INTERSECTplus

In Brazil, a study on Perinatal loss: “Bereavement process after the experience of a traumatic birth” has been carried out by Bárbara Albasini Bard (Master’s Student), supervised by Professor Daniela Centenaro Levandowski at UFCSPA (Federal University of Health Sciences of Porto Alegre). This study aims to examine the bereavement process of women who experienced perinatal loss (the loss of the baby between the 22 weeks gestation, and 1 week after birth) and perceived the birth process as traumatic or not.

In the UK, Scarlett Spratt, Dr Rebecca Webb, Prof Susan Ayers and Dr Georgie Constantinou are currently exploring the structure of maternity care in relation to birth-trauma and PTSD. Events during birth increase the risk of developing birth-trauma and PTSD e.g., negative birth experience, unplanned operative birth, and lack of support during birth. These events may be more likely to happen in certain maternity care settings. The funding (public vs private) and structure (hospital vs birth centre; midwifery led vs obstetric led) of maternity services varies between countries. Furthermore, some countries do not allow the birth partner to attend the birth. These differences in how maternity services are structured and offered will impact on maternal safety and outcomes and women’s experiences of pregnancy and birth. No previous research has attempted to understand how the way maternity systems are structured can impact on birth-related PTSD. It is important that this is researched because these findings have the potential to inform policy about childbirth practices. Objectives: 1. To identify different categorisation methods of maternity care systems using a systematic review (Phase 1) 2. To develop a measure of differences in maternity care systems using the results from Phase 1 (Phase 2) 3. To validate the measure of differences in maternity care through a panel of expert stakeholders (Phase 3) For more information please contact: Rebecca.webb.2@city.ac.uk

In Ireland, Ursula Nagle is currently undertaking a PhD at Trinity College Dublin titled ‘The Impact of Perinatal Trauma – A mixed methods study investigating and exploring the prevalence, women’s experiences and related factors associated with birth trauma in an Irish maternity setting’. Under the supervision of Prof Joan Lalor (Trinity College Dublin), Prof Susan Ayers (City University London) and Prof Antje Horsch (University of Lausanne), the study proposes to measure the prevalence, manifestations and etiology of childbirth-related PTSD (CB-PTSD) through INTERSECT study in one hospital-based location in Ireland, and to explore and understand the experiences of postnatal women with a history of interpersonal trauma (IPT) who also experience birth as a traumatic event. Within the interviews, there is a focus on help-seeking behaviours. This will be achieved using a two-phase mixed-methods study design. In phase 1 (quantitative), systematic sampling will identify participants who have experienced a traumatic birth from INTERSECT study. Results of this phase will provide new data on the prevalence, symptom presentation and etiology of birth-related trauma in Ireland. In phase 2 (qualitative), criterion-based sampling from INTERSECT will identify participants with a history of IPT who have experienced a traumatic birth. In-depth interviews will seek to explore and understand women’s experiences with a focus on help-seeking behaviour. Data collection for both phases is well underway and is expected to be completed in June 2024. Little is known about the impact of childbirth-related PTSD in Ireland. This is important knowledge which can impact national and international clinical practice, policy making and contribute to the development of trauma-informed evidence-based education, practice and service developments. For more information please contact: nagleu@tcd.ie @PerinatalMW

The INTERSECT study also has four groups of researchers from different countries extending the study into specific areas of interest these include; - Fathers/birth partners - Fear of childbirth - Mother-baby bond - Maternal mistreatment These groups met frequently in the early stages of the study to decide upon the measures they would add to the core INTERSECT measures to collect additional data which could be analysed across countries on these interests. For more information please contact: intersect@city.ac.uk

The INTERSECT study also has a postgraduate group which was set up by PhD Student Ursula Nagle from Ireland. This group was put in place to connect those postgraduate students working on the INTERSECT project internationally to give an opportunity to network and support one another. For more information or to join please contact: nagleu@tcd.ie

Carried out by Taghreed Alsubaie and supervised by Dr. Haya Zedan at Saudi Electronic University, Saudi Arabia and Professor Susan Ayers, City, University of London, UK, this project aims to understand the influence or relationship between culture, traditions, and societal expectations on incidence or prevalence rates of postpartum stress, PTSD and and mood disorders in women within the Saudi Arabian context. For more information contact: Taghreed.Alsubaie@city.ac.uk

This project explores how childbirth-related stress is reflected in hair cortisol, a biomarker of chronic stress, in postpartum women. Embedded in the international INTERSECT survey, it examines links between physiological stress, traumatic birth experiences, PTSD, and postpartum depression across multiple countries.

Wave 1 of the INTERSECT data is available on the UK Data Service. Researchers are welcome to apply to access this data and carry out secondary analyses. Examples of secondary analysis projects include: •The role of prior interpersonal vs. non-interpersonal trauma in moderating the association between support during childbirth and CB-PTSD. •Differences in mental health outcomes following childbirth among women with a history of sexual violence across income-level countries. •Prevalence and mental health correlates of CB-PTSD among mothers with multiple births. •Profiles of postpartum PTSD–depression comorbidity identified using latent profile analysis and their cultural correlates. •Associations between pregnancy complications (e.g., gestational diabetes, preeclampsia) and postpartum PTSD, anxiety, and depression. •The relative contribution of subjective birth experience versus perceived social support to postpartum stress, anxiety, and depression. •Mental healthcare utilization among mothers with CB-PTSD: country-level differences and associated sociodemographic factors. •Birth companion type and birth satisfaction as predictors of perceived birth trauma across cultural settings. •Adverse life events and postpartum depression: cross-national moderation by country of birth •The role of immigration status on CB-PTSD while controlling for a range of socio-demographic and birth related variables. You can apply to access the INTERSECT dataset via the UKDS: https://datacatalogue.ukdataservice.ac.uk/studies/study/9295#details

Multiple researchers have included a qualitative component to INTERSECT. These include: •Exploring women’s symptoms of CB-PTSD after birth (Ijlas El Founti-Khsim, Spain) •Exploring and understanding women who have experienced inter-personal violence, experiences of CB-PTSD with a focus on help-seeking behaviour (Ursula Nagle, Ireland) •Understanding women’s experiences of childbirth trauma and postpartum PTSD, by exploring the psychological and emotional experience of social, cultural and health care-related factors in the Solomon Islands (Lydia Kaforau, Solomon Islands) •Exploring memories of birth experiences in a group of women who meet all the diagnostic criteria for CB-PTSD, guided by Deci and Ryan’s Self-Determination Theory (Natalia Murawska, Poland)