Treatment of Traumatic Birth Experience with Postpartum Early Eye Movement Desensitization and Reprocessing Therapy: A Randomized Clinical Trial.

Abstract

BACKGROUND A traumatic birth experience can have negative consequences for both mother and infant, including developing (symptoms of) posttraumatic stress disorder, postpartum depression, difficulties in mother-infant bonding, fear of childbirth, or reduced quality of life. OBJECTIVES This study aimed to investigate the effectiveness and safety of early trauma-focused therapy, specifically eye movement desensitization and reprocessing therapy, in reducing symptoms and incidence of posttraumatic stress disorder at nine weeks postpartum in women with a traumatic birth experience, compared with care as usual (controls). STUDY DESIGN A randomized controlled trial was conducted in a hospital and 25 midwifery practices in Amsterdam, the Netherlands, enrolling women within fourteen days postpartum who reported a traumatic birth experience. The participants received two eye movement desensitization and reprocessing therapy sessions of 60 min per session (treatment group) or two telephone calls (controls) between two and five weeks postpartum. The primary outcome was symptoms of posttraumatic stress disorder at nine weeks postpartum measured by the self-report questionnaire PTSD Checklist for DSM-5 (PCL-5, cutoff ≥29 indicative of posttraumatic stress disorder) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), a structured interview. Secondary outcomes included symptoms of depression, mother-infant bonding, fear of childbirth, quality of life, and breastfeeding rates. RESULTS Of 10,963 women screened, 861 reported a traumatic birth experience and 151 participants were randomly assigned (1:1) to the treatment group (n=76) or control group (n=75). After randomization, seven participants withdrew informed consent and one participant was inaccessible leaving 74 participants in the treatment group and 69 in the control group for intention-to-treat analyses. The treatment group showed a larger reduction in PCL-5 scores than the control group (adjusted mean difference on square root scale =-0.82, 95% CI -1.24 to -4.04; P <0.001, mean difference =-8.7 points). Square root transformed CAPS-5 symptom severity scores were significantly lower in the treatment group (adjusted mean difference=-0.73, 95% CI -1.23 to -0.23, P =0.004, mean difference =-3.8 points). The incidence of probable posttraumatic stress disorder decreased more in the treatment group (39.2% (n=29) to 11.1% (n=8)) than in controls (44.9% (n=31) to 29.2% (n=19)); adjusted odds ratio=0.32, 95% CI 0.14 to 0.73; P =0.006. However, posttraumatic stress disorder diagnosis rates per CAPS-5 were not significantly different between groups: three participants (4.2%) in the treatment group versus six participants (9.1%) in the control group, P =0.310. Eye movement desensitization and reprocessing therapy reduced depressive symptoms (P <0.001), symptoms of mother-infant bonding difficulties (P =0.008), fear of childbirth (P =0.001), and quality of life in the psychological domain (P =0.006). No differences in breastfeeding rates were observed. Serious adverse events were not observed. CONCLUSION Compared to controls, eye movement desensitization and reprocessing therapy proved both effective and safe in reducing symptoms of posttraumatic stress disorder and related psychological distress in postpartum women with a traumatic birth experience. Its integration into postnatal care protocols may be of great benefit to this group.