Obstetric factors associated with postpartum post‐traumatic stress disorder after spontaneous vaginal birth

Abstract

Background This study aimed to determine whether there is an association between clinical practices carried out during spontaneous vaginal birth (SVB), or clinical situations that arise during vaginal birth, and the incidence of post‐traumatic stress disorder (PTSD). Methods A cross‐sectional study with 839 puerperal women in Spain was conducted. The Perinatal Post‐traumatic Stress Disorder Questionnaire (PPQ) was administered online. The relationship between the risk of postpartum PTSD and various intrapartum complications was studied in addition to practices or procedures performed during the intrapartum period. Results PTSD (PPQ scores ≥19) was identified in 8.1% (68) of the women who participated. Among the risk factors for PTSD was a concerning intrapartum FHR tracing (adjusted OR: 2.24, 95% CI: 1.07‐4.66). Other intrapartum practices also put women at risk of PTSD, including the administration of an enema (aOR: 7.01, 95% CI: 2.14‐23.01), being required to stay lying down throughout the labor and birth (aOR: 5.75, 95% CI: 3.25‐10.19), artificial amniorrhexis without consent (aOR: 2.28, 95% CI: 1.31‐3.97), administration of synthetic oxytocin without consent (aOR: 2.18, 95% CI: 1.26‐3.77), fundal pressure during pushing (aOR: 3.14, 95% CI: 1.72‐5.73), repeated vaginal examinations performed by different people (aOR: 4.84, 95% CI: 2.77‐8.47), and manual removal of the placenta without anesthesia (aOR: 3.45, 95% CI: 1.81‐6.58). Conclusions Various intrapartum clinical practices, all related to dehumanized treatment, and intrapartum complications, were associated with an increased risk of PTSD. There is a need to eradicate obstetric mistreatment and to increase access to evidence‐informed, respectful care in Spain. Care practitioners need to better appreciate their roles in preventing PTSD.

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

“…Regarding the reported mode of birth in the included studies, four studies examined one mode of birth, i.e., vaginal birth [ 36 , 54 , 55 ] or emergency caesarean section (emergency CS) [ 56 ], whereas two studies examined two modes of birth, i.e., vaginal birth and caesarean section (CS) [ 22 , 57 ]. Six studies differentiated between vaginal birth, operative vaginal birth and CS [ 37 , 38 , 58 , 59 , 60 , 61 ], whereas three studies differentiated between vaginal birth, elective caesarean section (elective CS) and emergency CS [ 62 , 63 , 64 ].…”

“…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 ].…”

“…Compared with uncomplicated spontaneous vaginal births, vaginal births with intrapartum interventions and complications were associated with CB-PTS/D. One study found several intrapartum interventions such as administration of an enema, Kristeller maneuver, requirement to give birth in a supine position, artificial rupture of membranes without consent and repeated vaginal examination by different people during vaginal birth to be associated with CB-PTS/D [ 55 ]. However, no association was found if the labouring women were informed about those practices in advance and gave informed consent [ 55 ].…”

“…Compared with uncomplicated spontaneous vaginal births, vaginal births with intrapartum interventions and complications were more likely to be associated with CB-PTS/D [ 36 , 37 , 55 , 72 ]. As no association was found when women are informed and give consent before interventions [ 55 ], the lack of consent appears to be the precipitating factor and not the birth interventions as such [ 77 ].…”