Abstract
The primary aim of the study was to analyze differences in post-traumatic stress symptoms (PTSS) and quality of life (QoL) between women with and without severe fear of childbirth postpartum (PP FOC). The secondary aims were to analyze the correlation between PP FOC and PTSS, and PP FOC and QoL, in women undergoing complicated childbirth. This cross-sectional study was conducted in South-East Sweden. Women aged ≥ 18 years who had undergone complicated childbirth (i.e., acute or emergency cesarean section, vacuum extraction, child in need of neonatal care, manual placenta removal, sphincter rupture, shoulder dystocia, or hemorrhage ≥ 1000 ml) were invited. Seventy-six women answered demographic questions and three validated instruments measuring PP FOC, PTSS, and QoL. The study population was divided into two sub groups: severe PP FOC or no severe PP FOC. Statistical analyses were conducted using Mann–Whitney U-test, chi-square test or Fisher’s exact test, and Spearman’s rank-order correlation. Severe PP FOC was reported by 29% of the women, and 18% reported PTSS indicating post-traumatic stress disorder. Women with severe PP FOC reported significantly higher levels of PTSS, and significantly lower QoL in five dimensions: physical role functioning, emotional role functioning, energy/fatigue, emotional well-being, and social functioning. There was a positive significant correlation between level of PP FOC and PTSS. There were also significant negative correlations between level of PP FOC and most of the QoL dimensions. In conclusion, almost one-third of the women with complicated childbirth reported severe PP FOC, and almost one-fifth reported PTSS indicating post-traumatic stress disorder. PP FOC correlated with PTSS and deteriorated QoL.
Highlights
Our results show that women with severe PP FOC express higher levels of post-traumatic stress symptoms (PTSS) and report lower quality of life (QoL)
Almost one-fifth, 18%, scored over the cut-off for PTSS indicating post-traumatic stress disorder (PTSD). This can be compared with 10% reporting stress symptoms and 1–6% diagnosed with PTSD in the general postpartum population (Ayers 2004; Söderquist et al 2009; Yildiz et al 2017)
Women in this study reported a deteriorated QoL in all subscales except for physical functioning and general health compared with a normal population of adult Swedish women (Sullivan et al 2002)
Summary
Becoming a mother is a profound life event that affects women’s lives on several levels: socially, emotionally, mentally, and physiologically. For many women, it is the most intense emotional transition in life (Halldorsdottir and Karlsdottir 1996; Martins 2019). The first 6 weeks after childbirth is FOC can be experienced on a continuum and varies from almost no fear to phobic fear. Severe FOC interferes with the women’s personal lives including emotional, social, and working aspects, and can influence their willingness to become pregnant again FOC during pregnancy increases the risk of experiencing the childbirth as traumatic and stressful (Ayers 2004)
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