Psychological therapies found effective against childbirth-related PTSD

Psychological therapies found effective against childbirth-related PTSD | Image Credit: © Feng Yu - © Feng Yu - stock.adobe.com.

The risk of childbirth-related posttraumatic stress disorder (PTSD) is reduced by trauma-focused and non-trauma-focused psychological therapies during the early period after a traumatic childbirth, according to a recent study published in the American Journal of Obstetrics & Gynecology.

Stressful and potentially traumatic childbirth is experienced by approximately 1 in 3 women, with severe maternal morbidity (SMM) reported in approximately 60,000 US women per year. Maternal psychological welfare may be experienced by traumatic childbirth, with data indicating a link between traumatic childbirth and PTSD.

Childbirth-related PTSD (CB-PTSD) is reported in 5% to 6% of postpartum women, and the risk is increased nearly 3-fold in Black and Hispanic women. Untreated CB-PTSD can adversely impact maternal postpartum functioning and child health, indicating a need for early interventions to prevent PTSD development.

To determine which therapies are most effective for CB-PTSD prevention, investigators conducted a systematic review and meta-analysis. Primary, secondary, and tertiary prevention methods were all assessed.

Eligibility criteria included being an interventional study, having indication of any type of treatment for PTSD stemming from childbirth, indications of posttreatment CB-PTSD measures, and being written in English.

Articles were obtained from the Embase, Google Scholar, PsycInfo, Pubmed, PsycArticles, CINAHL, Sociological Abstracts, ProQuest, Scopus, ScienceDirect, Web of Science, and Cochrane databases. Articles were assessed by 3 independent authors, with study information extracted by 1 author and cross-checked by another.

Relevant data included sample characteristics, sample type, study design, intervention type, treatment modality and duration, primary and secondary outcomes, and posttreatment time point. If evaluated, satisfaction with treatment was also reported.

Modalities targeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were assessed. Numeric scores for outcome measures were reported as excellent for scores of 29 to 31, good for 22 to 28, fair for 17 to 21, and poor for 16 or less.

Primary interventions were those delivered before childbirth, while secondary interventions were those delivered after traumatic childbirth. Finally, tertiary interventions were those delivered in the months and years after childbirth among women with CB-PTSD.

There were 41 studies included in the final analysis, 32 of which were randomized controlled trials (RCTs) and 9 non-RCTs. Primary interventions were assessed in 3 trials, secondary in 24, and tertiary in 14.

Therapies evaluated included psychological debriefing, trauma-focused therapies, crisis interventions, expressive writing, eye movement desensitization and reprocessing (EMDR), psychological counseling, memory consolidation and reconsolidation blockade, mother-infant-focused therapies, and alternative approaches.

Self-administered questionnaires were used to measure CB-PTSD. PTSD symptoms specified to childbirth were included in the questionnaires. Treatment duration was usually reported based on short- or moderate-term effects, though several studies reported long-term outcomes.

Debriefing was tested as a secondary intervention in 4 trials. The treatment was valued by patients, but there was no data indicating efficacy against CB-PTSD from use shortly after childbirth vs treatment as usual (TAU) in a healthy live birth. However, moderate-term improvements were reported from a session following a traumatic childbirth.

Crisis intervention was also associated with decreased CB-PTSD symptoms at discharge vs TAU. Trauma-focused cognitive behavioral therapy was assessed as a secondary and tertiary measure, with moderate-term reductions in CB-PTSD following secondary use and mixed results following tertiary use.

When used as a secondary intervention, a single session of EMDR led to decreased CB-PTSD symptoms. However, CB-PTSD diagnoses were not impacted. Expressive writing was associated with reduced CB-PTSD and postpartum depression.

Memory consolidation included engaging with activities such as Tetris after birth to manipulate memory of the trauma. This method had mixed results for CB-PTSD prevention, showing no advantage when measured based on clinical evaluations. However, limited evidence of memory consolidation as a tertiary prevention indicated improved symptoms.

Additional methods with efficacy for preventing CB-PTSD or reducing symptoms include psychological counseling, mother-infant–focused therapy, and alternative therapies such as biofeedback, mindfulness-based stress reduction, and music therapy. Educational interventions were also associated with fewer CB-PTSD symptoms.

These results indicated reduced CB-PTSD symptoms from trauma-focused and non-trauma-focused psychological therapies. Investigators recommended providers utilize these therapies on a case-by-case basis to reduce maternal psychological burden after childbirth.

Reference

Dekel S, Papadakis JE, Quagliarini B, et al. Preventing posttraumatic stress disorder following childbirth: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology. 2024;230(6):610-641.E14. doi:10.1016/j.ajog.2023.12.013