Tackling intrusive traumatic memories after childbirth: Study protocol of a single-blind waitlist randomized controlled trial
1Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Switzerland; 2Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Switzerland; 3Division of Clinical Psychology and Psychotherapy, Saarland University, Saarbrücken, Germany; 4Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland; 5School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland; 6Department of Psychology, University of Geneva, Geneva, Switzerland; 7Neonatology Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
Childbirth-related posttraumatic stress disorder (CB-PTSD) concerns up to 6.8% of high-risk mothers. However, there is limited evidence regarding the effectiveness of available treatments for established CB-PTSD. Therefore, developing evidence-based treatments is essential. A core symptom of CB-PTSD are intrusive traumatic memories (ITMs). Preliminary evidence suggests that the reconsolidation of ITMs can be disrupted by reactivating the memory and completing a visuospatial task. In a pilot study (n = 18), we applied a single-session behavioural intervention, composed of a brief evocation of the childbirth followed by Tetris gameplay, which showed a median reduction of 82% of the number of CB-ITMs and a mean reduction of 57% of CB-PTSD symptom severity.
Building on this pilot study, this single-blind waitlist randomized controlled trial will test the efficacy of this intervention in 90 women with established CB-ITMs.
Participants will report their CB-ITMS, previously screened with the Clinician-Administered PTSD Scale for DSM-5, during the two weeks pre- and post-intervention in diaries (1 and 2). The immediate treatment group will also complete a third diary during the fifth and sixth weeks post-intervention. The primary outcome will be the difference in change of the number of CB-ITMs between diary 1 and 2 across groups. Secondary outcomes include the severity of CB-PTSD symptom assessed using the City Birth Trauma Scale at two and six week post-intervention, the number of CB-ITMs in diary 3 and the acceptability of intervention.
This study will contribute to developing a single-session behavioural intervention to reduce CB-PTSD symptoms.
Bridging the Swiss Milk Gap: Creation of the First Human Milk Bank in Western Switzerland at the CHUV
1Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, Switzerland; 2Laboratoire de Préparation Cellulaire et d’Analyses, Département Innovation et Produits Thérapeutiques, Transfusion Interrégionale CRS, Epalinges, Switzerland; 3The University of Queensland, Australia; 4HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland; 5Clinic of Obstetrics, University Hospital Zurich, for Breastfeeding Promotion Switzerland; 6Laboratoire de Recherche sur les Produits Sanguins, Département Innovation et Produits Thérapeutiques, Transfusion Interrégionale CRS, Epalinges, Switzerland; 7Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland; 8Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
AIM: Mother’s own milk (MOM) is the ideal nutrition and provides protection most especially for premature, sick or low birth weight neonates. When MOM is limited, donor human milk (DHM) from a human milk bank (HMB) is the recommended alternative, as it reduces the risk of necrotizing enterocolitis, hospital stay and costs, and supports breastfeeding rates. In Switzerland, unequal access to DHM remains a public health issue in the absence of national policies. To address the need of DHM for at-risk neonates, the CHUV collaborated with the Interregional Blood Transfusion (TIR) of the Swiss Red Cross, to establish an innovative, safe, equitable and sustainable HMB model.
METHODS: The project began in 2019, merging the expertise of both the CHUV, in newborn care, nutritional and breastfeeding support, and the TIR in the collection of donations, analyses, traceability, quality and safety of biological products. Interdisciplinary work groups (recruitment, processing, nutrition, ethics, traceability and logistics) developed roadmaps, deliverables, risk analyses, budgets, timelines, processes and procedures based on national and international recommendations and the scientific literature. The project team led the monitoring and coordination with the guidance of the steering committee.
RESULTS: After 2.5 years of development, validation, training, and simulations, the Lactarium of the CHUV opened in May 2022 with the support of the Public Health Department, Canton of Vaud. The team has qualified the first donors, coordinated the collections, microbiological tests, processing, storage and distribution of pasteurized DHM to neonates with medical indications.
DISCUSSION: The creation of the first HMB in Romandy, based on an innovative model, bridges a part of the milk gap to respond to the critical needs of hospitalized neonates and their families. Political and health leaders must establish frameworks and strengthen education and research at both regional and national levels.
Digital storytelling (DST) as an approach to creating health-promoting narratives in pregnant women with fear of childbirth (FOC) after a previous traumatic birth experience: a qualitative narrative enquiry in the Swiss-German context
Zürich University of applied sciences
FOC has become a common phenomenon reported by pregnant women. The latest reports suggest a rising trend, with rates in Europe varying from 4.5% to 15.6% and an estimated global prevalence of 14%. Narratives drawn from a group-based DST process are increasingly being used in health promotion to support emotional recovery from posttraumatic events and empower participants to adopt healthy behaviours. The process, as much as the end product of DST, can increase a sense of self-efficacy and social support and positively impact physical and mental health.
A narrative research design will seek to uncover the lived stories of pregnant women. The DST process described by Gubrium (2009) will be used to facilitate the workshops, which includes an initial individual phase, where pregnant women will be introduced to the objectives of the workshop, write their stories accordingly, collect images and learn the basics of DST; a group or “story circle” phase where participants will present a draft of their stories to other group members and investigators and receive structured feedback; and a final story screening phase, where participants will introduce and screen their digital stories and conclude with a group discussion and reflection on the content of each story, to elicit information about FOC and how the DST process has affected their subjective experiences.
This approach will focus on pregnant women's self-generated meanings of FOC. The DST process and end product will offer an array of qualitative data in visual, oral, aural and textual forms. Most of this data will be captured by the created digital stories. Gubrium (2009) argues that the story circle and the reflection phases of the DST process serve as a focus group moderated by the storyteller. The value of using these two phases as focus groups is that lived experiences can be uncovered within a social context and everyday language as participants consider their views with others.
“Of course I’m abstinent! I hardly drink anymore” - Measuring and understanding women's abstinence during pregnancy: practical issues of qualitative results
1Hesav, (Haute Ecole Santé Vaud) Lausanne, HES-SO (Haute Ecole Spécialisée de Suisse Occidentale); 2ZHAW, (Zürcher Hauchschule für Angewandte Wissrenschaften), Winterthur, Depatment Gesundheit, Institut für Hebammen
Alcohol use during pregnancy is a public health issue. Official guidelines have become more stringent, recommending that pregnant women abstain from all alcohol consumption. Preventing risks is part of maternity care. Different tools allow to assess the consumption, and to define an appropriate follow-up. Nevertheless, the issue of alcohol is not systematically addressed and professionals do not always feel comfortable or competent to inform and question about alcohol consumption.
This presentation is based on a thematic secondary analysis of around sixty interviews with pregnant women in the context of two qualitative surveys. The aim is to explore the meaning of the notion of abstinence from the pregnant women’s perspective, and to address the implications for perinatal health professionals.
From “zero alcohol” to “significantly reduced” consumption, women have varying definitions. The recommendation to abstain is often interpreted in different and complex ways by women, involving their attitudes towards public health messages and scientific uncertainty about the effects of low or moderate drinking; their interpretation of their own risk and acceptable consumption; their personal experience; their representations of the mechanisms of alcohol’s harm to the fetus.
To the question: “Madam, do you drink alcohol?”, the answer “no” is unequivocal. The consideration by health professionals of the meanings for pregnant women can avoid certain misunderstandings, improve the approach to alcohol issues, screening, as well as information on risks and official recommendations.
A conversational approach could improve the accuracy of reported quantities and enable better support for women.
Mothers and Fathers : what are their Social Support Needs During the Early Postpartum Period : A Qualitative Study
1Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Switzerland; 2Department woman-mother-child, Lausanne University Hospital, Switzerland
Introduction: Transition to parenthood is challenging for both first-time mothers and fathers. In the early postpartum, up to 50% of parents have reported inappropriate professional support. Social support that appropriately meets parents’ needs is a protective factor for parents’ wellbeing. However, little is known about social support needs of first-time mothers and fathers during that time.
Methods: This qualitative study, conducted in two maternity services in Western Switzerland, aimed to determine first-time mothers and fathers’ social support needs in the early postpartum and to identify which healthcare professionals’ (HCPs) behaviors are likely to meet their needs. Individual semi-structured interviews were transcribed verbatim and analysed using thematic analysis.
Results: 15 mothers and 11 fathers were interviewed. 6 themes were identified in mothers and 4 in fathers. Mothers’ themes were mainly related to body and emotional changes after birth. Fathers’ themes were related to the ambivalence they faced between wanting “to be involved and have support” and “not wanting to take the support off their partner. Themes shared by mothers and fathers were related to the newborn: “caring for their newborn” and “returning home”. No differences were found in HCPs’support behaviors as reported by parents and included “welcoming parents”, “establishing a partnership with parents”, “guiding parents in acquiring their new role”, “caring for parent’s emotions”, and “creating a serene atmosphere”.
Discussion: Mothers needed more emotional support than fathers, as fathers were ambivalent about their social support needs. Helpful support behaviors according to parents were related to staff listening to and acknowledging their experience.
Conclusion: Mothers’ and fathers’ needs differed in terms of social support needed, but not when related to their baby. Both mothers and fathers agreed on what helpful HCPs behaviors were.