Gamble, J., & Creedy, D. (2004).Birth,31(3), 213-221.

In 1994, childbirth was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a recognized cause of post-traumatic stress disorder. Despite the recognition of these connections, little evidence exists on the effectiveness of counseling strategies to relieve trauma symptoms after a distressing birth experience. The purpose of this study was to describe the current state of knowledge on the effectiveness of interventions to reduce trauma symptoms in women after distressing birth experiences.

Nineteen publications were retrieved from a search of major databases on the topic. Two tested a counseling intervention for postpartum psychological trauma; five explored women's responses to distressing birth experiences; eight described approaches to psychological debriefing; one discussed midwifery practice policies; and three evaluated postpartum listening services. Common problems emerged that make replication of interventions difficult: Interventions were poorly described; specialty psychotherapeutic training may be required; outcomes were unmeasured; single sessions may not provide a powerful enough "dose"; and interpersonal factors preceding the birth may add to the post-trauma of a distressing birth experience. Only one of the studies was a randomized controlled trial, which exemplifies the problems of evidence-based practice on the outcomes of counseling strategies for psychosocial issues.

We all would agree that providing women with opportunities to discuss their birth experiences using interpersonal counseling skills, active listening, paraphrasing, reflection of feeling, and empathy is useful. But does it improve post-traumatic stress disorder outcomes? Sometimes these evidence-based practice columns in MCN suggest a body of evidence already exists for particular aspects of maternal-child health. Sometimes a review like this one reminds us of what a long way we have to go. Currently, evidence doesn't exist for interventions that consistently improve outcomes for women with distressing birth experiences. We don't even know the incidence and prevalence of post-traumatic stress disorder following childbirth and its short- and long-term effects on women. Finally, we don't know the effectiveness of treatments that systematically break distressing birth and post-traumatic stress disorder connections.

Comment by Linda Beth Tiedje