. 2019 Dec 30;9(12):e032469.

doi: 10.1136/bmjopen-2019-032469.

Improving mental health and physiological stress responses in mothers following traumatic childbirth and in their infants: study protocol for the Swiss TrAumatic biRth Trial (START)

Vania Sandoz¹, Camille Deforges¹, Suzannah Stuijfzand¹, Manuella Epiney², Yvan Vial³, Nicole Sekarski⁴, Nadine Messerli-Bürgy⁵, Ulrike Ehlert⁶, Myriam Bickle-Graz⁷, Mathilde Morisod Harari⁸, Kate Porcheret⁹, Daniel S Schechter^{8

10}, Susan Ayers¹¹, Emily A Holmes¹², Antje Horsch^{13

7}; START Research Consortium

Collaborators, Affiliations

Affiliations

¹ Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland.
² Department Woman-Child-Adolescent, Geneva University Hospital and University of Geneva, Geneva, GE, Switzerland.
³ Obstetrics and Gynecology Service, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland.
⁴ Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland.
⁵ Clinical Child Psychology & Biological Psychology, University of Fribourg, Fribourg, FR, Switzerland.
⁶ Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, ZH, Switzerland.
⁷ Neonatology Service, Woman-Mother-Child Department, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland.
⁸ Service of Child and Adolescent Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland.
⁹ Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.
¹⁰ Department of Psychiatry, University of Geneva Faculty of Medicine, Geneve, GE, Switzerland.
¹¹ Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, London, London, UK.
¹² Department of Psychology, Uppsala University, Uppsala, Sweden.
¹³ Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland antje.horsch@chuv.ch.

PMID: 31892657
PMCID: PMC6955544
DOI: 10.1136/bmjopen-2019-032469

Improving mental health and physiological stress responses in mothers following traumatic childbirth and in their infants: study protocol for the Swiss TrAumatic biRth Trial (START)

Vania Sandoz et al. BMJ Open. 2019.

. 2019 Dec 30;9(12):e032469.

doi: 10.1136/bmjopen-2019-032469.

Authors

Affiliations

¹ Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland.
² Department Woman-Child-Adolescent, Geneva University Hospital and University of Geneva, Geneva, GE, Switzerland.
³ Obstetrics and Gynecology Service, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland.
⁴ Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland.
⁵ Clinical Child Psychology & Biological Psychology, University of Fribourg, Fribourg, FR, Switzerland.
⁶ Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, ZH, Switzerland.
⁷ Neonatology Service, Woman-Mother-Child Department, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland.
⁸ Service of Child and Adolescent Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland.
⁹ Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.
¹⁰ Department of Psychiatry, University of Geneva Faculty of Medicine, Geneve, GE, Switzerland.
¹¹ Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, London, London, UK.
¹² Department of Psychology, Uppsala University, Uppsala, Sweden.
¹³ Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland antje.horsch@chuv.ch.

PMID: 31892657
PMCID: PMC6955544
DOI: 10.1136/bmjopen-2019-032469

Abstract

Introduction: Emergency caesarean section (ECS) qualifies as a psychological trauma, which may result in postnatal post-traumatic stress disorder (PTSD). Maternal PTSD may not only have a significant negative impact on mother-infant interactions, but also on long-term infant development. The partner's mental health may also affect infant development. Evidence-based early interventions to prevent the development of postpartum PTSD in mothers are lacking. Immediately after a traumatic event, memory formation is vulnerable to interference. There is accumulating evidence that a brief behavioural intervention including a visuospatial task may result in a reduction in intrusive memories of the trauma.

Methods and analysis: This study protocol describes a double-blind multicentre randomised controlled phase III trial testing an early brief maternal intervention including the computer game 'Tetris' on intrusive memories of the ECS trauma (≤1 week) and PTSD symptoms (6 weeks, primary outcome) of 144 women following an ECS. The intervention group will carry out a brief behavioural procedure including playing Tetris. The attention-placebo control group will complete a brief written activity log. Both simple cognitive tasks will be completed within the first 6 hours following traumatic childbirth. The intervention is delivered by midwives/nurses in the maternity unit.The primary outcome will be differences in the presence and severity of maternal PTSD symptoms between the intervention and the attention-placebo control group at 6 weeks post partum. Secondary outcomes will be physiological stress and psychological vulnerability, mother-infant interaction and infant developmental outcomes. Other outcomes will be psychological vulnerability and physiological regulation of the partner and their bonding with the infant, as well as the number of intrusive memories of the event.

Ethics and dissemination: Ethical approval was granted by the Human Research Ethics Committee of the Canton de Vaud (study number 2017-02142). Dissemination of results will occur via national and international conferences, in peer-reviewed journals, public conferences and social media.

Trial registration number: NCT03576586.

Keywords: HRV; PTSD; cortisol; early intervention; infant development; maternal mental health.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Study variables: processes in mothers, partners, infants and their interactions following traumatic childbirth. ANS, autonomic nervous system; HPA, hypothalamic–pituitary–adrenal.

**Figure 2**
Flowchart of study procedure. ECS, emergency caesarean section.

See this image and copyright information in PMC

References

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1. American Psychiatric Association Diagnostic and statistical manual of mental disorders. 5 ed Arlington, VA: American Psychiatric Publishing, 2013.
1. Yildiz PD, Ayers S, Phillips L. The prevalence of posttraumatic stress disorder in pregnancy and after birth: a systematic review and meta-analysis. J Affect Disord 2017;208:634–45 https://doi.org/ 10.1016/j.jad.2016.10.009 - DOI - PubMed
1. Horsch A, Vial Y, Favrod C, et al. . Reducing intrusive traumatic memories after emergency caesarean section: a proof-of-principle randomized controlled study. Behav Res Ther 2017;94:36–47 https://doi.org/ 10.1016/j.brat.2017.03.018 - DOI - PMC - PubMed
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Improving mental health and physiological stress responses in mothers following traumatic childbirth and in their infants: study protocol for the Swiss TrAumatic biRth Trial (START)

Collaborators

Affiliations

Improving mental health and physiological stress responses in mothers following traumatic childbirth and in their infants: study protocol for the Swiss TrAumatic biRth Trial (START)

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical