Emmens, Berbel, Hollins Martin, Caroline, J., Patterson, Jenny and Martin, Colin (2023) A thematic analysis of narratives about birth satisfaction and health awareness from postnatal Women who have high and low trauma scores on the Posttraumatic Stress Disorder Checklist. International Journal of Childbirth. ISSN 2156-5287

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Abstract

Background: Around one third of women experience childbirth trauma, with 3-15% developing Postpartum Posttraumatic Stress Disorder (PP-PTSD).
Aim: Explore birth satisfaction and health perception across two groups of postnatal women with either high or low trauma scores.
Method: Forty postnatal women were divided into groups dependent upon Posttraumatic Stress Disorder Checklist (PCL-5) scores: high-severity (n=20; range 25-57) or low-severity (n=20; range 0-7). Semi-structured interviews explored women’s childbirth experiences related to birth satisfaction and reports of postnatal health. Thematic analysis was performed.
Findings: Narrative content differed appreciably between High(A) and Low(B) scoring groups. Group A narratives were more negative (A1: Overall, a negative recall), referencing lack of autonomy, support or being heard (A2: Missing needs) and negative influences (A3: Disrupting my bubble). Group B recalled more birth satisfaction (B1: Mostly positive recall) associated with (B2: Autonomy; B3: Being cared for; B4: Intuition, instinct, and primal force). Group A narratives focused strongly on mental health (A4: Reduced awareness; A6 Experiencing PTSD; A7: Needing help); with some focus on physical health (A5: How I feel physically); Group B spoke less about health (B5: My health).
Discussion: High-quality psychological care during labour, with continuity, choice, support, and control, alongside postnatal health follow-up may improve birth satisfaction and reduce incidence of PP-PTSD.
Conclusion: To increase birth satisfaction and reduce trauma maternity care providers must be supported to prioritise high-quality psychological care to women during labour, providing choice, control, and continuity within trusting relationships. Trusting relationships are key to ongoing conversations regarding health and seeking/receiving help. Routine birth satisfaction screening and education for care providers about signs of trauma are important.

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