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)
Myriam Bickle-Graz,
Jean-François Tolsa,
Antje Horsch,
Mathilde Morisod Harari,
Emily A Holmes,
Vania Sandoz,
Camille Deforges,
Suzannah Stuijfzand,
Manuella Epiney,
Yvan Vial,
Nicole Sekarski,
Nadine Messerli-Bürgy,
Ulrike Ehlert,
Kate Porcheret,
Daniel S Schechter,
Susan Ayers,
Valérie Avignon,
Cristina Borradori Tolsa,
Julie Bourdin,
Dominique Delecraz,
David Desseauve,
Isabelle Eragne,
Emily A. Holmes,
Justine Imbert,
Micah M. Murray,
Jardena J. Puder,
Véronique Othenin-Girard,
Daniel S. Schechter
Affiliations
Myriam Bickle-Graz
14 Clinic of Neonatology, Department Women-Mother-Child, Lausanne University Hospital Centre, Lausanne, Switzerland
Jean-François Tolsa
Antje Horsch
Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
Mathilde Morisod Harari
Emily A Holmes
Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
Vania Sandoz
Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland
Camille Deforges
Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
Suzannah Stuijfzand
Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland
Manuella Epiney
Department Woman-Child-Adolescent, Geneva University Hospital and University of Geneva, Geneva, GE, Switzerland
Yvan Vial
Obstetrics and Gynecology Service, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland
Nicole Sekarski
Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland
Nadine Messerli-Bürgy
Family and Development Research Center (FADO), Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
Ulrike Ehlert
Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, ZH, Switzerland
Kate Porcheret
Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
Daniel S Schechter
Service of Child and Adolescent Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland
Susan Ayers
City University of London, London, UK
Valérie Avignon
Cristina Borradori Tolsa
Julie Bourdin
Dominique Delecraz
David Desseauve
Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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 NCT 03576586.
