Traumatic Birth Experiences within the Family Context: The Role of Adverse Childhood Experiences, Postpartum Mental Health, Bonding and Infant Emotion Identification

Obstetric complications and emergencies are an increasing concern in the United States with over fifty thousand women experiencing severe life-threatening emergencies annually (CDC, 2020). Beyond the stark realities of increasing rates of serious complications and death during childbirth are reports that up to one third of women would describe the birth of their child as “traumatic” and indicate that they feared that they or their child would die or be seriously injured (Soet, Brack & DiLorio, 2003). Research indicates that these traumatic experiences have negative physical, emotional and social sequalae for the women involved (Ayers et al., 2008; Skinner et al., 2018). Despite increasing awareness of the ramifications of traumatic childbirth, the relationship between these experiences and parent-child bonding is not well understood. More specifically, there is a lack of understanding of how overall parental adverse childhood experience scores, specific forms of traumatic birth experiences, and infant emotion identification may relate to the development of healthy parent-child bonding. This dissertation examined three research questions: Are there significant differences between low history of trauma and high history of trauma as measured by the ACE checklist in post-natal depression, post-birth PTSD, and bonding, in those who experienced birth trauma? Are there significant differences between types of birth trauma in post-natal depression, post-birth post-traumatic stress disorder, and bonding in those who have experienced birth trauma? In those who have experienced traumatic birth experiences, are there significant differences in frequencies of infant emotions identified in those who report high and low birth-related trauma and bonding?Three-hundred and nineteen participants responded to an online survey and were asked to respond to questions about adverse childhood experiences, types of birth trauma, postpartum mental illness, parent-infant bonding and infant emotion identification. The results of the study indicated that those who experience birth trauma report much higher rates of postpartum depression, postpartum post-traumatic stress disorder and parent-infant bonding disorders than rates reported by the general population (Gavin et al., 2005; Muzik, Bockneck, Broderick, Richardson, Rosenblum, Thelen, & Seng, 2013; O’Hara & Wisner, 2014; Postpartum Support International, 2020; Reck, Klier, Pabst, Stehle, Steffenelli, Struben, Backenstrass, 2006). In this study, parental adverse childhood experiences did not appear to be related to rates of postpartum depression, postpartum posttraumatic stress disorder or disorders of parent-child bonding. Although prior adversity was not associated with birth trauma outcomes, some physical, psychological and relational aspects of traumatic birth experiences were associated with higher levels of postpartum depression, post-natal post-traumatic stress disorder and bonding disorders. Experiencing traumatic birth as interpersonal in nature and differences in attributions of responsibility demonstrated differing outcomes for postpartum PTSD and bonding. Finally, parents who identified higher rates of identification of passivity, unusual “other” responses and lower rates of interest in images of infants expressing ambiguous and mixed emotions endorsed more difficulty in parent-child bonding in this sample. The findings of this study highlight concerning rates of postpartum mental illness and disorders of parent-child bond in those experiencing birth trauma. Moreover, this study speaks to the possible negative ramifications that interpersonal forms of birth trauma may have for postpartum individuals and their families. Further research may continue to examine the role of parents’ identification of infants’ emotions as a precursor to healthy bonding in those experiencing traumatic birth. Keywords: adverse childhood experiences, attachment theory, birth trauma, infant emotion identification, interpersonal trauma, parent-infant bond, postpartum depression, postpartum post-traumatic stress disorde