What makes labour and birth traumatic? A survey of intrapartum 'hotspots'

Evidence suggests between 1% and 6% of women develop post-traumatic stress disorder (PTSD) after childbirth. 'Hotspots' are moments of extreme distress during traumatising events that are implicated in symptoms of PTSD. This cross-sectional internet survey of hotspots examined (1) the content of intrapartum hotspots and (2) whether particular events, cognitions or emotions during hotspots are related to PTSD. Women (N?=?675) who experienced a difficult or traumatic birth completed a questionnaire composed of a validated measure of PTSD, questions concerning the existence of hotspots, and a newly developed measure of emotions and cognitions during hotspots. The majority of women (67.4%) reported at least one hotspot during birth and 52.9% had re-experiencing symptoms of these hotspots. Women were more likely to have PTSD if hotspots involved fear and lack of control (odds ratio (OR) 1.30, 95% CI 1.17-1.43) or intrapartum dissociation (OR 1.12, 95% CI 1.05-1.19). Risk of PTSD was higher if hotspots concerned interpersonal difficulties (OR 4.34, 95% CI 2.15-8.77) or obstetric complications (OR 3.35, 95% CI 1.64-6.87) compared to complications with the baby.     

What makes labour and birth traumatic? A survey of intrapartum ‘hotspots’

Evidence suggests between 1% and 6% of women develop post-traumatic stress disorder (PTSD) after childbirth. ‘Hotspots’ are moments of extreme distress during traumatising events that are implicated in symptoms of PTSD. This cross-sectional internet survey of hotspots examined (1) the content of intrapartum hotspots and (2) whether particular events, cognitions or emotions during hotspots are related to PTSD. Women (N?=?675) who experienced a difficult or traumatic birth completed a questionnaire composed of a validated measure of PTSD, questions concerning the existence of hotspots, and a newly developed measure of emotions and cognitions during hotspots. The majority of women (67.4%) reported at least one hotspot during birth and 52.9% had re-experiencing symptoms of these hotspots. Women were more likely to have PTSD if hotspots involved fear and lack of control (odds ratio (OR) 1.30, 95% CI 1.17–1.43) or intrapartum dissociation (OR 1.12, 95% CI 1.05–1.19). Risk of PTSD was higher if hotspots concerned interpersonal difficulties (OR 4.34, 95% CI 2.15–8.77) or obstetric complications (OR 3.35, 95% CI 1.64–6.87) compared to complications with the baby.     

Posttraumatic stress symptoms following childbirth and mothers' perceptions of their infants

Postpartum psychological distress can adversely affect the early mother–infant relationship; however, this has not been investigated in relation to posttraumatic stress disorder (PTSD) following childbirth. This article explores whether PTSD symptoms relating to labor and delivery are associated with mothers' early perceptions of their infant. Using labor and childbirth as the stressor criterion, 211 women were assessed at 6 weeks' postpartum for symptoms of intrusions, avoidance, and hyperarousal. Their perceptions of their infants, of mother‐to‐infant attachment, and infant behavioral characteristics also were evaluated. In sum, 3.8% of the women fulfilled full diagnostic criteria, and a further 21.3% reported clinically significant symptoms on at least one dimension of PTSD. Those meeting full or partial criteria perceived their attachment relationships to be significantly less optimal and reported more negative maternal representations in terms of their infants being less warm and more invasive. They also rated them as being temperamentally more difficult, prone to distress, and less easy to soothe. However, when the effects of depression were partialled, only the effect for perceived warmth remained. Posttraumatic stress symptoms relating to labor and delivery may adversely influence maternal perceptions of infants, with potentially adverse implications for the developing mother–infant relationship. The overlap with depressive symptoms requires further exploration.     

LEAVING A SEXUALLY COERCIVE DATING PARTNER: A PROSPECTIVE APPLICATION OF THE INVESTMENT MODEL

In the present study, an investment model framework was applied to identify associations between partner verbal sexual coercion and dating relationship outcomes, including relationship commitment and maintenance. Undergraduate women ( N = 180) provided self-report data on investment model variables and verbal sexual coercion within their current relationships and returned 6 to 8 weeks later to report on their relationship status. About 28% of the participants endorsed partner verbal sexual coercion. Women in sexually coercive relationships reported greater investment but did not differ from other women in satisfaction, commitment, or later relationship maintenance. Results revealed indirect effects of partner sexual coercion on relationship commitment through greater perceived investment. Sustaining verbal sexual coercion in ongoing dating relationships may represent a type of relationship investment that indirectly promotes subjective commitment. Additional studies of verbal sexual coercion in committed romantic relationships are needed.     

Obstetric Autonomy and Informed Consent

I argue that public officials and health workers ought to respect and protect women’s rights to make risky choices during childbirth. Women’s rights to make treatment decisions ought to be respected even if their decisions expose their unborn children to unnecessary risks, and even if it is wrong to put unborn children at risk. I first defend a presumption of medical autonomy in the context of childbirth. I then draw on women’s birth stories to show that women’s medical autonomy is often ignored during labor. Medical interventions are performed during childbirth without women’s consent. Childbirth is risky and some coercive medical interventions may be understood as attempts to protect children and to prevent mothers from acting impermissibly. However, even if it is wrong to make risky choices during childbirth, women have rights to do wrong in these cases. Therefore, coercive medical interventions are impermissible during childbirth and institutions should adopt specific protections for obstetric autonomy.     

AUTOMATIC RELATIONSHIP–HARM ASSOCIATIONS AND INTERPERSONAL TRAUMA INVOLVING CLOSE OTHERS

Women exposed to violence early in life are at risk of revictimization. The interpersonal schema hypothesis of revictimization proposes that revictimized women will be more likely to hold negative expectations about intimate relationships, including expectations that relationships involve harm, relative to singly or nonvictimized women. To test the interpersonal schema hypothesis, we used the implicit lexical decision task to examine automatic associations between relationship and harm concepts among college women who reported histories of no, single, or multiple types of interpersonal trauma involving close others (e.g., family member, partner). Women exposed to multiple types of interpersonal trauma involving close others showed stronger relationship–harm associations than singly or nonexposed women. Relationship–harm associations predicted the number of interpersonal trauma types (e.g., sexual, physical trauma) involving close others reported by participants, but were unrelated to posttraumatic stress disorder (PTSD) symptoms. Findings suggest that relational schemata held by women exposed to multiple types of interpersonal trauma involving close others include concepts of harm, which may have implications for how multiply victimized women behave in and think about intimate relationships.     

Family Imprisonment,Maternal Parenting Stress and Its Impact on Mother-Child Relationship Satisfaction

Parental imprisonment, and more recently other close family imprisonment, has been associated with long-term harms to children. A number of researchers have proposed that parenting stress caused by family imprisonment could impact on caregivers’ ability to offer a secure parent–child relationship after a close family member is imprisoned. Such relationship problems might then mediate further harms to children. The Family Stress-Proximal Process (FSPP) model conceptualises family imprisonment as an ongoing stressor that influences relational processes in families. Using HILDA, a nationally-representative Australian survey, we test key aspects of this theoretical model for women affected by close family imprisonment. We demonstrate that recent close family imprisonment does indeed significantly increase risks of high maternal parenting stress. Women affected by this high parenting stress are also significantly more likely to report feeling less satisfied with their relationship with their child one year later. Nonetheless, only a third of women experiences high parenting stress after close family imprisonment. And, women who experience close family imprisonment without high parenting stress do not have a greater risk of subsequent relationship dissatisfaction. We conclude that the prevention or reduction of parenting stress in families affected by close family imprisonment could have a protective effect on subsequent mother-child relationships.     

The Quality of Home Environment in Brazil: An Ecological Model

Based on Bronfenbrenner's (1999) ecological perspective, a longitudinal, prospective model of individual differences in the quality of home environment (Home Observation for Measurement of the Environment—HOME) was tested in a sample of 179 Brazilian children and their families. Perinatal measures of family socioeconomic status (SES) and child birth weight had direct effects on HOME at preschool age. As either family SES or child birth weight increased, HOME also increased through diminished emotional distress in the mother a month following childbirth. SES had a negative effect on number of children in the household, which in turn had a long-term negative impact on HOME. Compared to mothers who had reported not to plan their pregnancy, those who did were more likely to have fewer children, to report more spouse support during childbearing, and to show less emotional distress a month after childbirth, all of which also influenced HOME at preschool age. These findings are discussed in light of the broader socio-ecological Brazilian context, with direct implications to clinical practice aimed at improving the quality of home environment.     

Gender and working models of attachment: Consequences for perceptions of self and romantic relationships

Several theorists have proposed that differential socialization experiences lead men and women to differ in the importance they assign to relationships and in how they interpret and respond to relationships. To explore this idea, this study examined whether men and women who reported similar attachment experiences responded differently to information about the same kind of relationship. Men and women with secure, preoccupied, or avoidant models of attachment imagined themselves in a relationship with a hypothetical partner who displayed secure, preoccupied, or avoidant behavior. As predicted, avoidant men and preoccupied women, whose attachment models exaggerated gender-role stereotypes, expressed the most negativity toward themselves and the relationship. Women also were more likely than men to apply specific information about the imagined relationship to general beliefs about their own relationships. In addition, men and women whose attachment models matched the partner's behavior responded more favorably to the relationship if they both expressed security, but less favorably if they both expressed avoidance. Findings for gender and partner matching closely paralleled those for couples in long-term relationships and support the idea that the meaning and consequences of attachment models must be considered within the context of gender roles.     

From prematurity to parenting stress: The mediating role of perinatal post-traumatic stress disorder

Preterm delivery may lead to the emergence of symptoms of Post-Traumatic Stress disorder (PTSD), which may, in turn, affect the quality of the mother-child relationship. The aim of this study is to shed light on the development of parenting stress in mothers of preterm and full-term children. It is hypothesized that PTSD symptoms mediate the relationship between preterm/full-term birth and the levels of parenting stress. Perinatal PTSD, parenting stress and social support were assessed in 156 mothers of full-term children and 87 mothers of preterm children. Mothers of preterm children experienced more post-traumatic stress and parenting stress than mothers of full-term children. However, the relationship between preterm delivery and subsequent levels of parenting stress was mediated by PTSD symptoms. These findings suggest that the maternal perception of childbirth as a traumatic experience and the subsequent development of PTSD symptoms are pivotal in the emergence of parenting stress.     

Establishing family foundations: intervention effects on coparenting, parent/infant well-being, and parent-child relations.

This study investigated the ability of a theoretically driven, psychosocial prevention program implemented through childbirth education programs to enhance the coparental relationship, parental mental health, the parent-child relationship, and infant emotional and physiological regulation. A sample of 169 heterosexual, adult couples who were expecting their 1st child was randomized to intervention and control conditions. The intervention families participated in Family Foundations, a series of 8 classes, delivered before and after birth, that was designed as a universal prevention program (i.e., it was applicable to all couples, not just those at high risk). Intent-to-treat analyses indicated significant program effects on coparental support, maternal depression and anxiety, distress in the parent-child relationship, and several indicators of infant regulation. Intervention effects were not moderated by income, but greater positive impact of the program was found for lower educated parents and for families with a father who reported higher levels of insecure attachment in close relationships. These findings support the view that coparenting is a potentially malleable intervention target that may influence family relationships as well as parent and child well-being.     

TRANSITION TO PARENTHOOD AND MENTAL HEALTH IN FIRST‐TIME PARENTS

This study aimed to examine the transition to parenthood and mental health in first‐time parents in detail and explore any differences in this transition in the context of parental gender and postpartum mental health. Semistructured clinical interviews (Birmingham Interview for Maternal Mental Health) were carried out with 46 women and 40 men, 5 months after birth. Parents were assessed on pre‐ and postpartum anxiety, depression, and postpartum posttraumatic stress disorder (PTSD), and a range of adjustment and relationship variables. One fourth of the men and women reported anxiety in pregnancy, reducing to 21% of women and 8% of men after birth. Pregnancy and postpartum depression rates were roughly equal, with 11% of women and 8% of men reporting depression. Postpartum PTSD was experienced by 5% of parents. Postpartum mental health problems were significantly associated with postpartum sleep deprivation (odds ratio [OR] = 7.5), complications in labor (OR = 5.1), lack of postpartum partner support (OR = 8.0), feelings of parental unworthiness (OR = 8.3), and anger toward the infant (OR = 4.4). Few gender differences were found for these variables. This study thus highlights the importance of focusing interventions on strengthening the couple's relationship and avoiding postnatal sleep deprivation, and to address parents’ feelings of parental unworthiness and feelings of anger toward their baby.     

Changes in the marital relationship during the transition to first time motherhood: effects of violated expectations concerning division of household labor

This research combined cross-sectional and longitudinal analyses to evaluate the hypothesis that violated expectations with respect to sharing child care and housekeeping responsibilities contribute to women's dissatisfactions with their marital relationships after the birth of their first child. The cross-sectional sample consisted of 670 women who completed questionnaires at one of six phases in relation to birth. The longitudinal sample consisted of 48 women who filled out questionnaires late in pregnancy and at three periods postpartum. The results showed, consistent with previous findings, that women reported less positive feelings about their husbands during the postpartum period than during pregnancy, and that women reported doing much more of the housework and child care than they had expected. Moreover, regression analyses indicated, as predicted, that violated expectations concerning division of labor were related to negative feelings postpartum concerning some aspects of the marital relationship. Additional findings suggested that the negative implications of the birth of a baby for the marital relationship may not be as great as has been emphasized in previous literature, and that expectancy violations affect some parts of the relationship but not necessarily the core affective feeling.     

The Mediation Effect of Posttraumatic Stress Disorder Symptoms on the Relationship of Intimate Partner Violence and IFN-γ Levels

Background: Women who experience intimate partner violence (IPV) report greater stress and negative health consequences than nonabused women. Although an association between psychological stress and altered immune function has been shown, IPV studies have not investigated this relationship. Objective: This study explored the association of IPV with mental health symptoms and an immune marker to determine if posttraumatic stress disorder (PTSD) symptoms mediate the effect of IPV on pro-inflammatory (IFN-γ) cytokine levels. Methods: A cross-sectional, comparative design was used to compare 62 women with IPV and 39 nonabused women. Results: Mean IFN-γ values were higher in abused women and in women with current PTSD symptoms. There were no significant relationships with potential confounding variables that could provide an alternative explanation for the increase in production of proinflammatory cytokines. Conclusions: PTSD symptoms mediate the association between IPV and IFN-γ levels and may partially explain the association of mental health symptoms with physical health sequelae in IPV.     

Expanding perspectives: A social inequities lens on intimate partner violence,reproductive justice,and infant mental health

Intimate partner violence (IPV) poses a threat to the attainment of reproductive justice. Women who experience IPV are limited in their ability to parent their children in a secure and nurturing environment, which can have negative effects on the mother and child immediately and long-term, potentially distressing reproductive well-being across generations. Societal inequities faced by women, particularly women of color, within education, economic, and legal systems are associated with risk factors for IPV. This article will use national- and state-level data with case examples and the lens of reproductive justice to consider the impact of and potential solutions to historical and institutional inequities related to IPV.     

Women’s mate retention behaviors,personality traits,and fellatio

Women perform oral sex on their male partner (i.e., fellatio) as part of a Benefit-Provisioning mate retention strategy, and women’s personality predicts their interest in, and time spent, performing fellatio. We explored whether women’s mate retention behavior mediates the relationship between their personality traits and their performance of fellatio in a long-term romantic relationship. Women (n = 401) reported their personality traits, the frequency with which they performed mate retention behaviors during the past month, and their interest in and the time they spent performing fellatio on their partner during their most recent sexual encounter. The results indicate that women higher in Conscientiousness spend more time performing fellatio on their partner, and this relationship is mediated by their Benefit-Provisioning mate retention. Women higher in Agreeableness report greater interest in performing fellatio on their partner, and less Cost-Inflicting mate retention, but mate retention behaviors do not mediate the relationship between their Agreeableness and their interest in performing fellatio. The current research is the first to investigate the relationship between women’s personality traits and oral sex behaviors, and contributes to research documenting that mate retention strategies are associated with sexual behavior.     

Maternal Trauma and Children’s Functioning: The Role of Kinship Social Support

Although research has documented the detrimental effects of maternal trauma on child behavior (Lambert, Holzer, & Hasbun, 2014), the role of extended family support in potentially mitigating the effects of intergenerational transmission of trauma is not clearly understood. With a diverse community sample of 52 trauma-exposed mothers and their children between the ages of 7 and 12, we investigated relationships between kinship social support, maternal trauma exposure severity, maternal posttraumatic stress disorder (PTSD) symptom severity, and child behavioral problems. Results showed that kinship social support was negatively related to maternal trauma exposure severity, maternal PTSD symptom severity, child internalizing behaviors, and child externalizing behaviors. Additionally, kinship social support moderated the relationship between maternal trauma exposure severity and child internalizing behaviors. These results have implications in the implementation of interventions aimed at supporting diverse families facing trauma that incorporate extended family networks.     

IS SEXUAL ORIENTATION A MATTER OF CHOICE?

Ninety women in lesbian and heterosexual couples were compared on relationship values, views of same-gender and cross-gender intimate relationships, and perceived choice of sexual orientation. Both groups reported similar values, levels of self-esteem, and capacity for intimacy. The majority in both groups described their relationships with women as more emotionally and intellectually intimate than those with men. A majority of women in lesbian couples (58%) and a third of women in heterosexual couples reported choosing the orientation of their current sexual relationship. Women with male partners did not perceive major differences between homosexual and heterosexual relationships, citing sexual attraction as the primary reason they chose a male partner. In contrast, many women with female partners characterized lesbian relationships as more intimate and equal, and less gender-role stereotyped, frequently citing these characteristics, along with sexual attraction, as reasons for their relationship preference.     

Testing Posttraumatic Stress as a Mediator of Childhood Trauma and Adult Intimate Partner Violence Victimization

This study examined whether potential posttraumatic stress disorder (PTSD) mediated the relationships between different forms of childhood trauma (sexual abuse, physical abuse, violence between caregivers) and intimate partner violence (IPV) victimization (psychological, physical, sexual). Participants were 1,150 female nurses and nursing personnel. Path analytic findings revealed potential PTSD partially mediated the relationships between childhood sexual abuse and psychological IPV and childhood sexual abuse and sexual IPV. Potential PTSD did not mediate the relationship between other types of childhood trauma and IPV. This study adds to the literature indicating PTSD as a risk factor for revictimization in the form of adult IPV among women. Screening for and treatment of PTSD among female child sexual abuse survivors could prevent future IPV victimization.     

Keeping it real: Young adult women's authenticity in relationships and daily condom use

The role of relationship authenticity in shaping women's daily condom use was investigated. Forty‐seven sexually active women in dating relationships completed a measure of relationship authenticity and then reported on their daily condom use and relationship events for 14 consecutive days. Inauthentic women were less likely than more authentic women to use condoms, particularly on days with frequent negative events such as major disagreements with a romantic partner. These critical Person × Situation interactions remained significant after controlling for the use of another form of birth control, sexual frequency, knowledge of a partner's sexual history, and relationship satisfaction. Implications for sexual risk‐taking behaviors and future research using daily experience methods to study sexuality in dating relationships are discussed.