Childbirth and the development of acute trauma symptoms: Incidence and contributing factors
Childbirth and the development of acute trauma symptoms: Incidence and contributing factors
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DOI：
10.1046/j.1523-536x.2000.00104.x
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发表时间：
2000-06-01
影响因子：
2.5
通讯作者：
Horsfall, J
中科院分区：
文献类型：
--
作者：
Creedy, DK;Shochet, IM;Horsfall, J
背景：关于妇女的分娩经历和创伤症状的发展之间的关系，人们知之甚少。本研究旨在了解因分娩和分娩经历而导致的女性急性创伤症状和创伤后应激障碍的发生率，并找出导致女性心理痛苦的因素。方法：采用前瞻性、纵向设计，从4家公立医院产前诊所招募怀孕最后三个月的妇女。在产后4至6周对499名参与者进行了电话采访，以探讨分娩的医疗和助产管理、对产中护理的看法以及创伤症状的存在。结果：1/3的妇女(33%)确定了创伤性分娩，并报告至少存在三种创伤症状。28名女性(5.6%)符合DSM-IV的急性创伤后应激障碍标准：产前变量不会导致急性或慢性创伤症状的发展。分娩期间所经历的产科干预水平(Beta=0.351，p<；0.0001)和产中护理不足(Beta=0.319，p<；0.0001)与急性创伤症状的发展一致相关。结论：产后创伤后应激障碍是一种较少被认识的现象。与接受过高水平产科干预的妇女或认为自己的护理不足的妇女相比，同时经历了高水平产科干预和对其产中护理不满意的妇女更有可能出现创伤症状。这些发现应该促使认真审查在分娩和分娩期间的干预性产科干预，以及为分娩妇女提供的护理。
Background: Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder in women as a result of their labor and birth experiences, and to identify factors that contributed to the women's psychological distress. Method: Using a prospective, longitudinal design women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Telephone interviews with 499 participants were conducted at 4 to 6 weeks postpartum to explore the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms. Results: One in three women (33%) identified a traumatic birthing evens and reported the presence of at least three trauma symptoms. Twenty-eight women (5.6%) met DSM-IV criteria for acute posttraumatic stress disorder: Antenatal variables did not contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (beta = 0.351, p < 0.0001) and the perception of inadequate intrapartum care (beta = 0.319, p < 0.0001) during labor were consistently associated with the development of acute trauma symptoms. Conclusions: Posttraumatic stress disorder after childbirth is a poorly recognized phenomenon. Women who experienced both a high level of obstetric intervention and dissatisfaction with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. These findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the care provided to birthing women.