Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study

Abstract

Preventative psychological interventions to aid women after traumatic childbirth are needed. This proof-of-principle randomized controlled study evaluated whether the number of intrusive traumatic memories mothers experience after emergency caesarean section (ECS) could be reduced by a brief cognitive intervention. 56 women after ECS were randomized to one of two parallel groups in a 1:1 ratio: intervention (usual care plus cognitive task procedure) or control (usual care). The intervention group engaged in a visuospatial task (computer-game 'Tetris' via a handheld gaming device) for 15 min within six hours following their ECS. The primary outcome was the number of intrusive traumatic memories related to the ECS recorded in a diary for the week post-ECS. As predicted, compared with controls, the intervention group reported fewer intrusive traumatic memories (M = 4.77, SD = 10.71 vs. M = 9.22, SD = 10.69, d = 0.647 [95% CI: 0.106, 1.182]) over 1 week (intention-to-treat analyses, primary outcome). There was a trend towards reduced acute stress re-experiencing symptoms (d = 0.503 [95% CI: -0.032, 1.033]) after 1 week (intention-to-treat analyses). Times series analysis on daily intrusions data confirmed the predicted difference between groups. 72% of women rated the intervention "rather" to "extremely" acceptable. This represents a first step in the development of an early (and potentially universal) intervention to prevent postnatal posttraumatic stress symptoms that may benefit both mother and child.

Clinical trial registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT02502513.

Keywords: Acute stress disorder; Childbirth; Cognitive; Computerized; Early intervention; Posttraumatic stress disorder; Proof-of-principle randomized controlled study; Universal intervention.

Fig. 1

Study flowchart.

Fig. 2

Mean number of intrusive traumatic memories recorded in the diary during the first 7 days following an emergency caesarean section for the Control (based on “per protocol” analysis): Usual care (n = 24; M = 9.00, SD = 9.32, SEM = 1.90) and Intervention: Tetris plus usual care (n = 25; M = 3.54, SD = 11.16, SEM = 2.23) groups, F = 10.94***, d = 0.945, SE = 0.308, 95% CI = 0.349, 1.532. ***p < 0.005. Error bars represent +1 SEM.

Fig. 3

Frequency scattergraphs showing the time-course of the number of intrusive traumatic memories recorded in the diary from day 1 to day 7 for the Control: Usual care (n = 24) and Intervention: Tetris plus usual care (n = 25) groups. The size of the circles represents the number of participants who reported the indicated number of intrusive traumatic memories on that particular day, scaled separately for each condition. The solid lines are the fit of the generalized additive model (see Equation (1)) to summarise the number of intrusive traumatic memories through the seven-day period. Parametric analysis (repeated measures ANCOVA) confirms that there is a significant reduction in the number of intrusive traumatic memories through time (F = 6.412, df = 1,337, p = 0.012) and a significant difference between Control and Intervention groups (F = 10.5310, df = 1,337, p = 0.001) on the overall number of intrusive traumatic memories.

Fig. 4

Mean number of self-reported acute stress disorder (ASD) symptoms after 1 week and posttraumatic stress disorder (PTSD) symptoms after 1 month following an emergency caesarean section (based on “per protocol” analysis) for the Control group: Treatment-as-usual and Intervention group: Tetris. Asterisks indicate a significant difference between groups (*p < 0.05). Error bars represent +1 SEM.

Fig. 5

Horsch, A. (Photographer). (2013). Study participant carrying out the cognitive task procedure via Nintendo DS [photograph]. Department Woman-Mother-Child, University Hospital Lausanne, Switzerland. With permission.