title: Post-Traumatic Stress Disorder after childbirth and the influence of maternity team care during labour and birth: A cohort study.
abstract: OBJECTIVE
  we examined the prevalence of Post-Traumatic Stress Disorder (PTSD) and the role of personal and obstetric risk factors, as well as the role of midwifery team care factors in a cohort of Flemish women.
  
  
  METHODS
  prospective cohort study. Data collection was performed at two times post partum: During the first week, socio-demographic and obstetric data as well as information related to midwifery team care factors were assessed using self-report measures. To asses PTSD symptomatology, the Impact of Event Scale-Revised (IES-R) and the Traumatic Event Scale (TES) were used. At six weeks post partum, PTSD symptoms were reassessed either by telephone interviews or e-mail. Results were calculated in frequencies, means and standard deviations. Differences between week one and six were analysed using parametrical and non-parametrical statistics. Multiple and logistic regression was performed to determine risk factors for PTSD symptomatology. P-value was set at 0.05.
  
  
  METHODS
  maternity wards in Flanders, Belgium.
  
  
  METHODS
  the first (week 1) and follow-up (week 6) sample of the data collection consisted of 340 and 229 women respectively.
  
  
  RESULTS
  the prevalence of PTSD symptoms after childbirth ranged from 22% to 24% in the first week and from 13% to 20% at six weeks follow-up. Multiple regression analysis showed that Islamic belief, a traumatic childbirth experience, family income <€2500, a history of psychological or psychiatric consults and labour/birth with complications significantly predicted PTSD symptomatology at six weeks post-birth. Midwifery team care and the opportunity to ask questions, as well as experiencing a normal physiological birth were significantly associated with less postnatal PTSD symptoms. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTISE: the results of this study suggest that contextual factors such as religion, socio-economic status, and childbirth experience might be important factors to address by the midwifery team. Midwifery team care factors such as 'providing the opportunity to the mother to ask questions' and the 'perception of the midwife being in control' proved to be potential protective factors for postnatal PTSD symptoms. Despite its prevalence, PTSD symptoms after birth are not yet well understood by health care workers. Further research concerning the influence of midwifery team care factors on developing childbirth related PTSD is required.
authors.affiliation: Karel de Grote University College - Healthcare Department, Van Schoonbekestraat 143, 2018 Antwerp, Belgium. Electronic address: sarah.deschepper@kdg.be.
authors.forename: Sarah
authors.initials: S
authors.lastname: De Schepper
authors.affiliation: Karel de Grote University College - Healthcare Department, Van Schoonbekestraat 143, 2018 Antwerp, Belgium. Electronic address: tinne.vercauteren@kdg.be.
authors.forename: Tinne
authors.initials: T
authors.lastname: Vercauteren
authors.affiliation: Nursing Departments of Mother & Child, Surgery and Polyvalent Care, ZNA Jan Palfijn, Lange Bremstraat 70, 2170 Merksem, Belgium. Electronic address: jolein.tersago@zna.be.
authors.forename: Jolein
authors.initials: J
authors.lastname: Tersago
authors.affiliation: University of Antwerp, Antwerp University Hospital UZA, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium. Electronic address: yves.jacquemyn@uza.be.
authors.forename: Yves
authors.initials: Y
authors.lastname: Jacquemyn
authors.affiliation: Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, 3000 Leuven, Belgium. Electronic address: filip.raes@ppw.kuleuven.be.
authors.forename: Filip
authors.initials: F
authors.lastname: Raes
authors.affiliation: Karel de Grote University College - Healthcare Department, Van Schoonbekestraat 143, 2018 Antwerp, Belgium; Centre of Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2610 Wilrijk, Belgium. Electronic address: erik.franck@kdg.be.
authors.forename: Erik
authors.initials: E
authors.lastname: Franck
mesh_terms: D000328:Adult; D001530:Belgium / Q000453:epidemiology; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology*; D008880:Midwifery / Q000458:organization & administration*; D036801:Parturition / Q000523:psychology*; D010348:Patient Care Team; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D015995:Prevalence; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Midwifery team; Post partum; Post-Traumatic Stress Disorder; Risk factors