Long-Term High Risk of Postpartum Post-Traumatic Stress Disorder (PTSD) and Associated Factors

Abstract

Postpartum post-traumatic stress disorder (PTSD) is not a specific process but can last for months and may manifest itself during any subsequent pregnancies or even become chronic. This study aimed to determine the factors associated with long-term PTSD symptoms one year after delivery. A cross-sectional study was conducted on 1301 Spanish puerperal women. Data were collected on sociodemographic, obstetric, and neonatal variables. The Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) was administered online through midwives’ associations across Spain. Crude odds ratio (OR) and adjusted odds ratio (aOR) and their 95% confidence intervals were calculated. A PPQ score ≥ 19 (high-risk) was recorded for 13.1% (171) of the participants. Identified risk factors were not respecting a birth plan (aOR = 1.89 (95% CI 1.21–2.94)), formula-feeding of the baby at discharge (aOR = 2.50 (95% CI 1.20–5.17)), postpartum surgical intervention (aOR = 2.23 (95% CI 1.02–4.85)), hospital readmission (aOR = 3.45 (95% CI 1.21–9.84)), as well as verbal obstetric violence (aOR = 3.73 (95% CI 2.52–5.53)) and psycho-affective obstetric violence (aOR = 3.98 (95% CI 2.48–6.39)). During childbirth, some clinical practices, such as formula-feeding of the newborn at discharge or types of obstetric violence towards the mother, were associated with a higher risk of PTSD symptoms one year after delivery.

The Impact of Mode of Birth on Childbirth-Related Post Traumatic Stress Symptoms beyond 6 Months Postpartum: An Integrative Review

“…Some were based on the DSM-IV criteria, including the Posttraumatic Diagnostic Scale (PDS) [ 9 , 22 , 38 , 57 , 59 ], PTSD Symptom Scale—self report (PSS-SR) [ 4 , 18 , 68 ], Traumatic Event Scale (TES) [ 36 , 60 , 61 , 66 ], Impact of Event Scale (IES) [ 36 , 58 , 67 ], Posttraumatic Stress Disorder Checklist (PCL) [ 65 ], Post-traumatic checklist scale (PCLS) [ 56 ], and Primary Care PTSD Screen (PC-PTSD-IV) [ 70 ]. The City Birth Trauma Scale (CityBits) [ 62 , 64 , 67 , 69 , 74 ], PTSD-short scale [ 54 ] and Perinatal PTSD Questionnaire (PPQ) [ 37 , 55 , 73 , 75 ] were based on the DSM-V criteria.…”

“…Five studies administered the questionnaires during an interview with assistance from a healthcare professional [ 4 , 9 , 54 , 58 , 62 ], while 20 studies administered self-report questionnaires sent by postal mail, e-mail or online survey [ 18 , 22 , 36 , 37 , 38 , 55 , 56 , 58 , 59 , 60 , 61 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 73 , 75 ].…”

“…For the detailed information about the included studies see Table 1 . In total twelve studies examined (crude or adjusted) associations between mode of birth and CB-PTS/D [ 22 , 36 , 37 , 38 , 58 , 59 , 61 , 66 , 70 , 72 , 73 , 75 ] ( Figure 3 ).…”

“…Eight studies indicated that operative vaginal birth was associated with CB-PTS/D, compared with spontaneous vaginal birth [ 36 , 37 , 38 , 58 , 66 , 70 , 72 , 75 ]. Four of those studies found an association between operative vaginal birth and CB-PTS/D in the univariate analyses, but this association was no longer significant after controlling for confounders such as social behavioral variables [ 36 , 66 , 70 , 75 ]. Nevertheless, in other studies the association between operative vaginal birth and CB-PTS/D remained significant even after controlling for confounders [ 37 , 38 , 58 , 72 ].…”

Perception of obstetric violence in a sample of Spanish health sciences students: A cross-sectional study

“…Consequences include Post-traumatic Stress Disorder (PTSD), which affects roughly 5% of new mothers (Bradley, 2017). The risk of postpartum PTSD in Spanish women increases to 13.1%, and is found to be related to obstetric violence (Martínez-Vazquez et al, 2021). There are reports of women having difficulties returning to sexual relationships, rage about and mistrusting relationships with healthcare professionals, and secondary infertility from fear of suffering obstetric violence (Ministerio de Sanidad, 2010) again.…”