Psychosocial Predictors of Postpartum Posttraumatic Stress Disorder in Women With a Traumatic Childbirth Experience

Abstract

Objective: To analyze the predictive value of antepartum vulnerability factors, such as social support, coping, history of psychiatric disease, and fear of childbirth, and intrapartum events on the development of symptoms of postpartum posttraumatic stress disorder (PP-PTSD) in women with a traumatic childbirth experience.Materials and methods: Women with at least one self-reported traumatic childbirth experience in or after 2005 were invited to participate through various social media platforms in March 2016. They completed a 35-item questionnaire including validated screening instruments for PTSD (PTSD Symptom Checklist, PCL-5), social support (Oslo social support scale, OSS-3), and coping (Antonovsky's sense of coherence scale, SoC).Results: Of the 1,599 women who completed the questionnaire, 17.4% met the diagnostic criteria for current PTSD according to the DSM-5, and another 26.0% recognized the symptoms from a previous period, related to giving birth. Twenty-six percent of the participating women had received one or more psychiatric diagnoses at some point in their life, and five percent of all women had been diagnosed with PTSD prior to their traumatic childbirth experience. Women with poor (OR = 15.320, CI = 8.001–29.336), or moderate (OR = 3.208, CI = 1.625–6.333) coping skills were more likely to report PP-PTSD symptoms than women with good coping skills. Low social support was significantly predictive for current PP-PTSD symptoms compared to high social support (OR = 5.557, CI = 2.967–7.785). A predictive model which could differentiate between women fulfilling vs. not fulfilling the symptom criteria for PTSD had a sensitivity of 80.8% and specificity of 62.6% with an accuracy of 66.5%.Conclusions: Low social support, poor coping, experiencing “threatened death” and experiencing “actual or threatened injury to the baby” were the four significant factors in the predictive model for women with a traumatic childbirth experience to be at risk of developing PP-PTSD. Further research should investigate the effects of interventions aimed at the prevention of PP-PTSD by strengthening coping skills and increasing social support, especially in women at increased risk of unfavorable obstetrical outcomes.

Correlation between Kind of Cesarean Section and Posttraumatic Stress Disorder in Greek Women

“…Additionally, Ryding et al in aninvestigation for PTSD reaction among women with EMCS, showedthat 1/3 of the study population sufferedfrom serious PTSD reactions [21]. On the contrary, the study by Lopez et al didnot find an association between the kind of CS and PTSD [19].Additionally, the paper published by van Heumen et al defends thatpsychosocial characteristics arestronger predictors than the kind of delivery [8]. However, this study found that 13.1% of the study population met the DSM-V criteria for PTSD (31.7% after EMCS and 1% after ELCS), while 8.1% of women were suffering from PTSD Profile according to the DSM -V (14.3% after EMCS and 4.1% after ELCS) ( Table 3).…”

“…This prospective study is the firstto investigate the development of PTSD and PTSD Profile in two groups of high-risk postpartum women (EMCS and ELCS). Furthermore, it is one of the few studieswhere they used all the diagnostic criteria (A, B, C, D, E) for PTSD postpartum, according to the DSM-V( Table 3) [8] and this increases the sensitivity of the measure, compared with similar surveys in the past.…”

“…Most of them experience birth as a pleasant experience, but in a small percentage, this experience becomes a traumatic event, affecting to a significant extent the woman herself and everyone around her. Various conditions seem to affect the development of this disorder, such as pregnancy pathology, complications during birth, emergency cesarean section, history of psychiatric disorders, fear during childbirth, and previous traumatic events in the mother's life [7][8][9][10]. A traumatic birth experience that evolves into PTSD or PTSD Profile can overshadow the mother-child relationship, the relationship with the partner, and the desire to acquire another child in the future [11].…”

“…When there are past traumatic events in the mother's life, it is very difficult to determine what has caused the symptoms of PTSD postpartum. After a birth experience, it is known that past traumas of the mother's life can be recalled and cause symptoms that lead to the re-experiencing of an old PTSD [7,8,12].…”

“…In contrast, however, both old and new surveys show a great correlation between EMCS and PTSD compared to other types of birth [6,12,20], while only two investigate the correlation of EMCS with PTSD [21,22]. Some researchers also consider that the psychosocial characteristics of women, previous traumas, and history of mental disorders are stronger risk factors than EMCS in the development of PTSD [8,23,24].…”