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Depression and negative experiences biggest risk factors for birth-related post-traumatic stress

Research will be used to inform screening, prevention and intervention in maternity care


The biggest risk factors for post-traumatic stress disorder (PTSD) in response to events of childbirth are depression in pregnancy and negative experiences during birth, according to a study by academics at City University London, University of Sussex and Linköping University.

The meta-analysis which reviewed over 50 international papers in the literature will be used to update our understanding about the origins of birth-related PTSD and inform screening, prevention and intervention in maternity care.

Approximately 136 million women give birth to a live or stillborn baby every year with 5.4 million of those taking place in Europe. Looking at 50 studies, which included 21,429 participants from 15 countries including the UK, USA and Nigeria, the research was analysed for the pre-birth, birth and post-birth vulnerability factors most strongly associated with PTSD. The countries contributing the most studies were the UK, Netherlands and Sweden.

To find relevant research papers, the team undertook systematic literature searches on PsychInfo, PubMed, Scopus and Web of Science. Studies were included if they reported primary research that examined factors associated with birth-related PTSD at least one month after birth.

The results show that the antenatal factors most associated with birth-related PTSD were depression in pregnancy, fear of childbirth, poor health or complications in pregnancy, and a history of PTSD and prior counselling for birth-related factors. Birth factors most strongly associated with PTSD were negative birth experiences, having an operative birth (assisted vaginal or caesarean) and lack of support. After birth, PTSD was associated with poor coping and stress and was highly associated with depression.

Speaking about the research, Professor Susan Ayers, lead of the Centre for Maternal and Child Health Research at City University London and one of the authors of the paper, said:

“In this study we aimed to identify the key vulnerability and risk factors for birth-related PTSD because there is clear potential to prevent or minimise its effects by changing maternity and postpartum care to improve women’s experiences of pregnancy and birth.

“What we found is that pregnancy and birth factors are important, and that PTSD is associated with a range of problems after birth such as stress and depression. Our meta-analysis also identified several new factors that will be used to update our model of how birth-related PTSD occurs and can inform screening, prevention and treatment of birth-related PTSD as it is a condition that has a serious impact on women and their families.”

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