'Dissertation Hell' has started. I have a topic. I have motivation. I just dont have a clue.

[tiredemma]

Here we go.
Dissertation hell is here.

Im actually quite revved up with this, found a topic that has interested me, have already approached my supervisor and had good feedback.

Just need to start.

Oh dear. My life willbe non-existent for the next six months.

Ho hum.

Join the club.
Tis grim.
What on?

Ok, subject?

Start with literature search - no point reinventing the wheel. By doing the lit search, you can see where your chosen title fits into the overall subject, and if there is a niche you can carve into.

Post traumatic stress disorder following complicated childbirth.

Its an extended lit review with proposal for further rrsearch (it would take too long to get ethics approval to conduct our own research apparently )

Blimey.
Ah well, rich source of info here surely?

yes!!

trying to look at the misdiagnosis of PTSD as PND really and how this affects women. Lots of stuff out there.

Well I always found it best to start broad, then hone in. So maybe start with a general search using the keywords of 'childbirth' and 'outcome'.

You obviously will need to define 'complicated' also - are you talking about complicated within labour, or complicated in the sense that the childbirth experience was not what the lady hoped for?

For example, would a woman set on a home water birth be having a 'complicated' birth if she had PROM, so had to go to hospital when she went into labour, despite having a perfectly 'natural' birth, just not in the location of her choice?

Would a woman who had to have an elective section for transverse lie qualify as having a 'complicated' birth, because she actually wanted a vaginal birth?

On the other hand, does an elective section by choice no longer count as a 'complicated' birth?

Sorry if this seems picky, I just think that your outcome could be very different according to your criteria for 'complicated'.

I suppose what I am getting at is that 'complicated birth' is very subjective, and the same intervention may be a complication for one woman, and not for another.

thanks for your help lou, thats really helpful not at all picky- these are all the things that i need to look at in order to find my research question.

very helpful.

Glad to help I remember the stress of it!

Perhaps you could do a search on MN for stories of women who had a 'bad' birth and try to identify common themes. I know that I did qualitative research, interviewing people, and then I transcribed the interviews, and looked for common phrases. It really helped me to identify recurring themes.

Obviously, your advantage is that on MN it is already written down for you. It could be that you find 'disappointment' is the overriding factor rather than the degree of complication physically, for instance.

shame really te, because on mumsnet alone you probably would, sadly, find a rather large number that would participate....

but what a good topic...the effect of negative childbirth, sadly, will have to be spelled out in capital letters to change things in order to avoid it....

hmmm...in relation to lous post....I think it is the post traumatic strss syndrome....don't think a person just gets that because birth happened in the "wrong" place...there will always be a number of reasons of why it becomes traumatic....surely?

Can you try to get ethical approval whilst you work on the boring version? You could then add in the survey results?

Your starting point (hypothesis?) could be that women do suffer with PTSD. Then try to prove it through existing literature and studies. Adding the MN survey later would enhance it.

I suppose it depends on how much time it really takes to get approval.

And definately explain the definition of complicated. Medical dictionary v womens perception in RL. e.g for me complicated meant that DD did a spinning act halfway though labour and was face down half way through (having been in a perfect spot just hours before). She carried on with her acrobatics and ended up the right way up for delivery. It did complicate things imo as she took a long time to work her way out although by traditional definition she was a "natural" birth as I had no medical intervention.

Fairlady, that is my point exactly, although not necessarily clearly

What I mean is that you can't define complication by a set criteria for an event, because threads on here are very clear that you can get a PTSD reaction from what, for another woman, would be a non-event.

I have read threads where I have read the description of what took place, and thought "so?" Not unfeeling, but the bare facts are not traumatic. However, the woman experiencing them has been traumatised. For some women, it is having to have a CS when a vaginal birth was their plan. The CS is not in itself the traumatic trigger, it is the loss of control and loss of their ideal birth.

I hope that makes sense. I just think that it needs to be clearly identified that a complication does not necessarily mean a 'bad' birth - it can just mean a different birth, or a fast birth, or a long birth, etc.

it does [make sense] lou...

Best advice - think of question for your area. Do loads of research. The bigger the references,the bigger the grade. More emphasis on primary research (research you have done yourself i.e. interviews, surveys, )Primary research is where you are offered more marks,trust me I've done dissertaions for undergraduate and post grad.

Cant do my own interviews or surveys Charliechew as I wont have ethics approval.

You have all been realy helpful without realising it, becuase your posts are encouraging me to 'dig deeper' IYKWIM??

have spent the day trawling and trawlig the net. Have also managed to get my student midwife friend to get a copy of 'Birth Crisis' by Sheila Kitzinger for me to look at - see what I can get from that.

Im not massively academic and tbh struggle to atriculate what I am trying to do. I know that I want to look at childbirh related PTSD and all of your comments have really helped me. Does it seem plausable to perhaps focus my research on what the most prominent factors are that contribute to childbirth related PTSD? -for example as it has already been suggested - is it the 'medicalisation' of the birth experience that creates this trauma??

Does any of this make sense? Your help really has been fantastic so far- if you can offer any more I would be grateful ( really dont want to balls it all up!!)

It is such a pisser that I cannot do a study in realtion to this on here, I would have masses of valuable info im sure.

Sounds like a great topic for you to research. Hope you don't mind me asking - why won't you get ethics approval (am just starting second year).

A problem is as you mentioned before that all women will see things differently, and that if two women suffered with similar things (such as forceps), then one could suffer from PTSD, and the other could feel completely fine. This also follows the complication of childbirth (what would be complicated)?

Could you have a look to see how it may be connected to a loss of control rather than specific things?

HTH, but not too sure if it will!

thats the kind of angle im considering jofe- look at the given 'reasons' for PTSD.

With regards to the ethics- we only have six months to do the dissertation, it could take all that time to get ethical approval, so unless we can 'tag' into a current postgrad students research project which already has ethical approval, we have been advised to just do an extended lit review.

It's a shame with the ethics approval, (and also something for me to think of for next year!).

I'm sure I've read something recently on PTSD, (Maybe Midirs, practing midwifery). Will look for you later if you want.

Also, there is some information in a book I have got if you want me to email you the details. It simply offers a framework into what can cause PTSD.

(BTW, I suffered with it after dd was born, so got interest in it!).

Tiredemma, you have three broad routes you could go down:

1. Your initial idea of "Does PTSD following childbirth get misdiagnosed as PND, and how does that affect women?" - So differences between PTSD & PND, & treatments, stigma, etc.

2. "What leads to PTSD following birth? Why do two women with similar experiences have different outcomes? i.e. Why does forceps at birth lead to PTSD with one woman & not another? Loci of control, etc.

3. Coping with childbirth related PTSD - what are treatments? Group therapy? You could then use MN as a huge source of examples of women gaining therapeutic benefit from effective strangers with understanding. Your dissertation could go on to suggest research into self-help group funding and resourcing by the NHS as a compliment to the traditional CBT & counselling routes.

My brain is also dead. I feel quite overwhelmed with it all (working a night shift last night and still not getting any sleep today doesnt help either, I cant think straight)

Lou- you are fantastic ( will you be my supervisor???? ) Really- that is so helpful- I have struggled to formulate exactly what it is I am hoping to do. Really need to get my brain into gear, as I said earlier, im not academic (but I am fab on placement!) at all and I really want to do well in this.

tiredemma...how about looking into the correlation between attitude/ behaviour of staff at birth and the outcome ...

I know that, had the staff at the Hospital been better with me I wold have been fine, even though ys birth was far away from the birth that I wanted....but the way I was treated was what made the difference and tipped me over the edge...
do I make sense?

tiredemma - I would accept with great honour, in a virtual MN way

Seriously, I think that if you struggle to articulate you need to bring it all down.

I think your plan of action should start with:

1. Ignore the fact that it is a dissertation, and do a big brainstorm/spider diagram of everything you associate with PTSD/ PND/ Traumatic Childbirth.

You might find it better to do 3 separate diagrams. Then you can look at each of them, and see where the similarities lie.

So, off top of my head,

PTSD - Trauma, or perceived trauma, unexpected outcome, ongoing inability to function fully in life. Anxiety, etc.

PND - ongoing inability to function fully in life, Inability to enjoy parenting freely, anxiety, etc.

Traumatic Childbirth - Trauma, or perceived trauma, ?unexpected outcome, inability to 'move on, etc.

Then, you would look at the three, and pick out the similar ones, and that gives you an idea of why they might be confused, for example.

In medical terms it is known as a 'differential diagnosis'.

Fairlady brings in another point that can be missed, in that given the same circumstances, a different attitude from the 'gatekeepers' of communication and care, power, can be the difference between a positive and negative experience.

The more I think about it, I think you should definitely keep the 'Locus of control' thing firmly in your mind when considering women who have PTSD following child birth.