PhD Study : Developing and testing an EMDR Early intervention to improve mothers’ cognitive processing of trauma associated memories embedded during an unexpected caesarean birth

Summary

Background

The RQIA (2017) reported NI as having the highest CS rates in the UK with rates of 25- 35% with with costs substantially higher than vaginal births (£3,781 vs £1,985).   However, following one CS, about 75% of women with an uncomplicated pregnancy who go into spontaneous labour can give birth vaginally (RCOG, 2016) and NICE (2012) states that women who request a CS due to fear and anxiety should be referred to mental health support services.  Increasing the rates of normal vaginal deliveries by reducing CS and encouraging uptake of Vaginal birth after CS (VBAC) is a public health priority: reducing FoC or Postpartum PTSD, due to traumatic birth is an important factor. Reducing FoC is proposed to reduce CS rates and increase VBAC and serves the common goal of promoting normal birth and woman-centred care, reducing rates of costly interventions.

Study Aim

This study aims to develop and test an Early EMDR intervention for prevention of the longer term effects associated with a traumatic birth

EMDR

Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapeutic approach that has been shown to be effective in the treatment of PTSD in several large randomized controlled trials (RCT). The therapy consists of a standard protocol which includes eight phases and Alternating Bilateral Sstimulation (ABS) to desensitize traumatic memories.  The effectiveness of EMDR therapy in treating PTSD has undergone the scrutiny of several meta-analyses looking at its effectiveness resulting in the World Health Organization (2013/15) identifying it as a psychotherapy of choice in the treatment of PTSD in children, teenagers, and adults.  To date, however, few studies have explored the potential of EMDR to address trauma arising from obstetrical emergencies occurring in pregnancy and childbirth such as an emergency caesarean birth.

Method

The study design is action research and the approach selected is the PDSA cyle (The Plan-Do-Study-Act cycle) as this is clinically relevant for a HSC project designed to bring about change http://www.academy.solent.nhs.uk/media/37336/guide-to-pdsa-cycles.pdf

Sample

The sample will be mothers who have had an emergency CS and they will be recruited from one or more HSC Trusts in Northern Ireland.

Relevant references

PDSA cycles http://www.academy.solent.nhs.uk/media/37336/guide-to-pdsa-cycles.pdf (Accessed 04/09/2018)

National Institute for Health and Care Excellence (2012).  Caesarean section Clinical guideline [CG132].  Available at:  https://www.nice.org.uk/guidance/cg132/chapter/1-guidance  (Accessed 04/09/2018)

National Institute for Health and Care Excellence (2014) Clinical guideline [CG192] Antenatal and postnatal mental health: clinical management and service guidance. Available at: https://www.nice.org.uk/guidance/cg192 (Accessed 04/09/2018)

National Institute for Health and Care Excellence (2016) Caesarean Section Costing Report. Available at: https://www.nice.org.uk/guidance/cg132/resources/costing-report-184766797 (Accessed 04/09/2018)

NHS 2018 https://improvement.nhs.uk/documents/2142/plan-do-study-act.pdf (Accessed 04/09/2018)

RQIA 2017 https://www.rqia.org.uk/  (Accessed 04/09/2018)

World Health Organization, Human Reproduction Programme (2015) Statement on caesarean section rates.  Available at: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/ (Accessed 04/09/2018)

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.

• Experience using research methods or other approaches relevant to the subject domain

Funding and eligibility

The University offers the following levels of support:

Department for the Economy (DFE)

The scholarship will cover tuition fees at the Home rate and a maintenance allowance of £19,000 (tbc) per annum for three years (subject to satisfactory academic performance).

This scholarship also comes with £900 per annum for three years as a research training support grant (RTSG) allocation to help support the PhD researcher.

• Candidates with pre-settled or settled status under the EU Settlement Scheme, who also satisfy a three year residency requirement in the UK prior to the start of the course for which a Studentship is held MAY receive a Studentship covering fees and maintenance.
• Republic of Ireland (ROI) nationals who satisfy three years’ residency in the UK prior to the start of the course MAY receive a Studentship covering fees and maintenance (ROI nationals don’t need to have pre-settled or settled status under the EU Settlement Scheme to qualify).
• Other non-ROI EU applicants are ‘International’ are not eligible for this source of funding.
• Applicants who already hold a doctoral degree or who have been registered on a programme of research leading to the award of a doctoral degree on a full-time basis for more than one year (or part-time equivalent) are NOT eligible to apply for an award.

Due consideration should be given to financing your studies. Further information on cost of living

Candidates should have ordinary UK residence to be eligible for both fees and maintenance (£14,777).

Non UK residents who hold ordinary EU residence may also apply but if successful will receive fees only.