Abstract
To determine the association between experiencing obstetric violence and the incidence of postpartum post-traumatic stress disorder (PTSD). A cross-sectional study with puerperal women was conducted in Spain following ethical approval. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) was administered online. Sociodemographic, clinical, and obstetric violence variables and the risk of dichotomized PTSD (low/high) were studied by bivariate and multivariate analysis with binary logistic regression. 955 women were invited to participate. 53 women refused to participate, three did not complete all survey questions and, finally, 899 women were included. The risk of PTSD (score ≥ 19) using the PPQ was 12.7% (114). The mean score was 9.10 points (SD = 8.52). Risk factors identified were having a delivery plan that was not respected (aOR: 2.85, 95% CI 1.56–5.21), elective caesarean delivery (aOR: 2.53, 95% CI 1.02–2.26), emergency caesarean section (aOR: 3.58, 95% CI 1.83–6.99), admission of the newborn to the neonatal intermediate care unit (aOR: 4.95, 95% CI 2.36–10.36), admission to the intensive care unit (aOR: 2.25, 95% CI 1.02–4.97), formula feeding on discharge (aOR: 3.57, 95% CI 1.32–9.62), verbal obstetric violence (aOR: 5.07, 95% CI 2.98–8.63), and psycho-affective obstetric violence (aOR: 2.61, 95% CI 1.45–4.67). Various clinical practices were identified with the risk of PTSD, highlighting various types of obstetric violence. Partner support and early breastfeeding were identified as protective factors. Sensitizing professionals is essential to prevent the risk of PTSD.
Highlights
Mothers of infants admitted to intensive care, or whose infants were formula-fed at discharge showed a higher incidence of this disorder
Those women who started breastfeeding in the first hour postpartum and felt supported by their partner had a lower risk of developing post-traumatic stress disorder (PTSD)
There are clinical practices that are related to the risk of PTSD, including the type of delivery a woman has, formula-fed newborn at hospital discharge, mother-child separation, her birth plan not being respected, and verbal and psycho-affective obstetric violence
Summary
Childbirth, and postpartum are periods in which a woman’s risk of developing a mental disorder increases; despite this, mental health is an aspect that does not usually receive a lot of attention in the care provided during these periods [1,2].Postpartum post-traumatic stress disorder (PTSD) is one of these disorders and may be present in 0.8–43% of women, depending on whether the assessment uses only selfdeclared symptoms, the diagnostic criteria of the DSM, or if the study has been carried out at a community level or in the at-risk population [3,4,5,6,7,8].Women who experience this disorder report re-experimentation of the event, a feeling of disconnection from the baby, absence of reality, nightmares, irritability, rejection of new motherhood, or may even develop tocophobia (the fear of pregnancy and childbirth) [9,10,11,12,13,14].The maximum expression of these symptoms appears between 4–6 weeks postpartum, the symptoms can remain for months or years later, and even in future pregnancies [3,15].Different variables have been associated with the risk of developing PTSD, such as having been abused during childhood [16], exposure to trauma [17], the type of delivery, the Kristeller maneuver being performed in the expulsive period, having third or fourth-degree perineal tears [18], having a postpartum hemorrhage [19], or being afraid of childbirth [20]. Postpartum post-traumatic stress disorder (PTSD) is one of these disorders and may be present in 0.8–43% of women, depending on whether the assessment uses only selfdeclared symptoms, the diagnostic criteria of the DSM, or if the study has been carried out at a community level or in the at-risk population [3,4,5,6,7,8]. Women who experience this disorder report re-experimentation of the event, a feeling of disconnection from the baby, absence of reality, nightmares, irritability, rejection of new motherhood, or may even develop tocophobia (the fear of pregnancy and childbirth) [9,10,11,12,13,14]. Age, parity, and having resources, such as coping skills, have been associated with the incidence of PTSD [21,22]
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