Kelli MacMillan

Background
Growing evidence highlights maternal risk factors that can increase the likelihood of traumatic childbirth experience. Yet little is known about the availability of primary antenatal intervention for childbirth trauma to facilitate optimal maternal and infant outcomes. The aim of this study was to conduct a systematic review of the literature and empirical evidence to identify antenatal interventions and their effectiveness for treatment of childbirth trauma, post-traumatic stress disorder (PTSD), subthreshold PTSD, or post-traumatic stress (PTS) from childbirth.

Methods
Four databases were accessed: PUBMED, CINAHL, ProQuest, and EBSCOHOST. PRISMA guidelines were followed for screening and reporting. Inclusion criteria were as follows: (1) peer reviewed articles; (2) samples of pregnant women; (3) published in English; (4) measure of PTSD, PTSD symptoms, PTS or fear of childbirth; (5) variable of childbirth trauma or childbirth experience; (6) antenatal intervention; and (7) human studies.

Results
We identified 2034 articles, with 12 articles in the final sample. The most common antenatal intervention in four studies was childbirth plans, which were associated with an increase in positive childbirth experience, childbirth control, mastery, and participation, as well as increased self-efficacy and reduced PTSD symptoms (p < 0.01). Other interventions included antenatal counseling and psychoeducation; eye movement desensitization and reprocessing; counseling; haptotherapy; trauma-informed care; cognitive behavioral therapy; and hypnosis for childbirth trauma.

Conclusions
Methodological limitations as well as a lack of inclusion of women with perinatal mental health difficulties represent gaps in knowledge. Findings suggest promising evidence for the implementation of antenatal interventions in clinical and hospital contexts to treat childbirth trauma.

While there is substantial research in maternal antidepressant treatment and depression and child mental health outcomes very few studies examine the role of remission of depression and whether this improves parenting and child outcomes. This study utilises data from a sample of 246 women from the first trimester of pregnancy until the child reached 4 years of age including 49 women who took antidepressants in pregnancy, 23 women who had untreated depressive disorder and 174 control women. At recruitment the Structured Clinical Interview for DSM (SCID) was administered. The Edinburgh Postnatal Depression Scale (EPDS) twice in pregnancy and at 6 and 12 months postpartum. At 6 months, the parent-infant relationship was measured using the Emotional Availability Scales (EAS). Child mental disorders were measured at 4 years of age with the Preschool Age Psychiatric Assessment (PAPA). Women whose depression was not successfully treated were more likely to have a child with an emotional disorder. Women with higher concurrent EPDS scores and those with lower EAS scores were both more likely to have a child with a behavioural disorder. The quality of the parent-infant relationship was not found to mediate a relationship between antidepressant treatment and either child behavioural or emotional disorders outcomes at 4 years of age. Successful treatment of antenatal depression reduced vulnerability to childhood emotional disorders; however, how this occurs is unclear and it was not found to be through improving parent-infant relationship quality. Independently, the quality of early parent-infant relationship did predict later vulnerability to childhood behavioural disorders.

Coercive control (CC) involves an ongoing pattern of behaviour that can occur within intimate partner violence with the aim of controlling, containing, or compelling a person, with deleterious long‐term effects. This study addresses an evidence gap using Lagdon, Jordan, Devine, Tully, Armour and Shannon (2023: Journal of Family Violence 38, no. 1: 39–50) methodological approach to assess the Australian public awareness about CC. Participants reviewed two gendered CC scenarios, one more obvious and one less obvious, rated their agreement towards ten opinion statements, and answered if they had heard of the term ‘coercive control’. Binary logistic regression assessed predictors of CC awareness and split‐plot analysis of covariance models assessed agreement to opinion statements by CC obviousness and victim gender. Findings indicated that reporting low awareness of CC (42%; n = 152) was more likely among respondents aged 18–24 years ( p < 0.001) and among those who did not complete high school ( p < 0.001), and less likely among those living in non‐metropolitan locations ( p < 0.001) and among those earning a low income ( p = 0.009). There was stronger agreement ( p < 0.001) with statements for obvious CC, indicating respondents' difficulty identifying subtle behavioural patterns and male victim‐survivor experiences. Findings highlight the need for education campaigns that increase CC awareness, to facilitate early identification of less obvious CC and mitigate adverse long‐term effects.

In Western settings where solitary, continuous infant sleep throughout the night is emphasised, parents might perceive their infant's nightwaking as a problem and seek solutions. Interventions typically aim to reduce nighttime parent-infant interactions to facilitate independent infant sleep. There are concerns regarding the acceptability of these interventions to parents, and their applicability for families with diverse parenting practices, such as co-sleeping. The specific theories and strategies applied by evidence-based infant sleep interventions have not been systematically explored. This scoping review aimed to characterise infant sleep interventions for their theoretical underpinnings and behaviour change techniques (BCTs]. Where applicable, this review also aimed to explore associations between meaningful groupings of theory type and BCTs and outcomes including parent satisfaction and intervention adherence. Online databases were searched for Randomised Controlled and cluster Randomised Controlled Trials of non-pharmacological interventions delivered in non-acute primary care or community settings that targeted the prevention or treatment of sleep problems in infants (0–3 years). Twenty-eight of 34,898 retrieved articles were included, describing 34 unique interventions. Operant conditioning theory underpinned 50 % (13/26) of the theory-informed interventions. Interventions were found to be multicomponent and the application of BCTs was heterogeneous across interventions. Findings suggest a need for more diversity of theoretical underpinnings and a clear indication of BCTs included in interventions. Future research should identify theories that can be adapted to align with family cultural contexts and parenting practices, and BCTs that can be operationalised to facilitate acceptable and culturally sensitive approaches to infant sleep intervention.

Despite what some researchers may suggest, the association between child developmental outcomes and perinatal mental health disorders may not be consistently found. Wide methodological differences between the conceptualization and measurement of child development and perinatal mental health, including depression and anxiety, limit the comparability of findings, and small effects and differences in sample sizes ensure that reported associations are not to be overstated. For serious mental illnesses such as bipolar disorder, borderline personality disorder, eating disorders, schizophrenia, or substance use disorders, there is a lack of robust longitudinal evidence. What the existing literature tells us is that over and above perinatal mental health, it is the complex interaction of maternal and child factors that might explain the variation in developmental outcomes observed in the research rather than the maternal psychopathology itself. We have an obligation to those women who experience perinatal mental health difficulties to ensure the accurate translation of research findings so that intervention can be applied where risk factors are identified that may influence child developmental outcomes.

Emphasis on continuous infant sleep overnight may be driven by parental concern of risk to child mental health outcomes. The Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) examined whether infant sleep at 6 and 12 months postpartum predicts anxiety disorders at 2–4 years, and whether this is moderated by maternal depression, active physical comforting (APC) or maternal cognitions about infant sleep. Data included 349 women and infants. Infant sleep was measured using the Brief Infant Sleep Questionnaire and child anxiety disorders by the Preschool Age Psychiatric Assessment. The risk of developing generalised anxiety or social phobia disorders at 3–4 years was reduced by 42% (p = 0.001) and 31% (p = 0.001), respectively, for a one standard deviation increase in total sleep at 12 months. No other infant sleep outcomes were associated. Maternal depression, APC and cognitions about infant sleep did not significantly moderate these relationships. Focus may need to be on total infant sleep, rather than when sleep is achieved.

Purpose

To compare the prevalence of emotional and physical intimate partner violence (IPV) across pregnancy and the first year postpartum in those with and without clinical depression and assess the association between maternal childhood trauma, current stressful life events and depression and IPV over the perinatal period.

Methods

Data were obtained from 505 pregnant women from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a cohort study with data collected across pregnancy until 12 months postpartum. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV) with repeat measurement of perinatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). Trauma was measured using the Childhood Trauma Questionnaire, and experiences of physical and emotional intimate partner violence using items in the Stressful Life Events Scale.

Results

Women experiencing IPV across the perinatal period were significantly more likely to score over 13 on the EPDS (p < .001) at each timepoint in pregnancy and the postpartum and physical IPV was associated with clinical depression. Further, a history of childhood trauma and current additional stressful life events were significantly associated with reporting current IPV in the perinatal period.

Conclusions

This study confirmed the risk factors of childhood trauma and current stressful life events for reporting experiences of IPV in the perinatal period. Furthermore, women experiencing IPV reported higher depressive symptoms, providing evidence supporting the value of assessing those women who screen higher on the EPDS for IPV. Together these findings also support trauma informed care across pregnancy and the postpartum.