title: Childbirth and criteria for traumatic events.
abstract: OBJECTIVE
  for some women childbirth is physically and psychologically traumatic and meets Criterion A1 (threat) and A2 (intense emotional response) for Posttraumatic Stress Disorder of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV).This study differentiates Criterion A1 and A2 to explore their individual relationship to prevalence rates for posttraumatic stress, each other, and associated factors for childbirth trauma.
  
  
  METHODS
  women were recruited at three hospitals from October 2008 to October 2009. Questionnaires were completed at recruitment and at 14 days post partum.
  
  
  METHODS
  women in the third trimester of pregnancy (n=890) were recruited by a research midwife while waiting for their antenatal clinic appointment. Participants were over 17 years of age, expected to give birth to a live infant, not undergoing psychological treatment, and able to complete questionnaires in English.
  
  
  RESULTS
  this study found 14.3% of women met criteria for a traumatic childbirth. When the condition of A2 was removed, the prevalence rate doubled to 29.4%. Approximately half the women who perceived threat in childbirth did not have an intense negative emotional response. Predictors of finding childbirth traumatic were pre-existing psychiatric morbidity, being a first time mother and experiencing an emergency caesarean section.
  
  
  CONCLUSIONS
  the fear response is an important diagnostic criterion for assessing psychologically traumatic childbirth. The identification of risk factors may inform maternity service delivery to prevent traumatic birth and postpartum approaches to care to address long-term negative consequences.
  
  
  CONCLUSIONS
  prevention and treatment of traumatic childbirth are improved through knowledge of potential risk factors and understanding the woman's subjective experience.
authors.affiliation: School of Applied Psychology & Griffith Health Institute, Griffith University, Mt Gravatt, Qld 4122, Australia. Electronic address: r.boorman@uq.edu.au.
authors.forename: Rhonda J
authors.initials: RJ
authors.lastname: Boorman
authors.affiliation: School of Applied Psychology & Griffith Health Institute, Griffith University, Mt Gravatt, Qld 4122, Australia. Electronic address: grant@devilly.org.
authors.forename: Grant J
authors.initials: GJ
authors.lastname: Devilly
authors.affiliation: School of Nursing and Midwifery & Maternity and Family Unit, Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Logan, Qld 4131, Australia. Electronic address: j.gamble@griffith.edu.au.
authors.forename: Jenny
authors.initials: J
authors.lastname: Gamble
authors.affiliation: School of Nursing and Midwifery & Maternity and Family Unit, Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Logan, Qld 4131, Australia.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Creedy
authors.affiliation: School of Nursing and Midwifery & Maternity and Family Unit, Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Logan, Qld 4131, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fenwick
mesh_terms: D003376:Counseling; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008880:Midwifery; D036801:Parturition / Q000523:psychology*; D049590:Postpartum Period; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D015995:Prevalence; D011594:Psychometrics; D011793:Queensland / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Childbirth; PTSD; Prevalence; Trauma