title: Tormented by ghosts from their past': a meta-synthesis to explore the psychosocial implications of a traumatic birth on maternal well-being.
abstract: BACKGROUND
  women can experience an array of serious and enduring morbidities following a difficult or traumatic childbirth. These complications have a negative impact on maternal behaviours and infant and family well-being.
  
  
  OBJECTIVE
  to undertake a meta-synthesis of existing qualitative research to explore the psychosocial implications of a traumatic birth on maternal well-being.
  
  
  METHODS
  a systematic review across 10 databases was undertaken: Nursing and Allied Health Source, Medline, the Allied and Complementary Medicine Database (AMED), Embase, PsychINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), International Bibliography of Social Sciences (IBSS), Science Direct, Academic Search Complete and Health Management Information Consortium. Quality appraisal was conducted and Noblit & Hare's meta-ethnographic method adopted to identify first, second and third order constructs within the selected papers.
  
  
  RESULTS
  13 papers were included in the final synthesis. Three third order constructs were identified and are described as 'consumed by demons' (through the intense negative emotions and responses they endured and the subsequent dysfunctional coping strategies employed); an 'embodied sense of loss' (through women's loss of self and family ideals) and 'shattered relationships' (which reflected the fractious and difficult relationships that women described with their infants and partners). A line of argument synthesis was developed which revealed how women are 'tormented by ghosts' from their past.
  
  
  CONCLUSIONS
  this synthesis reveals how a traumatic birth experience can lead to women being drawn into a turmoil of devastating emotions that have long-term, negative repercussions on self-identity and relationships. Professionals require training, awareness and skill development to prevent against trauma and to enable them to identify and sensitively respond to women's psychosocial concerns. Further insights and research into the timing and type of interventions to resolve postnatal morbidity following a traumatic birth are needed.
authors.affiliation: Department of Midwifery, Mater Dei Hospital, Triq Dun Karm, Msida MSD 2090, Malta. Electronic address: Giliane.fenech@gov.mt.
authors.forename: Giliane
authors.initials: G
authors.lastname: Fenech
authors.affiliation: MAINN, School of Health, University of Central Lancashire, Preston PR1 2HE, UK. Electronic address: GThomson@uclan.ac.uk.
authors.forename: Gill
authors.initials: G
authors.lastname: Thomson
mesh_terms: D004420:Dystocia / Q000451:nursing / Q000523:psychology*; D005260:Female; D006801:Humans; D008880:Midwifery; D049590:Postpartum Period; D011247:Pregnancy; D013313:Stress Disorders, Post-Traumatic / Q000451:nursing / Q000523:psychology*
keywords: Meta-synthesis; Psychosocial; Traumatic birth; Women's experiences