Abstract
Existing research suggests that childbirth may be a significant trigger of posttraumatic stress symptoms (PTSS). The current study examined whether subjective birthing experiences and objective childbirth characteristics mediated the association between predisposing psychosocial factors measured during pregnancy (e.g., fear of childbirth, history of trauma, and social support) and PTSS during the postpartum period. Women were recruited during pregnancy from a large Midwestern hospital. Symptoms of posttraumatic stress, obsessive compulsive disorder (OCD), and depression, as well as PTSS-related risk factors, including social support, lifetime trauma exposure, fear of childbirth, subjective perceptions, and objective characteristics of childbirth, were measured during pregnancy and 4, 8, and 12 weeks postpartum. A path model revealed that subjective perceptions of childbirth mediated the association between fear of childbirth and PTSS at 4 weeks postpartum. Objective childbirth characteristics mediated the association between fear of childbirth and PTSS at 8 weeks postpartum, and there was a direct association between fear of childbirth and PTSS. Subjective perceptions of childbirth also mediated the effect of fear of childbirth on PTSS at 4 weeks postpartum when controlling for OCD symptoms. Further, the direct effect of fear of childbirth on PTSS at 8 weeks postpartum remained significant when controlling for OCD symptoms. The current study emphasizes the importance of fear of childbirth and subjective and objective birthing experiences in predicting postpartum psychopathology. Future research should examine these models in diverse and at-risk samples. Valid assessments and effective interventions for perinatal PTSS should be explored.
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Notes
The DSM-5 (American Psychiatric Association 2013) made significant changes to the trauma and symptom criteria for PTSD. Specifically, the A2 criterion requiring the experience of “fear, helplessness, and horror” to qualify as a traumatic event has been removed. Ayers et al. (2018) recently examined the differences in rates of traumatic childbirth due to the removal of criterion A2 and found only a minimal 2% increase in the percentage of women who identified childbirth as traumatic according to the DSM-5 versus DSM-IV trauma criteria.
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The authors would like to thank and acknowledge Dr. Jane Engeldinger for coding all participants’ medical records for data collection for the Peripartum Events Scale.
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Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Iowa. The Institute for Clinical and Translational Science provided contact information for all pregnant women at a large Midwestern hospital. The Institute for Clinical and Translational Science at the University of Iowa is supported by the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program, grant U54TR001356. The CTSA program is led by the NIH’s National Center for Advancing Translational Sciences (NCATS). This publication’s contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
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Grekin, R., O’Hara, M.W. & Brock, R.L. A model of risk for perinatal posttraumatic stress symptoms. Arch Womens Ment Health 24, 259–270 (2021). https://doi.org/10.1007/s00737-020-01068-2
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DOI: https://doi.org/10.1007/s00737-020-01068-2