Prenatal couple relationship satisfaction, romantic attachment, and childbirth-related posttraumatic stress symptoms

Background: Traumatic childbirth can lead to childbirth-related posttraumatic stress symptoms (CB-PTSS). Although underexplored, prenatal couple relationship satisfaction and romantic attachment orientations are modifiable factors that may increase or mitigate the risk of CB-PTSS after a traumatic childbirth experience.

Objectives: This study examined (1) the associations between prenatal couple relationship satisfaction and romantic attachment, traumatic childbirth and CB-PTSS; (2) whether prenatal couple relationship satisfaction moderates the association between traumatic childbirth and CB-PTSS; and (3) whether the interaction between prenatal couple relationship satisfaction and romantic attachment moderates the association between traumatic childbirth and CB-PTSS.

Method: The sample included 162 mothers from a Portuguese longitudinal cohort who completed self-report questionnaires at the third trimester of pregnancy (T1) and at two months postpartum (T2), on sociodemographic, mental health-related, and obstetric data (T1 and T2), couple relationship satisfaction (T1), romantic attachment (T1), traumatic childbirth experience (T2) and CB-PTSS (T2). Hierarchical regression analyses and moderated moderation models were performed.

Results: Lower prenatal couple relationship satisfaction predicted greater CB-PTSS severity, before accounting for attachment-related anxiety and avoidance. Attachment-related anxiety predicted greater CB-PTSS severity. The association between traumatic childbirth experience and CB-PTSS severity was only significant at low levels of prenatal couple relationship satisfaction and medium or high levels of attachment-related anxiety.

Conclusions: Especially in mothers reporting higher attachment-related anxiety, lower prenatal couple relationship satisfaction seems to increase the risk of CB-PTSS following the experience of a traumatic childbirth. Couple relationship satisfaction and romantic attachment orientations should be assessed during routine prenatal screenings, along with childbirth experiences.