Childbirth experiences and mother-infant relationships in Uganda

A high proportion of women in sub-Saharan Africa survive severe negative childbirth experiences each year, yet little is known about the psychological impact of maternal experiences on the mother and her baby in those countries. There is evidence from high income countries that the effects of posttraumatic stress symptoms following childbirth on mothers and their families can be long lasting. The aim of this exploratory mixed methods study was to examine the possible association between childbirth experiences and mother-infant interactions in a purposive sample of high risk mothers who delivered at an urban tertiary hospital in Uganda. The sample comprised of 49 mothers aged between 18-38 years and their 4-5-monthold babies. Each mother-infant dyad was observed in a 10-minute video recorded social interaction at home. All mothers completed self-report questionnaires assessing demographic factors, childbirth experiences, posttraumatic stress symptoms arising from labour and delivery, postpartum depression and maternal attachment style. Individual narrative interviews with 41 mothers were conducted exploring their experiences of pregnancy, labour, delivery and time spent at the hospital post-delivery. Quantitative data was analysed using descriptive statistics, Pearson correlations, ANOVA, and hierarchical multiple regressions and the narratives using structural narrative analysis. The findings were integrated using the weave strategy. Quantitative findings showed that fear of death, emergency caesarean section and prolonged labour were the most common problems during labour and delivery. Childbirth experiences were negatively associated with mother-infant interactions. Posttraumatic stress symptoms and postnatal depression were not associated with mother-infant interactions. The women’s experiences at the hospital partially predicted mother-infant interactions. Women’s narratives showed that experiences of childbirth were influenced by the mothers’ level of planning for pregnancy, personal circumstances, and cultural and religious beliefs about childbirth. The mothers’ experiences of childbirth demonstrated elements of restitution, chaos and quest narratives, mirroring aspects of illness narratives seen in populations living with chronic health conditions. These findings show that negative childbirth experiences present risks to both women’s postnatal mental health and their interactions with their infants. Two urgently required interventions for this population of women and their babies should involve 1) hospital organisational changes and staff training on quality intrapartum care. 2) Development and provision of trauma and attachment-based interventions for mothers and their infants.