Knowledge, Beliefs and Attitudes of Health Visitors In Relation to Postnatal Post-traumatic Stress Disorder: A Qualitative Investigation

Part One: Literature Review - Background: Women may experience birth-related PTSD and research has begun to examine the potential effects of this disorder on infant development. This article aimed to review that evidence. Method: Three databases were systematically searched. Results: 8 articles met inclusion criteria. The variables examined were categorised into mother-infant attachment, children’s temperament and parenting behaviour. Conclusions: The review highlighted a dearth of rigorously conducted research in this area. However, the articles provided limited evidence to support the claim that aversive birth experiences/PTSD can lead to less optimal parent-infant bonding and difficulties with infant temperament. Although tentative, these conclusions suggest professionals working with families postpartum should be alert for the possible impact of aversive birth experiences on their parent-infant bond and the infant’s temperament. Part Two: Research Report - Background: The traumagenic potential of childbirth is well-documented but no research has examined the way in which professionals understand birth-related trauma. Given the potential impact of these understandings for women’s care, this research aimed to explore the knowledge, attitudes and beliefs of health visitors regarding birth-related PTSD. Method: Three focus groups and three interviews were conducted with health visitors and their managers. Verbatim transcripts were analysed using template analysis. Results: Analysis highlighted two routes by which participants perceived birth could result in distress. The first emphasised qualitative aspects of a birth as traumagenic, whereas the second began with a ‘normal’ birth but was experienced as traumatic due to other circumstances. Discussion: Although much of the phenomenology described by participants was commensurate with that in the literature, a notable discomfort with the term ‘PTSD’ and a lack of emphasis on the role of meaning suggested participants may have lacked theoretical understanding of PTSD. Clinical implications of these findings are described. Part Three: Critical Appraisal - Reflections on the overall research process are provided