title: Risk factors associated with post-traumatic stress symptoms following childbirth in Turkey.
abstract: OBJECTIVE
  this study examined factors associated with symptoms of post-traumatic stress (PTS) following childbirth in women with normal, low-risk pregnancies in Nigde, Turkey.
  
  
  METHODS
  a prospective longitudinal design where women completed questionnaire measures at 20+ weeks' gestation and 6-8 weeks after birth.
  
  
  METHODS
  eligible pregnant women were recruited from nine family healthcare centres in Nigde between September 2013 and July 2014.
  
  
  METHODS
  a total of 242 women completed questionnaires at both time points.
  
  
  METHODS
  PTS symptoms were measured using the Impact of Event Scale-Revised (IES-R) 6-8 weeks after birth. Potential protective or risk factors of childbirth self-efficacy, fear of childbirth, adaptation to pregnancy/motherhood, and perceived social support were measured in pregnancy and after birth. Perceived support and control during birth was measured after birth. Demographic and obstetric information was collected in pregnancy using standard self-report questions.
  
  
  RESULTS
  PTS symptoms were associated with being multiparous, having a planned pregnancy, poor psychological adaptation to pregnancy, higher outcome expectancy but lower efficacy expectancy during pregnancy, urinary catheterization during labour, less support and perceived control in birth, less satisfaction with hospital care, poor psychological adaptation to motherhood and increased fear of birth post partum. Regression analyses showed the strongest correlates of PTS symptoms were high outcome and low efficacy expectancies in pregnancy, urinary catheterization in labour, poor psychological adaptation to motherhood and increased fear of birth post partum. This model accounted for 29% of the variance in PTS symptoms.
  
  
  CONCLUSIONS
  this study suggests women in this province in Turkey report PTS symptoms after birth and this is associated with childbirth self-efficacy in pregnancy, birth factors, and poor adaptation to motherhood and increased fear of birth post partum.
  
  
  CONCLUSIONS
  maternity care services in Turkey need to recognise the potential impact of birth experiences on women's mental health and adaptation after birth. The importance of self-efficacy in pregnancy suggests antenatal education or support may protect women against developing post partum PTS, but this needs to be examined further.
authors: School of Health, Nigde University, Nigde, Turkey.
authors: Gözde
authors: G
authors: Gökçe İsbİr
authors: School of Health, Nigde University, Nigde, Turkey.
authors: Figen
authors: F
authors: İncİ
authors: Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey.
authors: Murat
authors: M
authors: Bektaş
authors: Centre for Maternal and Child Health Research, City University London, UK.
authors: Pelin
authors: P
authors: Dikmen Yıldız
authors: Centre for Maternal and Child Health Research, City University London, UK. Electronic address: susan.ayers@city.ac.uk.
authors: Susan
authors: S
authors: Ayers
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D020377:Self Efficacy; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires; D014421:Turkey
keywords: Childbirth; Mental health; Post partum; Post-traumatic stress disorder; Pregnancy