When something goes
wrong…

Complications of
pregnancy and delivery,
miscarriage, prenatal
diagnosis, traumatic
delivery

Estimates of

reproductive problems

Estimated lifetime risk of

maternal death by geographic

region



Africa 1 in 21



Asia 1 in 54



South America

1 in 73



Caribbean

1 in 140



North America

1 in 6366



Northern Europe 1 in 9850

Reproductive statistics for

Poland

Women’s reactions to

complications in

pregnancy



Anxiety and fear



Worries over the course of pregnancy /
child’s health, one’s own health



Denial



Search for information / emotional support



Changes in lifestyle



Decision to undergo special diagnosis /
treatment

Prenatal diagnosis



WHEN



> 37, < 16



genetic diseases in
family



genetic disease in
previous children



malformed foetuses
in previous
pregnancies



2-3 miscarriages with
unknown reasons



WHAT



Ultrasound scan



Amniocentesis



Crionic villi
sampling

Psychological aspects of

ultrasound scan (C.Baillie,

1999)



Decreasing anxiety (artefact?)



No impact on lifestyle in pregnancy



Less stress



No changes in attitudes to pregnancy /
baby



No impact on prenatal bonding (in
normal)



More positive attitudes towards ultrasound
scan itself

How to persuade a patient to

go for amniocentesis ?

(T. Marteau,1993)



Offered to all 36 +



RISK of Down syndrome always mentioned



Not always info that the test reveals ONLY
50% of problems



No discussion - woman’s views ignored, not
attended to, directive communication



Wrong estimates of risk of Down syndrome
and of complications afterwards

Prenatal diagnosis -

feminist perspective (R.

Tong, 1997)



POSITIVE, if



possibility to
refrain from
procreation if
genetic risk



free decision to
undergo prenatal
tests



free decision to
deliver unhealthy
baby



NEGATIVE, if



not available for
every woman

Childbirth as an event
in autobiographical
memory

In autobiographical memory there
are events that …

… are experienced by an
individual
… are organised within a
sequence of other events
… are well placed in the time
frame
… make sense for an individual

Events evaluated less positively are
not remembered well (poorly
recalled)

Fear of labour in first and

second pregnancy - studies

in UŁ

Fear of labour in first and

second pregnancy - studies

in UŁ



FIRST
pregnancy



High in I and III
trimester, low in II



Fear mainly over
course of labour and
health of the child



Related to STAI-trait
scores (positively)



SECOND
pregnancy



Increases steadily
over the whole
pregnancy



Fear mainly over
maternal tasks and
well-being in
postpartum period



Related to STAI-trait
scores (positively)

Traumatic birth -
prevalence



Janet Menage (1993)



6 %



Suzanne Lyons
(1998)



9,5 %



Sarah Allen (1998)



13,7 %



Susan Ayers et al..
(2007)



5%

Childbirth as a traumatic

event

(Sarah Allen, 1998)

Harm to

a baby

Past

experiences

Pain

NOT IN CONRTOL

Attempt to access emotional

and practical support

Failure to

access support

Consequences of

traumatic birth



For a woman



development of PTDS syndrome



negative evaluation of a partner /
medical personnel



For her relations with a partner



less positive relationship with a
partner



disturbances in sexual life

Consequences of

traumatic birth



For the relationship with a baby



lack of close bonding



blaming a child



overprotectiveness



lack of confidence as a mother



For future procreation



no more pregnancies



Cesarean section preferred

Traumatic birth and PTSD in
men and women (Ayers et al.,
2007)



64 couples with babies 6-12 weeks of age



PTSD measured by the Impact of Events

Scale by Horowitz



The same intensity of symptoms of intrusions

and avoidance in men and women



PTSD not associated with couple’s

relationships or parent-baby bond



The best predictors of PTSD for men and

women: „something going wrong during

birth”, „delivery problems”, „emotions during

birth”

PTSD after delivery

studies in UŁ



SAMPLE



70 women (18 – 36

yrs)



M = 25,93



SD = 3,89



Labour 6 months

earlier



With a partner - 35



Without a partner - 35



Subgroups not

different according to

education, job,

duration of marriage



PROCEDURE



„Labour experience”

questionnaire



PTSD symptoms

from DSM-IV –

finally 15 items



Factor analysis



3 factors – 61,5%

variance explained



Arousal, avoidance,

re-experience



Other questionnaires



CISS

PTSD after delivery

studies in UŁ

PTSD after delivery

studies in UŁ

PTSD after delivery

studies in UŁ

PTSD after delivery

studies in UŁ

PTSD symptoms and coping

(Pearson’s r for women without a

partner)

*
*

*
*

*
*

*

** p <
0.01

* p <
0.05

Memories from childbirth –

studies in UŁ



SAMPLE



96 women



M = 27,73



SD = 4,46



Partner



Present at labour -

42



Partner absent -

54



Subgroups not different

according to education,

job, duration of

marriage



PROCEDURE



Descriptions of labour

and rating scales



Time 1 - prenatal ward



expectations related

to labour



Time 2 – in postnatal

ward



evaluation of the

birth expereince



Time 3 – 6 month after



evaluation of the

birth experience

Expectations and memories

Pearson’s r correlation

p <
0.001

Comments on

labour/delivery



Time 2 (just after)



Longer descriptions



More technical details



Staff – positive and negative remarks



Pain - more detailed description



Positive evaluation of a husband
being present

Comments on

labour/delivery



Time 3 (6 months after)



Shorter stories



Staff – negative remarks



More comments about the child



More comments about a woman’s well-
being



Pain - general description



Positive evaluation of a husband
being present

The presence

of the birth companion



General negative comments on

labour experience - less often



Less PTSD-like symptoms



Different opinions on a woman’s

own behaviour



WITH – stable opinion with time



WITHOUT – more negative with time



More negative evaluation of a

medical staff with time

The presence

of the birth

companion…



… is a source of possible support



emotional and practical



… helps a delivering woman to

maintain sense of control over the

event



a woman can rely on someone else

but the staff



… provides framework for a

woman’s own experiences



changes in evaluation of one’s

own behaviour and staff action

Prenatal attachment and

miscarriage

Intensity of

attachment

The level of

„psychological

investment” in

pregnacy

Intensity of

grief

Time

Pregnancy

loss

Depression after

miscarraige

Number of
miscarraiges

Maternal age

Duration of
pregnancy

Support from
medical staff

Number of
children

Poor
material
situation

Low perceived
social support

Low
resilience

No
pregnancy
/ delivery
within 1
year

The meaning
of
pregnancy
loss

Active
coping

Passive
coping

DEPRESSIO
N

Swanson, 2000

Experience of pregnancy

loss – theoretical model

(studies in UŁ)

Miscarriag

e

Circumstances

of pregnancy

loss

Attitude
towards

pregnancy

Coping / social

support

Woman’s

experience

after the loss

Present

experiences as

the result of loss

Partner’s

behaviour

after the loss

Support

for a

woman

Expression of

one’s own

reactions

Miscarriage – the effect on

a family



The replacement child syndrome (O’Leary,

2004)



The next child replaces the one who died during

miscarriage



The vulnerable child syndrome (O’Leary, 2004)



The next child needs a lot of support and care from

parents



Weaving babies lost in pregnancy into the

fabric of the family (Cote-Arsenault, 2003)



Other persons should be informed about the loss



Rituals commemorating the child lost in the miscarriage