personal sowie das Angebot professioneller psychologischer Unterstützung.Schlussfolgerung Frauenzentrierte Kommunikation insbesondere bei ungeplanten Geburtsverläufen und Nachbesprechungen von belastenden Geburtsverläufen sind bedeutsame Maßnahmen zur Stärkung des mütterlichen Wohlbefindens und der psychischen Gesundheit. Sie können einen positiven Einfluss auf die Entwicklung einer gesunden Mutter-Kind-Beziehung nehmen.

Abstract

Background Childbirth is combined with emotional challenges and individual anxiety. Unexpected birth experiences can trigger stress reactions and even post-traumatic stress disorders. Aim of the study The aim of the study was the qualitative evaluation of stressful perceived birth experiences and desired interventions.Methods A content-analytic evaluation of 117 free-text answers was conducted regarding stressful birth experiences and desired interventions using categories and frequencies in relation to birth mode.Findings Five themes emerged from the structured free text analysis: 1) Stressful experiences describing fear concerning the child and separation from the child after an emergency caesarean section; 2) Inadequate communication after an operative vaginal birth and unplanned caesarean section; 3) Feelings of failure and guilt after unplanned birth modes; 4) Helplessness with loss of personal control and the feeling of being at the mercy after an emergency caesarean section; 5) Inadequate support due to the absence of empathy or insufficient care. Expected interventions include immediate debriefing and professional psychological support.Conclusion Women-centered communication during childbirth and debriefing of stressful birth experiences are significant interventions for strengthening maternal well-being and mental health. They can have a positive impact on the development of a healthy mother-child relationship.

Publication History

Received: 18 November 2022

Accepted after revision: 10 February 2023

Article published online:
15 March 2023

© 2023. Thieme. All rights reserved.

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• Literatur

• 1 Ginter N, Takács L, Boon MJM. et al. The Impact of Mode of Birth on Childbirth-Related Post Traumatic Stress Symptoms beyond 6 Months Postpartum: An Integrative Review. Int J Environ Res Public Health 2022; 19: 8830 DOI: 10.3390/ijerph19148830.
  CrossrefPubMedGoogle Scholar
• 2 Wijma K, Söderquist J, Wijma B. Posttraumatic stress disorder after childbirth: A cross sectional study. Journal of Anxiety Disorders 1997; 11: 587-597 DOI: 10.1016/S0887-6185(97)00041-8.
  CrossrefPubMedGoogle Scholar
• 3 Söderquist J, Wijma K, Wijma B. Traumatic stress after childbirth: the role of obstetric variables. J Psychosom Obstet Gynaecol 2002; 23: 31-39 DOI: 10.3109/01674820209093413.
  CrossrefPubMedGoogle Scholar
• 4 Söderquist J, Wijma B, Thorbert G. et al. Risk factors in pregnancy for post-traumatic stress and depression after childbirth. BJOG: An International Journal of Obstetrics & Gynaecology 2009; 116: 672-680 DOI: 10.1111/j.1471-0528.2008.02083.x.
  CrossrefPubMedGoogle Scholar
• 5 Adams SS, Eberhard-Gran M, Sandvik ÅR. et al. Mode of delivery and postpartum emotional distress: a cohort study of 55,814 women. BJOG 2012; 119: 298-305 DOI: 10.1111/j.1471-0528.2011.03188.x.
  CrossrefPubMedGoogle Scholar
• 6 Dekel S, Ein-Dor T, Berman Z. et al. Delivery mode is associated with maternal mental health following childbirth. Arch Womens Ment Health 2019; 22: 817-824 DOI: 10.1007/s00737-019-00968-2.
  CrossrefPubMedGoogle Scholar
• 7 Yildiz PD, Ayers S, Phillips L. The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. J Affect Disord 2017; 208: 634-645 DOI: 10.1016/j.jad.2016.10.009.
  CrossrefPubMedGoogle Scholar
• 8 First MB. Diagnostic and statistical manual of mental disorders, 5th edition, and clinical utility. J Nerv Ment Dis 2013; 201: 727-729 DOI: 10.1097/NMD.0b013e3182a2168a.
  CrossrefPubMedGoogle Scholar
• 9 Anderson CA. The trauma of birth. Health Care Women Int 2017; 38: 999-1010 DOI: 10.1080/07399332.2017.1363208.
  CrossrefPubMedGoogle Scholar
• 10 Beck CT. Post-traumatic stress disorder due to childbirth: the aftermath. Nurs Res 2004; 53: 216-224 DOI: 10.1097/00006199-200407000-00004.
  CrossrefPubMedGoogle Scholar
• 11 Weiss DS, Marmar CR. The Impact of Event Scale – Revised. JP Wilson & TM Keane (eds) Assessing psychological trauma and PTSD. 1996. New York: Guilford; 399-411
  Google Scholar
• 12 Steetskamp J, Treiber L, Roedel A. et al. Post-traumatic stress disorder following childbirth: prevalence and associated factors-a prospective cohort study. Arch Gynecol Obstet 2022; DOI: 10.1007/s00404-022-06460-0.
  CrossrefPubMedGoogle Scholar
• 13 Ayers S, Wright DB, Thornton A. Development of a Measure of Postpartum PTSD: The City Birth Trauma Scale. Front Psychiatry 2018; 9 DOI: 10.3389/fpsyt.2018.00409.
  CrossrefPubMedGoogle Scholar
• 14 Weigl T, Beck-Hiestermann FML, Stenzel NM. et al. Assessment of Childbirth-Related PTSD: Psychometric Properties of the German Version of the City Birth Trauma Scale. Front Psychiatry 2021; 12: 731537 DOI: 10.3389/fpsyt.2021.731537.
  CrossrefPubMedGoogle Scholar
• 15 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; 11: 389-398 DOI: 10.1080/13548500600708409.
  CrossrefPubMedGoogle Scholar
• 16 Ryding EL, Wijma B, Wijma K. Posttraumatic stress reactions after emergency cesarean section. Acta Obstet Gynecol Scand 1997; 76: 856-861 DOI: 10.3109/00016349709024365.
  CrossrefPubMedGoogle Scholar
• 17 Rouhe H, Salmela-Aro K, Halmesmäki E. et al. Fear of childbirth according to parity, gestational age, and obstetric history. BJOG 2009; 116: 67-73 DOI: 10.1111/j.1471-0528.2008.02002.x.
  CrossrefPubMedGoogle Scholar
• 18 Zanardo V, Giliberti L, Giliberti E. et al. The role of elective and emergency cesarean delivery in maternal postpartum anhedonia, anxiety, and depression. Int J Gynecol Obstet 2018; 143: 374-378 DOI: 10.1002/ijgo.12657.
  CrossrefPubMedGoogle Scholar
• 19 Ryding EL, Wijma K, Wijma B. Psychological impact of emergency Cesarean section in comparison with elective Cesarean section, instrumental and normal vaginal delivery. Journal of Psychosomatic Obstetrics & Gynecology 1998; 19: 135-144 DOI: 10.3109/01674829809025691.
  CrossrefPubMedGoogle Scholar
• 20 Carter J, Bick D, Gallacher D. et al. Mode of birth and development of maternal postnatal post-traumatic stress disorder: A mixed-methods systematic review and meta-analysis. Birth 2022; DOI: 10.1111/birt.12649.
  CrossrefPubMedGoogle Scholar
• 21 Hosseini Tabaghdehi M, Kolahdozan S, Keramat A. et al. Prevalence and factors affecting the negative childbirth experiences: a systematic review. J Matern Fetal Neonatal Med 2020; 33: 3849-3856 DOI: 10.1080/14767058.2019.1583740.
  CrossrefPubMedGoogle Scholar
• 22 Schreier M. Qualitative Content Analysis in Practice. Sage Publications; 2012
  Google Scholar
• 23 de Graaff LF, Honig A, van Pampus MG. et al. Preventing post-traumatic stress disorder following childbirth and traumatic birth experiences: a systematic review. Acta Obstetricia et Gynecologica Scandinavica 2018; 97: 648-656 DOI: 10.1111/aogs.13291.
  CrossrefPubMedGoogle Scholar
• 24 Janzen JA, Silvius J, Jacobs S. et al. What is a health expectation? Developing a pragmatic conceptual model from psychological theory. Health Expect 2006; 9: 37-48 DOI: 10.1111/j.1369-7625.2006.00363.x.
  CrossrefPubMedGoogle Scholar
• 25 Webb R, Ayers S, Bogaerts A. et al. When birth is not as expected: a systematic review of the impact of a mismatch between expectations and experiences. BMC Pregnancy Childbirth 2021; 21: 475 DOI: 10.1186/s12884-021-03898-z.
  CrossrefPubMedGoogle Scholar
• 26 Nyberg K, Lindberg I, Öhrling K. Midwives’ experience of encountering women with posttraumatic stress symptoms after childbirth. Sex Reprod Healthc 2010; 1: 55-60 DOI: 10.1016/j.srhc.2010.01.003.
  CrossrefPubMedGoogle Scholar
• 27 Nystedt A, Högberg U, Lundman B. Some Swedish women’s experiences of prolonged labour. Midwifery 2006; 22: 56-65 DOI: 10.1016/j.midw.2005.05.003.
  CrossrefPubMedGoogle Scholar
• 28 Kountanis JA, Kirk R, Handelzalts JE. et al. The associations of subjective appraisal of birth pain and provider-patient communication with postpartum-onset PTSD. Arch Womens Ment Health 2022; 25: 171-180 DOI: 10.1007/s00737-021-01154-z.
  CrossrefPubMedGoogle Scholar
• 29 Hollander MH, van Hastenberg E, van Dillen J. et al. Preventing traumatic childbirth experiences: 2192 women’s perceptions and views. Arch Womens Ment Health 2017; 20: 515-523 DOI: 10.1007/s00737-017-0729-6.
  CrossrefPubMedGoogle Scholar
• 30 Flentje M, von Kaisenberg C, Achenbach J. et al. Betreuung der Patientin während eines Notfallkaiserschnittes – Evaluation von Qualitätsmerkmalen aus Patientensicht. Z Geburtshilfe Neonatol 2019; 223: 230-238 DOI: 10.1055/a-0756-5380.
  Article in Thieme ConnectPubMedGoogle Scholar
• 31 Tham V, Ryding EL, Christensson K. Experience of support among mothers with and without post-traumatic stress symptoms following emergency caesarean section. . Sex Reprod Healthc 2010; 1: 175-180 DOI: 10.1016/j.srhc.2010.06.004.
  CrossrefPubMedGoogle Scholar
• 32 Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 2002; 186: S160-S172 DOI: 10.1067/mob.2002.121141.
  CrossrefPubMedGoogle Scholar
• 33 Bowers BB. Mothers’ experiences of labor support: exploration of qualitative research. J Obstet Gynecol Neonatal Nurs 2002; 31: 742-752 DOI: 10.1177/0884217502239218.
  CrossrefPubMedGoogle Scholar
• 34 Weidner K, Garthus-Niegel S, Junge-Hoffmeister J. [Traumatic Birth: Recognition and Prevention]. Z Geburtshilfe Neonatol 2018; 222: 189-196 DOI: 10.1055/a-0641-6584.
  Article in Thieme ConnectPubMedGoogle Scholar
• 35 Mackey MC. Women’s evaluation of their childbirth performance. Matern Child Nurs J 1995; 23: 57-72
  PubMedGoogle Scholar
• 36 Christiaens W, Bracke P. Assessment of social psychological determinants of satisfaction with childbirth in a cross-national perspective. BMC Pregnancy Childbirth 2007; 7: 26 DOI: 10.1186/1471-2393-7-26.
  CrossrefPubMedGoogle Scholar
• 37 Schipper-Kochems S, Fehm T, Bizjak G. et al. Postpartum Depressive Disorder – Psychosomatic Aspects. Geburtshilfe Frauenheilkd 2019; 79: 375-381 DOI: 10.1055/a-0759-1981.
  Article in Thieme ConnectPubMedGoogle Scholar
• 38 O’Donnell KJ, Glover V, Barker ED. et al. The persisting effect of maternal mood in pregnancy on childhood psychopathology. Dev Psychopathol 2014; 26: 393-403 DOI: 10.1017/S0954579414000029.
  CrossrefPubMedGoogle Scholar
• 39 Ayers S, McKenzie-McHarg K, Slade P. Post-traumatic stress disorder after birth. Journal of Reproductive and Infant Psychology 2015; 33: 215-218 DOI: 10.1080/02646838.2015.1030250.
  CrossrefPubMedGoogle Scholar
• 40 Bergman C, Dellve L, Skagert K. Exploring communication processes in workplace meetings: A mixed methods study in a Swedish healthcare organization. Work 2016; 54: 533-541 DOI: 10.3233/WOR-162366.
  CrossrefPubMedGoogle Scholar
• 41 Goodman P, Mackey MC, Tavakoli AS. Factors related to childbirth satisfaction. J Adv Nurs 2004; 46: 212-219 DOI: 10.1111/j.1365-2648.2003.02981.x.
  CrossrefPubMedGoogle Scholar
• 42 Waldenström U. Why do some women change their opinion about childbirth over time?. Birth 2004; 31: 102-107 DOI: 10.1111/j.0730-7659.2004.00287.x.
  CrossrefPubMedGoogle Scholar
• 43 MacLellan J. Vulnerability in birth: A negative capability. J Clin Nurs 2020; 29: 3565-3574 DOI: 10.1111/jocn.15205.
  CrossrefPubMedGoogle Scholar
• 44 Borg Cunen N, McNeill J, Murray K. A systematic review of midwife-led interventions to address post partum post-traumatic stress. Midwifery 2014; 30: 170-184 DOI: 10.1016/j.midw.2013.09.003.
  CrossrefPubMedGoogle Scholar
• 45 Bastos MH, Furuta M, Small R. et al. Debriefing interventions for the prevention of psychological trauma in women following childbirth. Cochrane Database Syst Rev 2015; CD007194 DOI: 10.1002/14651858.CD007194.pub2.
  CrossrefPubMedGoogle Scholar
• 46 Dikmen-Yildiz P, Ayers S, Phillips L. Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors. Journal of Affective Disorders 2018; 229: 377-385 DOI: 10.1016/j.jad.2017.12.074.
  CrossrefPubMedGoogle Scholar