title: Acute stress reactions in the first 3 weeks postpartum: a study of 219 parturients.
abstract: OBJECTIVE
  There is increasing research on posttraumatic stress (PS) 4-6 weeks and 3 months postpartum, but, there are no data on acute stress reactions (ASR) in the first 3 weeks postpartum, i.e. the potential precursors of PS. However, ASR may have long-term effects, e.g., on a subsequent pregnancy without having manifested as PS in the meantime. We propose: (i) to describe the patterns of ASR after childbirth, (ii) to explore differences between women with normal and traumatogenic ASR, and (iii) to provide data on the early detection of traumatogenic ASR 2 and 3 weeks postpartum.
  
  
  METHODS
  Intra-event variables (relationship with caregivers, overall birth experience, and dissociative experiences, as well as obstetric variables) were assessed 48-96 h. postpartum, as were ASR (by means of the Impact-of-Event Scale IES) in weeks 1, 2, and 3 postpartum. According to research on PS the upper 33%-range of ASR in weeks 2 and 3 was defined as 'traumatogenic'.
  
  
  RESULTS
  Normal ASR in week 1 are at a level which in non-obstetric trauma-situations is considered as the upper range of low stress or lower range of medium distress. ASR decline constantly from week 1 to week 3. However, high ASR in week 1 do not drop faster than do low ones, thus indicating a prolonged stress reaction in women with high ASR in week 1. Low ASR (IES-scores <10) and high ASR (IES-scores >20) in week 1 are highly predictive for normal ASR, and traumatogenic ASR in weeks 2 and 3, respectively. Medium ASR (IES-scores 10-20) in week 1 are of uncertain predictive value for stress reactions in weeks 2 and 3 and have to be re-assessed at that time.
  
  
  CONCLUSIONS
  Clinical screening for ASR appears to be helpful in detecting women with a compromised ability to process childbirth-related stress. The association between ASR and long-term development should be further explored.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Bern, Switzerland. wstadlmayr@gmx.com
authors.forename: Werner
authors.initials: W
authors.lastname: Stadlmayr
authors.forename: Johannes
authors.initials: J
authors.lastname: Bitzer
authors.forename: Felix
authors.initials: F
authors.lastname: Amsler
authors.forename: Heidi
authors.initials: H
authors.lastname: Simoni
authors.forename: Judith
authors.initials: J
authors.lastname: Alder
authors.forename: Daniel
authors.initials: D
authors.lastname: Surbek
authors.forename: Dieter
authors.initials: D
authors.lastname: Bürgin
mesh_terms: D004213:Dissociative Disorders / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D036801:Parturition / Q000523:psychology*; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011446:Prospective Studies; D012720:Severity of Illness Index; D040701:Stress Disorders, Traumatic, Acute / Q000523:psychology*