REPRODUCTIVE JUSTICE

MEDICALIZATION IN MATERNAL HEALTHCARE

**NOTE**  Medical advancements have saved the lives of women and babies at risk for injury or death during pregnancy and birth.  This site is not about the doctors who properly use interventions to save lives; it is about those who use them unethically for profit or convenience.   Improperly used interventions have led to harm and death of women and babies and obstetrics  is the only field in which mortality rates are rising and non-medically needed interventions such as c-sections are related to 66% of maternal deaths. 

**NOTE**  This site is designed to share valid evidence for those working to change the maternal healthcare system who do not have access to databases of peered research. 

**NOTE** Chronological order allows users to find new data.  It also begs the question of why, when we have known for decades that such practices are harmful, do they not only continue to be used but are increasingly used.

POSTPARTUM DEPRESSION AND PTSD

Also see fathers/partners page as men often suffer from PPD/PTSD

WHAT DOES THE LITERATURE SAY?

2024

New York City Dept. of Health. (2024) Postpartum Depression. Accessed https://www.nyc.gov/site/doh/health/health-topics/post-partum-depression.page

• Most women suffering with depression take excellent care of their children. However, if depression is severe, or if a mother is suffering from other concerning psychiatric symptoms, sometimes children may be at risk unless the mother gets help.

2023

Joy, S. (2023) Postpartum Depression. Accessed  https://reference.medscape.com/article/271662-overview?form=fpf

• Patients and their caregivers frequently overlook postpartum depression, despite the fact that effective nonpharmacologic and pharmacologic treatments are available for this condition. ^[1, 2] Untreated postpartum affective illness places the mother and infant at risk and is associated with significant long-term effects on child development and behavior. 

2022

Nicole Ginter, Lea Takács, Martine J. M. Boon, Corine J. M. Verhoeven, Hannah G. Dahlen, & Lilian L. Peters. (2022). The Impact of Mode of Birth on Childbirth-Related Post Traumatic Stress Symptoms beyond 6 Months Postpartum: An Integrative Review. International Journal of Environmental Research and Public Health, 19(8830), 8830–. https://doi.org/10.3390/ijerph19148830

• From abstract:"Compared with vaginal birth, operative vaginal birth, and emergency caesarean section were associated with CB-PTS/D beyond 6 months postpartum. Qualitative studies revealed that some women were suffering from CB-PTS/D as long as 18 years after birth. (4) Conclusions: Long- term screening of women for PTSD in the postnatal period could be beneficial. More research is needed on models of care that help prevent CB-PTS/D, identifying women at risk and factors that maintain CB-PTS/D beyond 6 months postpartum. 

2021

Rizzatano, E. (2021).  More than the blues: Navigating postpartum depression. Accessed https://answers.childrenshospital.org/navigating-postpartum-depression/

• The transition from pregnancy to parenthood is called the postpartum period. For insight on what parents can expect in this period — and how to handle the ups and downs — we spoke with Dr. Andrea Sachs of Chestnut Hill Pediatrics in the Boston Children’s Primary Care Alliance.

Shiva, L., Desai, G., Satyanarayana, V. A., Venkataram, P., & Chandra, P. S. (2021). Negative Childbirth Experience and Post-traumatic Stress Disorder - A Study Among Postpartum Women in South India. Frontiers in Psychiatry, 12, 640014–640014. https://doi.org/10.3389/fpsyt.2021.640014   Accessed https://www.frontiersin.org/articles/10.3389/fpsyt.2021.640014/full

• CONCLUDED: "Childbirth is generally considered to be a pleasurable event in a woman's life but negative experience of childbirth often remains a tale not told. This study shows high rates of negative childbirth experience among urban women from South India who were in their postpartum period. Providing good intrapartum to women during delivery has been emphasized by many advocacies including the WHO and LaQshya programme by the Government of India which can in turn enhance positive childbirth experience. Liaison with the obstetricians, nurses, and midwives for increasing the availability of intrapartum analgesia, providing information to women and families and regularizing consent for procedures in addition to Respectful Maternity care during labour are necessary to improve maternal health care services in developing countries like India. Future studies using prospective cohort designs may examine other prenatal, antenatal as well postnatal factors to examine the association of negative childbirth experience with PTSD"

2020

Clark, M. (2020). Postpartum depression can persist well beyond a child's first birthday - Medicaid should adjust accordingly.  Accessed https://ccf.georgetown.edu/2020/11/04/postpartum-depression-can-persist-well-beyond-a-childs-first-birthday-medicaid-should-adjust-accordingly/

• Postpartum depression can last up to three years, new research from the National Institute of Health has found, and symptoms can often emerge well after the first months following delivery and get worse over time. The findings, published in the journal Pediatrics, suggest that providers, particularly pediatricians, should screen new mothers for depression through at least their child’s second year of life, and that Medicaid and CHIP coverage for pregnant women and new mothers should be better aligned to support access to care in the first years of their child’s life.

MacDougall, C. (2020). Childbirth Distress: A Call for Professional Engagement. Affilia, 35(3), 376–396. https://doi.org/10.1177/0886109919873909

• CONCLUDED (from abstract) "Among women who give birth, roughly half describe their birth experiences as traumatic. Childbirth trauma is a topic of growing global interest for health and mental health professions. However, social work remains peripheral in this emerging area of scholarship and practice. This article presents a portion of findings from recent feminist narrative social work research exploring women’s narratives of their experiences of emotional distress in childbirth to illustrate the need for increased professional engagement with this important social issue. Analysis of participants’ narratives illustrates how Foucault’s discourse and power/knowledge can be useful in understanding the subtle social forces that shape birth experiences which may result in emotional distress. In this article, I argue the topic of childbirth distress falls within the reproductive rights framework and should be of importance to social workers. The findings presented below are discussed in the context of the International Federation of Social Workers’ ethical principles and its policy statement on women to support this position."

2019

Patterson, J., Martin, C., Karatzias, T. (2019). Disempowered midwives and traumatized women: Exploring the parallel processes of care provider interaction that contribute to women developing PTSD post childbirth.  Midwifery 76 (2019) 21-35.   Accessed https://pubmed.ncbi.nlm.nih.gov/31154157/

• CONCLUDED: "Steps must be taken to emphasize the importance of care provider interaction and psychological well-being by improving working conditions of midwives so that they can focus on providing high quality provider interaction which has been shown to impact the levels of PTSD and trauma in postpartum women."

2018

Çapik, A., & Durmaz, H. (2018). Fear of Childbirth, Postpartum Depression, and Birth‐Related Variables as Predictors of Posttraumatic Stress Disorder After Childbirth. Worldviews on Evidence-Based Nursing, 15(6), 455–463. https://doi.org/10.1111/wvn.12326  Accessed: https://sigmapubs-onlinelibrary-wiley-com.webdb.plattsburgh.edu:2443/doi/pdfdirect/10.1111/wvn.12326

• CONCLUDED "Fear of childbirth, postpartum depression, the state of experiencing postpartum problems by the mother, satisfaction with the attitudes of the medical staff during birth, and the state of defining the childbirth experience by the mother are predictors of postpartum PTSD. The variable that has the most effects among these variables is postpartum depression, with the variance rate of 47%. These results show that RQ1 (Is fear of childbirth a predictor of postpartum posttraumatic stress?), RQ2 (Is postpartum depression a predictor of postpartum posttraumatic stress?), RQ3 (Is satisfaction with the attitudes of the medical staff during childbirth a predictor of postpartum posttraumatic stress?), RQ4 (Is defining the childbirth experience a predictor of postpartum posttraumatic stress?), and RQ5 (Is the state of experiencing postpartum problems by the mother a predictor of postpartum posttraumatic stress?) have been verified. The state of experiencing postpartum problems by the baby was not a predictor of postpartum PTSD. This result shows that RQ6 (Is the state of experiencing postpartum problems by the baby a predictor of postpartum posttraumatic stress?) has not been verified."

2017

Bromley, P., Martin, C. J. H., & Patterson, J. (2017). Post traumatic stress disorder post childbirth versus postnatal depression: a guide for midwives. British Journal of Midwifery, 25(8), 484–490. https://doi.org/10.12968/bjom.2017.25.8.484     Accessed https://web-s-ebscohost-com.webdb.plattsburgh.edu:2443/ehost/pdfviewer/pdfviewer?vid=0&sid=211c148f-0518-4372-86a3-047f2aa46528%40redis

• CONCLUDED: "This paper summarises the differences between PTSDPC and PND, which is key for a midwife to correctly identify and screen women for appropriate diagnosis, referral, and treatment. This understanding will inevitably improve morbidity and mortality outcomes for childbearing women with PTSD-PC and/or PND. In summary, as the woman’s primary carer throughout her childbearing experience, it is the midwife’s responsibility to develop knowledge and skills to appropriately assess perinatal mental health problems."

Lopez, U., Meyer, M., Loures, V., Iselin-Chaves, I., Epiney, M., Kern, C., & Haller, G. (2017). Post-traumatic stress disorder in parturients delivering by caesarean section and the implication of anaesthesia: a prospective cohort study. Health and Quality of Life Outcomes, 15(1), 118–118. https://doi.org/10.1186/s12955-017-0692-y  Accessed https://hqlo.biomedcentral.com/articles/10.1186/s12955-017-0692-y

• CONCLUDED: "This study identifies predictors for acute postpartum PTSD profile and acute PTSD after delivery by C-section that can be easily recognised before or during the surgical procedure, particularly as spinal anaesthesia is most often used. In patients with a high degree of dissociative experiences during the C-section, or when maternal or anaesthesia complications occur, the risk for a postpartum PTSD profile increases significantly. These patients are likely to benefit from a close follow up by members of the obstetrics and/or anaesthesia team. If needed, intensive psychological support should be put in place as soon as possible."

2016

De Schepper, Vercauteren, T., Tersago, J., Jacquemyn, Y., Raes, F., & Franck, E. (2016). Post-Traumatic Stress Disorder after childbirth and the influence of maternity team care during labour and birth: A cohort study. Midwifery, 32, 87–92. background https://doi.org/10.1016/j.midw.2015.08.010

• CONCLUDED "In the present study, we observed a prevalence of PTSD symptoms in the first week after birth of 22–24% of the women and 13–20% after six weeks. In addition, this study found a prevalence of 4% for PTSD at six weeks after birth. Risk factors were: a low family income, experiencing childbirth as traumatic, a labour or birth with complications and a history of psychological problems. The importance of the women feeling in control during the birthing process by being able to ask questions was demonstrated. An aim of this study was to inform midwifery care providers about PTSD as a possible post partum complication. It should be highlighted more to increase knowledge and encourage care providers to be attentive toward this condition. A lack of knowledge might cause these women to go unnoticed and not receive appropriate care. Therefore, we suggest that knowledge on postnatal Post-Traumatic Stress Disorder should be implemented in the education of both midwifery and medical students. Moreover, evidence based guidelines should be developed and implemented by all clinicians."  (material omitted)

2014

Fenech, & Thomson, G. (2014). Tormented by ghosts from their past’: A meta-synthesis to explore the psychosocial implications of a traumatic birth on maternal well-being. Midwifery, 30(2), 185–193. https://doi.org/10.1016/j.midw.2013.12.004  Accessed: https://www.sciencedirect.com/science/article/abs/pii/S0266613813003513

• CONCLUDED "This synthesis reveals how a traumatic birth leads to a turmoil of depression, PTSD, suicidal thoughts and intense feelings of loss and grief. It also illuminates the damaging and negative implications of a traumatic birth for women, their infants and their families. Professionals require training and awareness to minimise the potential for women to experience a traumatic birth. They also require skills development to enable them to identify and sensitively respond to women0 s psychosocial concerns. More research into the types of support required after a traumatic birth and efforts to establish when and how this support should be delivered are also needed"

2011

Beck, Gable, R. K., Sakala, C., & Declercq, E. R. (2011). Posttraumatic Stress Disorder in New Mothers: Results from a Two-Stage U.S. National Survey. Birth (Berkeley, Calif.), 38(3), 216–227. https://doi.org/10.1111/j.1523-536X.2011.00475.x  Accessed: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1523-536X.2011.00475.x

• CONCLUDED (from article, material omitted) "The following variables were significantly related to elevated posttraumatic stress symptoms levels: low partner support, elevated postpartum depressive symptoms, more physical problems since birth, and less health-promoting behaviors. In addition, eight variables significantly differentiated women who had elevated posttraumatic stress symptom levels from those who did not: no private health insurance, unplanned pregnancy, pressure to have an induction and epidural analgesia, planned cesarean birth, not breastfeeding as long as wanted, not exclusively breastfeeding at 1"

2008

Chase-Brand, J. (2008). Effects of maternal postpartum depression on the infant and older siblings. In S. D. Stone & A. E. Menken (Eds.), Perinatal and postpartum mood disorders: Perspectives and treatment guide for the health care practitioner (pp. 41–64). Springer Publishing Co.

• Postpartum depression robs a woman of her happiness, energy, and ability to parent at a time when her children deeply need her. For infants, the results of maternal depression are potentially devastating because a baby's physical, emotional, and cognitive growth all depend on developing a warm, secure attachment in the first months of life. However, as reviewed above, toddlers, preschoolers, older children, and teens are also at significant risk when a mother becomes depressed and may react to their mother's emotional withdrawal by developing depression and anxiety themselves or by acting out in anger at their loss.

2007

Ayers. (2007). Thoughts and Emotions During Traumatic Birth: A Qualitative Study. Birth (Berkeley, Calif.), 34(3), 253–263. https://doi.org/10.1111/j.1523-536X.2007.00178.x  Accessed https://www.researchgate.net/publication/6121005_Thoughts_and_Emotions_During_Traumatic_Birth_A_Qualitative_Study

• CONCLUDED (from intro) ""Previous research shows that 1 to 9 percent of women will develop  symptoms of posttraumatic stress disorder after childbirth. The objective of this study was to examine thoughts and emotions during birth, cognitive processing after birth, and memories of birth that might be important in the development of postnatal posttraumatic stress symptoms"

2006

Ayers, Eagle, A., & Waring, H. (2006). The effects of childbirth-related post-traumatic stress disorder on women and their relationships: A qualitative study. Psychology, Health & Medicine, 11(4), 389–398. https://doi.org/10.1080/13548500600708409   Accessed https://www.researchgate.net/publication/6668426_The_effects_of_childbirth-related_post-traumatic_stress_disorder_on_women_and_their_relationships_A_qualitative_study

• CONCLUDED "In summary, the present study adds to the literature on the effects of traumatic birth and suggests that clinically significant postnatal PTSD has both immediate and long-term effects on women, their relationship with their child and their relationship with their partner. However, further research is needed to compare these effects with the experience of women without postnatal PTSD, and further research is needed to look at the varying role of premorbid vulnerability factors and the events of birth."

2002

• CONCLUDED: "Given the magnitude of postpartum mood disorders and the potentially devastating impact that postpartum depression can have on the woman, the family, and society in general, one would think that prevention and subsequent social support would be an integral part of all prenatal programs. With the hallmark of most American hospital births being that of a medicalized event, it behooves health care workers to adopt existing programs or create new ones that support women during the childbearing period, with emphasis not just on the clinical surveillance of the physical health of the mother and fetus, but with equal attention given to the mother's psychological needs and supportive resources.  The early experience of mothering can be overwhelming, but there should be plans and resources in place to thwart any possibility of permitting it to become a catastrophic experience. Early detection and identification of postpartum depression can help alleviate long months of suffering for a woman and her family. With this in mind, the development of universal postpartum depression programs is essential. These education programs should include causes, treatment, interventions, referrals, and supportive resources. Hospital birthing departments should also include a doula referral service as part of their programs for those women who are identified as being at-risk for developing postpartum depression. Given the benefits that a doula can promote and provide, it would be sound practice to have a doula available upon request for any woman. The potential cost savings alone to the healthcare system should be an impetus. Narrowing the gap between lack of social support and caring for the woman during the several weeks before and following delivery must become a high priority in our current practices in the arena of birthing - can we truly afford anything less?"

1997

Reynolds. (1997). Post-traumatic stress disorder after childbirth: the phenomenon of traumatic birth. Canadian Medical Association Journal (CMAJ), 156(6), 831–835.  Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1227048/

• CONCLUDED "Pregnancy, labour and birth are powerful events in women’s lives. The vast majority of women appear to recover quickly after the birth of a child. Yet, for a small percentage, childbirth leaves them with prolonged suffering that can have an enormously detrimental effect on their lives and on the lives of their family members. Previous traumatic events may increase the probability of a woman having a traumatic birth experience. The evidence for the existence of a type of PTSD after birth is slim but compelling. Research in this area should be given a high priority. In the meantime, there are many things health care professionals can do to help prevent women from undergoing a traumatic birth experience and to address such an experience therapeutically if it occurs."

1995

INTRODUCTION PAGE

Last updated June 2024