Sze-Ning Chuah

Monash Health, Australia

Title: A secondary analysis of a mixed-methods cross-sectional survey to explore the associations between antenatal stress and anxiety, birth trauma and post-birth recovery experience in mothers of multiples

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Biography

Dr Sze-Ning Chuah (MBBS(Hons), MMHSci) is a medical doctor undertaking postgraduate clinical training in Psychiatry. She has recently completed the Master of Psychiatry course at Monash University, for which she completed her research project in understanding the mental health characteristics of women experiencing multiple pregnancies. Dr Chuah was supervised by Dr Izaak Lim (MBBS(Hons), BMedSc(Hons), FRANZCP, CertChildAdolPsych, MBioeth), a clinical academic psychiatrist with working and research experience in the field of perinatal, infant and early childhood mental health within public and private psychiatry services. As a current PhD candidate in the Monash University Department of Psychiatry, Dr Lim has experience conducting and supervising quantitative and qualitative research projects, has published several articles in peer reviewed journals, and has won competitive research grants.

Abstract

Background: Pregnancy and childbirth bring significant physical and psychological changes to women, which can lead to excessive stress and/or anxiety during the antenatal period. Birth trauma refers to the negative psychological experience and distressing effects of childbirth. Women pregnant with multiples are at higher risk of antenatal complications, obstetric emergencies, and unique conditions such as twin-twin transfusion. Their babies are also more likely to be born premature and require Neonatal Intensive Care Unit or Special Care Nursery support. These known complications and risks could influence the experience of antenatal stress and anxiety in women pregnant with multiples, which then could theoretically impact the risk of birth trauma and precipitate future postnatal mental health struggles and diagnoses.

Aim: We aim to investigate the associations between Antenatal Stress and Anxiety, Birth Trauma and Post-Birth Recovery experience. We also endeavour to understand the experiences of mothers with multiple pregnancies in relation to treatment and support for Antenatal Stress and Anxiety, Birth Trauma and Post-Birth Recovery.

Methods: We extracted the existing dataset from a 2021 online mixed methods cross-sectional descriptive survey conducted by the Australian Multiple Birth Association (AMBA) and Centre of Perinatal Excellence (COPE). A univariable logistic regression model was used to analyse the associations between quantitative variables of Antenatal Anxiety, Antenatal Stress, Birth Trauma and negative Post-Birth Recovery, with the subsequent results presented as Odds Ratios (OR) accompanied by 95% Confidence Intervals (CI) and p-values. Qualitative factors which positively and negatively influenced these variables were analysed using Braun and Clarke’s Reflexive Thematic Analysis.

Results: Antenatal Stress was associated with Birth Trauma (OR 3.20, 95% CI 2.33 – 4.40, p<0.001) and negative Post-Birth Recovery (OR 2.22, 95% CI 1.50 – 3.28, p<0.001). Antenatal Anxiety was also associated with Birth Trauma (OR 2.14, 95% CI 1.56 – 2.94, p<0.001) and negative Post-Birth Recovery (OR 1.90, 95% CI 1.29 – 2.81, p=0.001). Factors which hindered engagement in treatment and support were relational isolation and lack of empowerment. Factors which helped women engage in treatment and support were multifaceted relationship support and a balanced combination of preparation and flexibility.

Conclusions: There appear to be strong associations between Antenatal Stress, Antenatal Anxiety, Birth Trauma and negative Post-Birth Recovery in women with multiple pregnancies. Many women were not receiving formal diagnoses and appropriate treatment for their mental health struggles. Multifaceted relationship support and a balanced approach comprising of preparation and flexibility have been highlighted as important components in maintaining perinatal mental health and wellbeing. More research in this area of perinatal mental health in multiple pregnancies would be beneficial and should be encouraged.