The Association Between Doula Care and Childbirth-Related Post-Traumatic Stress Disorder Symptoms: The Mediating Role of Childbirth Experience

Introduction: Although the benefits of doula care during childbirth are well-known, its impact on childbirth-related post-traumatic stress disorder (CB-PTSD) symptoms are less thoroughly characterized. This study aimed to explore the association between doula care and CB-PTSD symptoms and the potential mediating role of childbirth experience on this association.

Methods: A prospective cohort study was conducted in a hospital in China, enrolling women with singleton live vaginal births. The exposure and primary outcome factors of interest were doula care and CB-PTSD symptoms, with childbirth experience as a mediating factor. Questionnaires were administered to collect baseline data and childbirth experience at 3 days postpartum, and CB-PTSD symptoms from participants at 42 days postpartum. Linear regression analysis was used to analyze the relationship between doula care, childbirth experience, and CB-PTSD symptoms, while the mediating role of childbirth experience was analyzed using the SPSS (PROCESS) modeling tool.

Results: A total of 445 eligible women were included in the final analysis, including 120 who received doula care and 325 who did not. Linear regression analyses found that doula care was independently associated with CB-PTSD symptoms (β = -0.11, p < 0.05) and childbirth experience (β = 0.50, p < 0.001). Childbirth experience was significantly associated with CB-PTSD symptoms (β = -0.17, p < 0.001). Childbirth experience mediated the association between doula care and CB-PTSD symptoms (indirect effect = -1.08, 95% CI -1.91 to -0.10), even after adjusting for potential confounders.

Conclusions: Childbirth experience serves as a mediator of the association between doula care and CB-PTSD symptoms. By providing supportive care for women during childbirth, their childbirth experience could be improved, thereby reducing the risk of CB-PTSD symptoms.