Treatment of traumatic birth experience with postpartum early eye movement desensitization and reprocessing therapy: a randomized clinical trial.

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.

OBJECTIVE: 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 9 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 14 days postpartum who reported a traumatic birth experience. The participants received 2 eye movement desensitization and reprocessing therapy sessions of 60 minutes per session (treatment group) or 2 telephone calls (controls) between 2 and 5 weeks postpartum. The primary outcome was symptoms of posttraumatic stress disorder at 9 weeks postpartum measured by the self-report questionnaire Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders (cutoff ≥29 indicative of posttraumatic stress disorder) and the Clinician-Administered Posttraumatic Stress Disorder Scale for Diagnostic and Statistical Manual of Mental Disorders, 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, 7 participants withdrew informed consent and 1 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 Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition scores than the control group (adjusted mean difference on square root scale=-0.82; 95% confidence interval, -1.24 to -4.04; P<.001; mean difference=-8.7 points). Square root transformed Clinician-Administered Posttraumatic Stress Disorder Scale for Diagnostic and Statistical Manual of Mental Disorders, fifth edition symptom severity scores were significantly lower in the treatment group (adjusted mean difference=-0.73; 95% confidence interval, -1.23 to -0.23; P=.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% confidence interval, 0.14 to 0.73; P=.006. However, posttraumatic stress disorder diagnosis rates per Clinician-Administered Posttraumatic Stress Disorder Scale for Diagnostic and Statistical Manual of Mental Disorders, fifth edition were not significantly different between groups: 3 participants (4.2%) in the treatment group vs 6 participants (9.1%) in the control group (P=.310). Eye movement desensitization and reprocessing therapy reduced depressive symptoms (P<.001), symptoms of mother-infant bonding difficulties (P=.008), fear of childbirth (P=.001), and quality of life in the psychological domain (P=.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.