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

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. This study aimed to investigate the...

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Published in:	American journal of obstetrics and gynecology Vol. 233; no. 6; pp. 654.e1 - 654.e25
Main Authors:	Hendrix, Yvette M.G.A., van Pampus, Maria G., Hofman, Amy, Henrichs, Jens, van der Horst, Henriëtte E., de Jongh, Ad
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01.12.2025
Subjects:	Adult Depression, Postpartum EMDR therapy eye movement desensitization and reprocessing Eye Movement Desensitization Reprocessing - methods Female Humans Netherlands obstetrics Parturition - psychology postpartum Postpartum Period - psychology posttraumatic stress disorder Pregnancy psychotherapy PTSD Quality of Life randomized controlled trial Stress Disorders, Post-Traumatic - therapy trauma-focused therapy traumatic birth experience Young Adult Netherlands PTSD EMDR therapy traumatic birth experience eye movement desensitization and reprocessing trauma-focused therapy postpartum psychotherapy obstetrics posttraumatic stress disorder randomized controlled trial
ISSN:	0002-9378, 1097-6868, 1097-6868
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Abstract	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. 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). 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. 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. 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. [Display omitted]
AbstractList	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. 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). 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. 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. 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. [Display omitted] 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. 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). 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. 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. 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. 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.BACKGROUNDA 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.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).OBJECTIVEThis 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).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.STUDY DESIGNA 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.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.RESULTSOf 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.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.CONCLUSIONCompared 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.
Author	Hendrix, Yvette M.G.A. de Jongh, Ad van der Horst, Henriëtte E. Hofman, Amy Henrichs, Jens van Pampus, Maria G.
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Keywords	PTSD EMDR therapy traumatic birth experience eye movement desensitization and reprocessing trauma-focused therapy postpartum psychotherapy obstetrics posttraumatic stress disorder randomized controlled trial
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SubjectTerms	Adult Depression, Postpartum EMDR therapy eye movement desensitization and reprocessing Eye Movement Desensitization Reprocessing - methods Female Humans Netherlands obstetrics Parturition - psychology postpartum Postpartum Period - psychology posttraumatic stress disorder Pregnancy psychotherapy PTSD Quality of Life randomized controlled trial Stress Disorders, Post-Traumatic - therapy trauma-focused therapy traumatic birth experience Young Adult
Title	Treatment of traumatic birth experience with postpartum early eye movement desensitization and reprocessing therapy: a randomized clinical trial
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