Childbirth and the development of acute trauma symptoms: incidence and contributing factors.
BACKGROUND
Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder in women as a result of their labor and birth experiences, and to identify factors that contributed to the women's psychological distress.


METHODS
Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Telephone interviews with 499 participants were conducted at 4 to 6 weeks postpartum to explore the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms.


RESULTS
One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty-eight women (5.6%) met DSM-IV criteria for acute posttraumatic stress disorder. Antenatal variables did not contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (beta = 0.351, p < 0.0001) and the perception of inadequate intrapartum care (beta = 0.319, p < 0.0001) during labor were consistently associated with the development of acute trauma symptoms.


CONCLUSIONS
Posttraumatic stress disorder after childbirth is a poorly recognized phenomenon. Women who experienced both a high level of obstetric intervention and dissatisfaction with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. These findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the care provided to birthing women.
Faculty of Nursing and Health, Griffith Univeristy, Meadbrook, Queensland, Australia.
D K
DK
Creedy
I M
IM
Shochet
J
J
Horsfall
D005260:Female; D006801:Humans; D015994:Incidence; D007743:Labor, Obstetric / Q000523:psychology*; D008137:Longitudinal Studies; D009773:Obstetric Nursing / Q000379:methods; D011247:Pregnancy; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012649:Self Concept; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D013997:Time Factors