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 (β=.15, p<.05), state anxiety (β=.17, p<.01), and perinatal psychoform (β=.17, p<.01) and somatoform (β=.17, p<.01) dissociation were identified as PTSD symptom risk factors three months postpartum. Antenatal depressive symptoms (β=.31, p<.001) and perinatal somatoform dissociation (β=.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.