title: The role of labor pain and overall birth experience in the development of posttraumatic stress symptoms: a longitudinal cohort study.
abstract: BACKGROUND
  The aim of this prospective study was to investigate the role of labor pain and overall birth experience in the development of posttraumatic stress symptoms in a comprehensive framework.
  
  
  METHODS
  The study sample (N = 1893) comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort, which targeted all women scheduled to give birth at Akershus University Hospital in Norway. Questionnaires were given at three different stages: from pregnancy weeks 17 to 32, from the maternity ward, and from 8 weeks postpartum. Data were also obtained from the hospital's birth record. Using structural equation modeling, a prospective mediation model was tested.
  
  
  RESULTS
  Posttraumatic stress symptoms were significantly related to both labor pain (r = 0.23) and overall birth experience (r = 0.39). A substantial portion (33%) of the effect of labor pain on posttraumatic stress symptoms was mediated by the overall birth experience.
  
  
  CONCLUSIONS
  Although the results of this study showed that both labor pain and overall birth experience played a role in the development of posttraumatic stress symptoms after childbirth, overall birth experience appeared to be the central factor. The women's birth experience was not only related to posttraumatic stress symptoms directly but also mediated a substantial portion of the effect of labor pain on posttraumatic stress symptoms. Future work should address which areas of birth experience confer protective effects on women to improve clinical care.
authors.affiliation: TU Dresden and at the Department of Psychosomatics and Health Behavior, Institute and Outpatient Clinics of Occupational and Social Medicine, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Susan
authors.initials: S
authors.lastname: Garthus-Niegel
authors.forename: Cecilie
authors.initials: C
authors.lastname: Knoph
authors.forename: Tilmann
authors.initials: T
authors.lastname: von Soest
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Nielsen
authors.forename: Malin
authors.initials: M
authors.lastname: Eberhard-Gran
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000523:psychology*; D008137:Longitudinal Studies; D009664:Norway; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: labor pain; longitudinal cohort study; overall birth experience; posttraumatic stress symptoms after childbirth