Symptoms of post-traumatic stress after emergency caesarean section : women's sense of coherence and perceived support from health care providers and family

The overall aim of the work presented in this thesis was to increase knowledge concerning which new mothers delivered by emergency caesarean section (EmCS) may need extra attention for post-traumatic stress symptoms. The first specific aim was to examine the associations between, on the one hand, sense of coherence (SOC) and obstetric and demographic variables a few days postpartum, and on the other hand, post-traumatic stress symptoms three months postpartum (I). The second specific aim was to explore the experiences and perceptions of support from staff and family as related by women with or without post-traumatic stress symptoms (II).

Methods: One-hundred-and twenty-two women delivered by emergency caesarean section (EmCS) participated in the prospective study. The Sense of Coherence Scale (SOC-13) was administered two days after the EmCS and the Impact of Event Scale (IES-15) was filled in three months after the EmCS (I). Experiences and perceptions of support postpartum were explored via telephone interviews six months later. We analyzed the interviews of 42 women with post-traumatic stress symptoms and 42 women without such symptoms (II). Manifest content analysis was used.

Results: Independent risk factors associated with post-traumatic stress symptoms after an EmCS were: the woman's low SOC (OR 4.12, 95% CI 1.72-9.86) and imminent foetal asphyxia as an indication for caesarean (OR 2.36, 95% CI 1.03-5.44). The women who experienced low SOC were more often those with an intense fear of childbirth during pregnancy, immigrants and socially underprivileged women (I).The midwives' actions, the content and organization of care, the women's emotions, and the role of the family, were main categories that seemed to influence the interviewees' perceptions of support in connection with childbirth. Women with posttraumatic stress symptoms mentioned nervous or non-interested midwives, intense fear during delivery, lack of postnatal follow-up, long-term postpartum fatigue and inadequate help from partners. Women without symptoms reported involvement in the decision to undergo EmCS and a feeling of relief (II). Postpartum follow-up was often lacking among the women with post-traumatic stress symptoms.

Conclusions: Symptoms of post-traumatic stress following EmCS are associated both with the new mother's personal coping style and the circumstances of the event. Both staff and family have important roles concerning support in connection with an EmCS. Women with post-traumatic stress symptoms tend to experience less support than women without symptoms. They also report more fear during the birth process and less involvement in the decision to perform an EmCS. Obstetric health care staff should actively contact new mothers with risk factors for stress symptoms following childbirth. Consultation by telephone may be a good alternative form of follow up.

List of scientific papers

I. Tham V, Christensson K, Ryding EL. (2007). Sense of coherence and symptoms of post-traumatic stress after emergency caesarean section. Acta Obstet Gynecol Scand. 86:1090-1096.
https://doi.org/10.1080/00016340701507693

II. Tham V, Ryding E L, Christensson K. (2010). Experience of support among new mothers with and without post-traumatic stress symptoms following emergency caesarean section. [Accepted]
https://doi.org/10.1016/j.srhc.2010.06.004