Antenatal intervention for childbirth trauma: the clinical profile of Australian women at a tertiary hospital

BACKGROUND: Despite global recognition of childbirth trauma, as well as identifiable factors in pregnancy that may increase its occurrence, there is an absence of accessible and cost-effective primary (i.e., before childbirth) antenatal intervention. This study describes an antenatal intervention, Sensitive Care Birth Plans (SCBP), currently implemented at the Women and Newborn Health Service (WNHS) in Western Australia and aims to analyse the maternal and infant characteristics of women accessing it for childbirth trauma. METHODS: Data were drawn from 126 patient files, which was the total number of women identified with SCBPs from January to December 2022 at WNHS in a retrospective file review. Where possible, outcomes of the SCBP cohort are compared to all other women who birthed during the same period at the service. RESULTS: Data were analysed using descriptive and inferential statistics. The SCBP cohort was 14.1-44.4 years of age (M = 30.34 years). Most women were diagnosed with the diagnostic category of a neurotic, stress-related and somatoform disorder (85.3%). There were high prevalences of childhood and adulthood trauma (63.5% and 63.2%, respectively), childbirth trauma (64.3%) and perinatal loss (54.1%). There was also high use of mental health services (84.8%), elevated antenatal admission days (M = 3.72), and caesarean section birth (44.3%) observed in the SCBP cohort. Infants born to women in the SCBP cohort, compared to the full birthing cohort, had a 79% (p<.001) increased likelihood of admission to the Special Care Nursery. CONCLUSIONS: By understanding the profile of women receiving SCBPs, this study provides an insight into the complex interaction of factors for women receiving antenatal intervention for childbirth trauma. Key additional risk factors for childbirth trauma such as perinatal loss are highlighted, with the high rates of childhood and adulthood trauma demonstrating the potential role of screening to ensure that women with known vulnerabilities are identified for comprehensive assessment.