title: Posttraumatic stress following childbirth in homelike- and hospital settings.
abstract: OBJECTIVE
  To assess the prevalence of posttraumatic stress disorder (PTSD) following childbirth in homelike versus hospital settings and to determine risk factors for the development of posttraumatic stress symptoms. METHODS.: Multi-center cross-sectional study at midwifery practices, general hospitals and a tertiary (university) referral center. An unselected population of 907 women was invited to complete questionnaires on PTSD, demographic, psychosocial, and obstetric characteristics 2 to 6 months after delivery. Prevalence of PTSD was based on women who met all criteria of the diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV), whereas risk factors were determined using the severity (sum-score) of posttraumatic stress symptoms.
  
  
  RESULTS
  PTSD following childbirth was found in 1.2% of the respondents (5/428 women, response rate 47%), while 9.1% of women (39/428) had experienced the delivery as traumatic. Posttraumatic stress symptoms were associated with unplanned cesarean section, low sense of coherence (coping skills), and high intensity of pain. Initial differences in posttraumatic stress symptoms between home and hospital deliveries disappeared after taking into account the (by definition) uncomplicated nature of home births.
  
  
  CONCLUSIONS
  In this Dutch study, 1 in 100 women had PTSD following childbirth, with no differences between home- and hospital deliveries after controlling for complications and interventions. Emergency cesarean section, severe labor pain, and poor coping skills were associated with more posttraumatic stress symptoms.
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands. c.a.i.stramrood@og.umcg.nl
authors.forename: Claire A I
authors.initials: CA
authors.lastname: Stramrood
authors.forename: K Marieke
authors.initials: KM
authors.lastname: Paarlberg
authors.forename: Elisabeth M J
authors.initials: EM
authors.lastname: Huis In 't Veld
authors.forename: Leonard W A R
authors.initials: LW
authors.lastname: Berger
authors.forename: Ad J J M
authors.initials: AJ
authors.lastname: Vingerhoets
authors.forename: Willibrord C M Weijmar
authors.initials: WC
authors.lastname: Schultz
authors.forename: Maria G
authors.initials: MG
authors.lastname: van Pampus
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006700:Home Childbirth / Q000523:psychology*; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology; D008875:Middle Aged; D011247:Pregnancy; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology*; D011795:Surveys and Questionnaires