Birth trauma: the mediating effects of perceived support
Many women experience their childbirth as traumatic, and 4-6% of mothers present with postnatal post-traumatic stress disorder.
To measure the relationship between obstetric intervention, perceived support in childbirth and mothers' experiences of postnatal trauma, and to identify salient aspects of the birth experience that are considered traumatic.
A total of 222 women in their first year postpartum were recruited between October and December 2018 via local mother and baby groups in southwest England (UK) and online social media pages. They completed an online survey regarding their birth experience. Further insight into mother's birth experiences was garnered through free-text responses in the survey.
Overall, 29% of mothers experienced a traumatic birth and 15% met full or partial criteria for post-traumatic stress disorder. Feeling supported mediated the relationship between obstetric intervention and postnatal trauma symptoms.
This study reinforces the value of supportive healthcare professionals and the power of a nurturing environment, which can buffer the potentially negative effects of an obstetrically complicated birth on postnatal trauma symptoms.
In recent years, birth trauma has become the focus of much perinatal research. Childbirth can be a triggering event for mothers and lead to symptoms of postnatal post-traumatic stress disorder (PTSD), including intrusive flashbacks of the birth, avoidance of hospitals or future pregnancy, or feelings of irritability, fear, guilt and shame (American Psychiatric Association [APA], 2013). A systematic review estimated postnatal PTSD prevalence to be between 4-6% (Dekel et al, 2017). However, the experience of birth trauma affects many more women who do not meet the clinical cut-off for PTSD but display symptoms of traumatic stress after birth (Ayers, 2004).
Mothers who experience obstetric complications or high levels of medical intervention during birth are more likely to present with postnatal PTSD (Adewuya et al, 2006; Andersen et al, 2012; Milosavljevic et al, 2016). However, this is not a clear and linear relationship consistently found in the literature and it is important to note that obstetric complications are not a prerequisite for a traumatic childbirth experience (Czarnocka and Slade, 2000). A birth without complications may be appraised as traumatic if the mother experiences poor quality interactions with healthcare providers, leading to a negative perception of her childbirth experience (Elmir et al, 2010; Simpson and Catling, 2016). Recent reviews of birth-related PTSD present subjective birth experiences to be a more powerful contributing factor of trauma compared to obstetric factors (Ayers et al, 2016; Dekel et al, 2017). A subjectively traumatising birth can include high levels of distress, fear for the self and/or baby, lacking control over the birth or feeling unsupported (Garthus-Niegel et al, 2013).
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