Abstract
BackgroundThis study aimed to examine whether a mismatch between a woman’s preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth.MethodsThe study sample consisted of 1,700 women scheduled to give birth between 2009 and 2010 at Akershus University Hospital, Norway. Questionnaire data from pregnancy weeks 17 and 32 and from 8 weeks postpartum were used along with data obtained from hospital birth records. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Based on the women’s preferred and actual mode of delivery, four groups were established: Match 1 (no preference for cesarean section, no elective cesarean section, N = 1,493); Match 2 (preference for cesarean section, elective cesarean section, N = 53); Mismatch 1 (no preference for cesarean section, elective cesarean section, N = 42); and Mismatch 2 (preference for cesarean section, no elective cesarean section, N = 112). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted to examine whether the level of post-traumatic stress symptoms differed significantly among these four groups.ResultsExamining differences for all four groups, ANOVA yielded significant overall group differences (F = 11.96, p < 0.001). However, Bonferroni post-hoc tests found significantly higher levels of post-traumatic stress symptoms only in Mismatch 2 compared to Match 1. This difference could be partly explained by a number of risk factors, particularly psychological risk factors such as fear of childbirth, depression, and anxiety.ConclusionsThe results suggest increased post-traumatic stress symptoms in women who preferred delivery by cesarean section but delivered vaginally compared to women who both preferred vaginal delivery and delivered vaginally. In psychologically vulnerable women, such mismatch may threaten their physical integrity and, in turn, result in post-traumatic stress symptoms. These women, who often fear childbirth, may prefer a cesarean section even though vaginal delivery is usually the best option in the absence of medical indications. To avoid potential trauma, fear of childbirth and maternal requests for a cesarean section should be taken seriously and responded to adequately.
Highlights
This study aimed to examine whether a mismatch between a woman’s preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth
By means of an analysis of variance (ANOVA), we examined whether the level of post-traumatic stress symptoms following childbirth differed significantly between these groups
Mean maternal age at delivery was 31.2 years (SD 4.6 years, range 18.8–45.4 years); 5.2% of the women had previously delivered by a cesarean section (CS), 18.4% had a medical risk for an elective CS and 47.2% were first-time mothers
Summary
This study aimed to examine whether a mismatch between a woman’s preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth. An estimated 2-6% of women experience the full constellation of symptoms of post-traumatic stress disorder (PTSD) and qualify for a clinical diagnosis [1]. The prevalence of these symptoms has typically been measured within the first six months postpartum, but there is evidence suggesting the potential longevity of post-traumatic stress responses in some women [2]. It has been suggested that a new pregnancy has the potential to reactivate post-traumatic stress symptoms [1]. Knowledge about risk factors of posttraumatic stress symptoms following childbirth is, of great importance, and may help identify mothers who may need intervention
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