Barbro Wijma

Posttraumatic stress disorder after childbirth : a cross sectional study

The prevalence of having a posttraumatic stress disorder (PTSD) profile after childbirth and womens cognitive appraisal of the childbirth were studied cross sectionally in an unselected sample of all women who had given birth over a 1-year period in Linköping, Sweden. The PTSD profile was assessed by means of Traumatic Event Scale (TES), which is based on diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994). The womens cognitive appraisal of the childbirth was measured by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Twenty-eight women (1.7%) of 1640 met criteria for a PTSD profile related to the recent delivery. A PTSD profile was related to a history of having received psychiatric/psychological counseling, a negative cognitive appraisal of the past delivery, nulliparity, and rating the contact with delivery staff in negative terms.

Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth

Up to now it has been difficult to study fear of childbirth because of a shortage of adequate psychological measurements. Therefore the Wijma Delivery Expectancy/ Experience Questionnaire (W-DEQ) was developed. This paper presents the theoretical background of the W-DEQ together with a documentation of the first psychometric studies. Examination of construct validity indicates that it seems to be possible to penetrate a psychological construct related to fear of childbirth by means of the W-DEQ, both before and after delivery, in nulliparous as well as in parous women. The questionnaire measures the construct more clearly in parous than in nulliparous women. Internal consistency reliability and split-half reliability of the W-DEQ of > or = 0.87 are good for a new research instrument. More research is on its way to make the W-DEQ suitable even for measurements in applied settings.

Risk factors in pregnancy for post‐traumatic stress and depression after childbirth

Objective  The objective of this study was to find risk factors in pregnancy for post‐traumatic stress and depression 1 month after childbirth. Furthermore, the relation between post‐traumatic stress and depression was explored.

Emotional, physical, and sexual abuse in patients visiting gynaecology clinics : a Nordic cross-sectional study

BACKGROUND Abuse against women causes much suffering for individuals and is a major concern for society. We aimed to estimate the prevalence of three types of abuse in patients visiting gynaecology clinics in five Nordic countries, and to assess the frequency with which gynaecologists identify abuse victims. METHODS We did a cross-sectional, multicentre study of women attending five departments of gynaecology in Denmark, Finland, Iceland, Norway, and Sweden. We recruited 4729 patients; 3641 (77%) responded and were included in the study. Participants completed a postal questionnaire (norvold abuse questionnaire) confidentially. Primary outcome measures were prevalences of emotional, physical, and sexual abuse, and whether abused patients had told their gynaecologist about these experiences. We assessed differences between countries with Pearsons chi(2) test. FINDINGS The ranges across the five countries of lifetime prevalence were 38-66% for physical abuse, 19-37% for emotional abuse, and 17-33% for sexual abuse. Not all abused women reported current ill-effects from the abusive experience. Most women (92-98%) had not talked to their gynaecologist about their experiences of abuse at their latest clinic visit. INTERPRETATION Despite prevalences of emotional, physical, and sexual abuse being high in patients visiting gynaecology clinics in the Nordic countries, most victims of abuse are not identified by their gynaecologists. This lack of discussion might increase the risk of abused patients not being treated according to their needs. Gynaecologists should always consider asking their patients about abuse.

Psychological impact of emergency Cesarean section in comparison with elective Cesarean section, instrumental and normal vaginal delivery

The purpose of the study was to compare the psychological reactions of women after emergency Cesarean section (EmCS), elective Cesarean section (ElCS), instrumental vaginal delivery (IVD) and normal vaginal delivery (NVD). The participants (EmCS, n = 71, ElCS, n = 70, IVD, n = 89, and NVD, n = 96) answered questionnaires a few days postpartum and 1 month postpartum. The EmCS group reported the most negative delivery experience at both times, followed by the IVD group. At a few days postpartum the EmCS group experienced more general mental distress than the NVD group, but not when compared with the ElCS or the IVD groups. At 1 month postpartum the EmCS group showed more symptoms of post-traumatic stress than the ElCS and NVD groups, but not when compared to the IVD group. An unplanned instrumental delivery (EmCS or IVD) should be regarded as a pointer with respect to possible post-traumatic stress.

Pre- and postpartum fear of childbirth in nulliparous and parous women.

The link between fear of childbirth and theories of anxiety in general is discussed. A possible expression of trait (T-fear) and state (S-fear) aspects of fear of childbirth was investigated in 77 nulliparous and 85 parous women based on data from gestational week 32, at 2 hours and at 5 weeks after childbirth. Data are based on the State Trait Anxiety Inventory and the Wijma Delivery Expectancy/Experience Questionnaire. According to their scores on the Wijma Delivery Expectancy/Experience Questionnaire during late pregnancy, women were divided into 3 groups: high, moderate and low levels of fear of childbirth. In gestational week 32, women in the low level of fear of childbirth group had lower trait anxiety than those in the moderate level of fear of childbirth group, who had lower trait anxiety than the women in the high level of fear of childbirth group. Nulliparous women had a higher level of fear of childbirth but a lower level of trait anxiety than did parous women. There was a significant decreasing trend in fear of childbirth from 2 hours to 5 weeks after delivery, in a parallel way for all 3 groups. Differences in fear of childbirth between nulliparous and parous women disappeared after delivery. These findings suggest that fear of childbirth comprises a considerable part of T-fear, with the risk of a vicious cycle, i.e. that during labour women experience what they are afraid of, which also influences the womens postpartum cognitive appraisal of the delivery.

Traumatic Stress after Childbirth: The Role of Obstetric Variables

In a sample of 1550 recently delivered women, traumatic stress after childbirth was studied in relation to obstetric variables A post-traumatic stress disorder (PTSD) symptom profile and traumatic stress symptoms were assessed by means of the Traumatic Event Scale (TES) Obstetric data comprised delivery mode, duration of the second stage of labor (the time from cervical dilation of 10 cm to partus) and the use of analgesia/anesthesia Traumatic stress symptoms and having a PTSD symptom profile were both significantly related to the experience of an emergency cesarean section or an instrumental vaginal delivery It is of clinical importance, however that most women with a PTSD symptom profile were found in the normal vaginal delivery group (NVD) This implies that a normal vaginal delivery can be experienced as traumatic, lust as an emergency cesarian section is not necessarily traumatic Traumatic stress symptoms were neither substantially correlated to the duration of the second stage of labor, nor to the use of analgesia/anesthesia

Posttraumatic stress reactions after emergency cesarean section

Background. The study aimed at answering the following questions: Do women experience emergency cesarean section as traumatic?

The longitudinal course of post-traumatic stress after childbirth

Post-traumatic stress was assessed in early and late pregnancy, and 1, 4, 7, and 11 months postpartum by means of questionnaires among 1224 women. Thirty-seven women (3%) had post-traumatic stress (meeting criteria B, C, and D for PTSD) at least once within 1–11 months postpartum. In pregnancy, depression, severe fear of childbirth, ‘pre’-traumatic stress, previous counseling related to pregnancy/childbirth, and self-reported previous psychological problems were associated with an increased risk of having post-traumatic stress within 1–11 months postpartum. Sum-scores of post-traumatic stress did not decrease over time among women who at least once had post-traumatic stress (criteria B, C, and D) within 1–11 months postpartum. Women with post-traumatic stress also showed a decrease in perceived social support over time postpartum.

Fear, pain and stress hormones during childbirth

Aims. To investigate the course of fear, pain and stress hormones during labor, and the associations between fear, pain, stress hormones and duration of labor in nulliparous women with and without epidural analgesia (EDA). Method. One day during gestation weeks 37–39, urinary and salivary samples were collected to measure catecholamines and cortisol. Hourly during labor, the participants answered the Delivery Fear Scale and a pain intensity scale, and urinary and salivary samples were collected to measure stress hormones. Results. The course of fear, pain and stress hormones differed throughout labor in women with and without EDA. Pain and cortisol increased throughout labor in women without EDA. Women who received EDA had more fear, but not more pain, before the administration of the EDA than women who did not receive EDA. Pain, fear and catecholamines decreased when women received EDA, but fear and pain increased again later in labor. Fear and pain correlated, as well as levels of fear in the different phases of labor. During phase one of labor epinephrine and duration of the phase were negatively correlated. Conclusion. The course of fear, pain and concentrations of stress hormones differed, highly influenced by the administration of EDA. Fear and pain correlated more pronounced than stress hormones and fear, pain and duration of labor.