PTSD after childbirth: A predictive ethological model for symptom development.

BACKGROUND: Childbirth can be a traumatic experience occasionally leading to posttraumatic stress disorder (PTSD). This study aimed to assess childbirth-related PTSD risk-factors using an etiological model inspired by the transactional model of stress and coping. METHODS: 348 out of 505 (70%) Dutch women completed questionnaires during pregnancy, one week postpartum, and three months postpartum. A further 284 (56%) also completed questionnaires ten months postpartum. The model was tested using path analysis. RESULTS: Antenatal depressive symptoms (ß=.15, p<.05), state anxiety (ß=.17, p<.01), and perinatal psychoform (ß=.17, p<.01) and somatoform (ß=.17, p<.01) dissociation were identified as PTSD symptom risk factors three months postpartum. Antenatal depressive symptoms (ß=.31, p<.001) and perinatal somatoform dissociation (ß=.14, p<.05) predicted symptoms ten months postpartum. LIMITATIONS: Almost a third of our sample was lost at three months postpartum, and 44% at ten months. The sample size was relatively small. The present study did not control for prior PTSD. The PTSD A criterion was not considered an exclusion criteria for model testing, and the fit index of the ten months model was just below suggested cut-off values. CONCLUSIONS: Screening for high risk pregnant women should focus on antenatal depression, anxiety and dissociative tendencies. Hospital staff and midwives are advised to be vigilant for perinatal dissociation after intense negative emotions. To help regulate perinatal negative emotional responses, hospital staff and midwifes are recommended to provide information about birth procedures and be attentive to women's birth-related needs.

Posttraumatic stress following childbirth: a review.

To assess the empirical basis of prevalence and risk factors of childbirth-related posttraumatic stress symptoms and PTSD in mothers, the relevant literature was critically reviewed. A MEDLINE and PSYCHLIT search using the key words "posttraumatic stress", "PTSD", "childbirth" and "traumatic delivery" was performed. The generated list of articles was supplemented by a review of their bibliographies. A total of 31 articles was selected. The primary inclusion criterion was report of posttraumatic stress symptoms or PTSD specifically related to childbirth. Case studies and quantitative studies on regular childbirth and childbirth by emergency cesarean section were identified. Consistency among studies was found with regard to development of posttraumatic stress symptoms as a consequence of traumatic delivery. Methodological issues concerning prevalence and risk factors were discussed. Case studies and quantitative studies confirm that childbirth may be experienced as so emotionally intense that it can lead to the development of posttraumatic stress symptoms or even a PTSD-profile. Among the identified risk factors were a history of psychological problems, trait anxiety, obstetric procedures, negative aspects in staff-mother contact, feelings of loss of control over the situation, and lack of partner support. The conclusion of the current review is twofold. First, traumatic reactions to childbirth are an important public health issue. Secondly, studying childbirth offers opportunity to prospectively study the development of posttraumatic stress reactions.

Peritraumatic dissociation and emotions as predictors of PTSD symptoms following childbirth.

UNLABELLED: The current study investigated the contributive role of perinatal dissociative and perinatal emotional responses to the development of PTSD symptoms following childbirth. METHOD: Using a prospective, longitudinal design, 140 women were studied who were followed from the first week after delivery to three months postpartum. RESULTS: Three women (2.1%) met criteria for PTSD and 21.4% reported a traumatic childbirth experience. Both perinatal negative emotional reactions and perinatal dissociative reactions were the predictors of PTSD symptoms at three months postpartum. The effect of perinatal dissociation, however, was partially mediated by perinatal emotional reactions. CONCLUSION: Posttraumatic stress disorder can be a consequence of the experience of childbirth. Women who reported high levels of negative emotions during and shortly after childbirth were more likely to develop PTSD symptoms than women who did not. Women who experienced an instrumental delivery and also reported higher levels of psychoform perinatal dissociation, were at higher risk than women who reported higher levels of perinatal dissociation during a spontaneous delivery. These findings add to the growing body of literature regarding traumatic childbirth and indicate that perinatal dissociative and emotional phenomena are associated with posttraumatic stress.