Running head: MOTHER CHILD BOND

The Effects of Post-traumatic Stress Disorder Symptoms on Mother Child Bonding Jessy Hart Loras College

MOTHER CHILD BOND Abstract Based on if a birth plan was followed or not and if Post-Traumatic Stress Disorder symptoms occur, it is hypothesized that mothers whose birth plan was not followed will have lower levels in mother child bonding and have PTSD symptoms. 60 women will be separated based on if

birth plan was followed or not followed. One month after childbirth both groups will be given an adapted version of the PTSD Diagnostic Scale, and again at six months and an interview will also be conducted at both sessions. The interview scores will be evaluated using an independent samples t-test. There will also be a Repeated Measures Analysis of Variance (ANOVA) to determine if there is an increase in PTSD symptoms. Mothers whose birth plan was not followed will be more likely to display PTSD symptoms as well as report lower levels of mother child bonding.

MOTHER CHILD BOND Mother Child Bonding

This study will be looking at mother child bonding based on birthing plan. Looking at the difference in the strength of the bond based on if the pregnancy went according to plan or not according to plan, and if it did not go according to plans did the mother show signs of posttraumatic stress disorder (PTSD). Labor and the birth of a child is a challenging life event for women with the potential for positive and negative experiences, and in recent years has been established as an event that can be perceived as traumatic (Sawyer & Ayers, 2009). Childbirth is classified as an event that can cause PTSD which affects the individual and their relationships following the birth such as the mother child bond. Birth factors that were most commonly mentioned by mothers with PTSD symptoms were pain, negative emotions in labor, perceived lack of control, lack of choice or involvement in decision making, and restricted movement or physical restraint (Nicholls & Ayers, 2007). The lack of control or changes in the birth plan can be traumatic for women and affect their ability to bond with their child. Post-Traumatic Stress Disorder can be very harmful in mothers relationships with their child, knowing the causes of PTSD may be a way to help researcher understand its impact better. PTSD symptoms were significantly higher in women that had a caesarean section when compared to women who underwent a normal delivery during childbirth; it was seen that woman who feel they have little control over their self and their environment during childbirth are more likely to experience PTSD symptoms following birth (Sawyer & Ayers, 2009). In the study conducted by Beck, Gable, Sakala, & Declercq (2011) one of the strongest predictors for elevated posttraumatic stress symptoms was elevated postpartum depressive symptoms and in another study by Zaers, Waschke & Ehlert (2008) the best predictor they found for posttraumatic stress symptoms was the onset of anxiety during late pregnancy rejected by their

MOTHER CHILD BOND partner as a result of lack of sexual contact and loss of intimacy. There can be post-traumatic

growth after childbirth, in a study conducted by Jenewein, Moergeli, Fauchre, Bucher, Kraemer, Wittmann, Schnyder, & Bchi (2007) it was found that post-traumatic growth displayed itself to be significantly higher than fathers. The duration of the PTSD symptoms can last years after the traumatic event. The study conducted by McDonald, Slade, Spiby, & Iles (2001) found that two years postpartum of a womens experiences of labor and childbirth, some women continue to report childbirth-related Post-traumatic stress disorder symptoms. The duration of the PTSD symptoms can hinder the mother-child relationship the longer it persists. PTSD and PTSD symptoms hinders and affects the bonding ability between the mother and child. In a study by Beck et al. (2011), mothers who were traumatized by childbirth shared that the following factors that hindered their breastfeeding attempts: flashbacks, disturbing detachment, enduring physical pain, feelings of violation, and an insufficient milk supply. The traumatic birth can change the way the mother views the child. Post-traumatic stress symptoms relating to labor and delivery may adversely influence maternal perceptions of infants, with potentially adverse implications for the developing mother-infant relationship (Davies, Slade, Wright & Stewart, 2008). Ayers, Joseph, McKenzie-McHarg, Slade & Wijma (2008) found that events such as daily contact with their baby can either intensify symptoms or reduce avoidance by giving the mother exposure to the child. In the study by Davies et. al. (2008) it was seen that a child may function as a trigger for the re-experiencing of a traumatic birth the study also found that mothers who met both full and partial criteria for PTSD following childbirth report a lower quality of attachment to their infants than mothers with no PTSD symptoms. In a qualitative study by Ayers, Eagle & Warning (2006) they interviewed women on how they felt about the child and interacted with them, women reported either avoidant or over-protective behavior

MOTHER CHILD BOND towards their baby, suggesting avoidant or over-anxious attachments. PTSD symptoms can add

stress on the parent and affect their parenting, in the study conducted by McDonald et. al. (2001) a link between PTSD measures and the parent stress scales concerning parental distress and difficulty in the interaction between mother and child. In trying to diagnosis PTSD it was noted in Zaers, Waschke and Ehlert (2008) post-traumatic stress symptoms were assessed six weeks and six months postpartum and no decline of the symptom levels was found. PTSD is difficult to diagnose due to the co-morbidity with depression symptoms. It is hypothesized that mothers whose birth plan was not followed will have lower levels in mother child bonding and are more likely to develop Post-Traumatic Stress Disorder. Method Participants Sixty women that have given birth to their first child with in the last month will be selected to participate in this study; these participants must not have a history of depression within the last 10 years. Thirty of those women will be selected because their pregnancy went according to their birth plan and the other 30 women will be selected because their pregnancy did not go according to their birth plan. These 60 women of either African American or Caucasian race will be selected based on convenience sampling from Mercy Hospital in Dubuque Iowa, the age range of the women will range from 18 to 35 years old. Not following the birth plan is defined as any unforeseen change made before, during, or after the birth that was not planned for the pregnancy and may or not be traumatic. Measures/Interview At this same session an interview with each of the mothers will be conducted in which mothers rate 3 questions on a 5 point based Likert scale The questions would be: how easily do

MOTHER CHILD BOND

you understand your child, (1= very difficult, 2= difficult, 3= average, 4= easy, 5=very easy), do you enjoy doing things with your child (1= never, 2= rarely,3=neutral, 4= most of the time, 5=always), how much time do you spend with your child (1= never, 2= rarely, 3=average, 4= most of the time, 5=always). Higher scores on the Likert scale interview indicates higher strength of the mother child bond. Procedure This is a between subject design, where the mother child bond, as well as Post-traumatic Stress Disorder (PTSD) symptoms in the mothers, will be measured over multiple time points. One month after childbirth both groups of mothers will be given a survey to determine if any of the mothers have any symptoms that meets the requirement for PTSD based on the DSM-IV using an adapted version of the PTSD Diagnostic Scale (Foa, Cashman, Jaycox, & Perry, 1997). Six months after the child was born a second survey will be given of the modified PTSD Diagnostic Scale, to determine if any new cases of PTSD have occurred and if any already known cases no longer meet the criteria or continue to meet criteria. The interview and testing will be done by a researcher who does not know if which group the women are in. Predicted Results The 30 mothers, between the ages of 18 to 35, whose birth plan was followed will be interviewed and scored on their mother child bonding, it would be expected that they would have higher scores than the 30 mothers, between the ages of 18 to 35, whose birth plan was not followed. The bonding interview scores will be evaluated using an independent samples t-test. The means between the two groups will be compared to see if there is a difference in the strength of the mother child bond, based on if the birth plans were followed according to plan or not. It would be expected that mothers whose birth plans were followed would have higher bonding

MOTHER CHILD BOND scores and mothers whose birth plans were not followed would have lower scores. There will also be a Repeated Measures Analysis of Variance (ANOVA) conducted to see if there an increase over time in PTSD symptoms between the two groups. It is also predicted that mothers whose birth plan were not followed will show more PTSD symptomatology. The set alpha level will be 0.05, the p value must be under 0.05 in order for the results to be significantly different. Discussion

As hypothesized, it would be expected that mothers whose birth plan was followed would have higher scores of mother child bonding and would not have PTSD symptoms. Those mothers whose birth plans were not followed would have lower mother child bonding scores and will be more likely to display PTSD symptoms. PTSD is not always observed in traumatic births but child birth is characterized as an event that can cause PTSD, although very few cases are diagnosed. With earlier diagnosis of PTSD from the PTSD assessment women displaying signs of PTSD and issues with the mother child bond will be able begin treatment soon and hopefully reverse any negative effects it has had on the mother child bond. Any women who receive lower scores on the interview about the mother child bond would be able to receive treatment and therapy to help improve their relationship with their infant. To prevent PTSD symptoms from diminishing the mother child bonding strength early diagnosis is vital. As found in Sawyer & Ayers (2009) women who experience little control during childbirth are more likely to experience PTSD symptoms following birth. By determining mothers who are more likely to experience PTSD symptoms treatment can occur so the PTSD symptoms will not hinder the mother child bond. Another predictive measure was recognized by Zaers, Waschke & Ehlert (2008), they found the best predictor of PTSD symptoms was the onset

MOTHER CHILD BOND of anxiety during late pregnancy. Noting predictive factors can help doctors keep an eye on mothers who may struggle with PTSD symptom and be able to begin treatment of the symptoms sooner; this could prevent irreversible damage to the mother child bond and allow mothers who suffer from PTSD symptoms to bond with their child more strongly. Future research needs to be done to determine the long term negative effects of PTSD symptoms on the mother child bond as well as the long term side effects on the childs development. The childs development and socialization skills may be hindered due to the lack of a mother child bond in early life because of the mothers Post-traumatic Stress Disorder symptoms.

MOTHER CHILD BOND References Ayers, S., Eagle, A., & Warning, 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. doi:10.1080/13548500600708409 Ayers, S., Joseph, S., McKenzie-McHarg, K., Slade, P., & Wijma, K. (2008). Post-traumatic stress disorder following childbirth: Current issues and recommendations for future research. Journal Of Psychosomatic Obstetrics & Gynecology, 29 (4), 240-250. doi:10.1080/01674820802034631 Beck, C., 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: Issues In Perinatal Care, 38(3), 216-227. doi:10.1111/j.1523-536X.2011.00475.x Davies, J., Slade, P., Wright, I., & Stewart, P. (2008) Posttraumatic stress symptoms following childbirth and mothers perceptions of their infants. Infant Mental Health Journal, 29(6), 537-554. doi:10.1002/imhj.20197 Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale. Psychological Assessment, 9(4), 445 451. doi:10.1037/1040-3590.9.4.445 Jenewein, J., Moergeli, H., Fauchre, J. C., Bucher, H.U., Kraemer, B., Wittmann, L., Schnyder, U., & Bchi, S. (2007). Parents mental health after the birth of an extremely preterm child: A comparison between bereaved and non-bereaved parents. Journal of Psychosomatic Obstetrics & Gynecology, 21(1), 53-60. doi:10.1080/01674820701640181 McDonald, S., Slade, P., Spiby, H., & Iles, J. (2001). Post-traumatic stress symptoms, parenting

MOTHER CHILD BOND stress and mother-child relationships following childbirth and at 2 years postpartum. Journal of Psychosomatic Obstetrics & Gynecology, 32(3), 141-146. doi:10.3109/0167482X.2011.596962

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Nicholls, K., & Ayers, S. (2007). Childbirth-related post-traumatic stress disorder in couples: A qualitative study. British Journal Of Health Psychology, 12(4), 491-509. doi:10.1348/135910706X120627 Sawyer, A., & Ayers, S. (2009). Post-traumatic growth in women after childbirth. Psychology & Health, 24(4), 457-471. doi:10.1080/08870440701864520 Zaers, S., Waschke, M., & Ehlert, U. (2008). Depressive symptoms and symptoms of posttraumatic stress disorder in women after child birth. Journal of Psychosomatic Obstetrics & Gynecology, 29(1), 61-71. doi:10.1080/01674820701804324