Trait anxiety and unplanned delivery mode enhance the risk for childbirth-related post-traumatic stress disorder symptoms in women with and without risk of preterm birth: A multi sample path analysis.

Sarah Sommerlad,Silvia Oddo-Sommerfeld,Valentina Lucia La Rosa,Frank Louwen,Karin Schermelleh-Engel,Jonathan E Handelzalts

doi:10.1371/journal.pone.0256681

Abstract

Childbirth-related post-traumatic stress disorder (CB-PTSD) occurs in 3–7% of all pregnancies and about 35% of women after preterm birth (PTB) meet the criteria for acute stress reaction. Known risk factors are trait anxiety and pain intensity, whereas planned delivery mode, medical support, and positive childbirth experience are protective factors. It has not yet been investigated whether the effects of anxiety and delivery mode are mediated by other factors, and whether a PTB-risk alters these relationships. 284 women were investigated antepartum and six weeks postpartum (risk-group with preterm birth (RG-PB) N = 95, risk-group with term birth (RG-TB) N = 99, and control group (CG) N = 90). CB-PTSD symptoms and anxiety were measured using standardized psychological questionnaires. Pain intensity, medical support, and childbirth experience were assessed by single items. Delivery modes were subdivided into planned vs. unplanned delivery modes. Group differences were examined using MANOVA. To examine direct and indirect effects on CB-PTSD symptoms, a multi-sample path analysis was performed. Rates of PTS were highest in the RG-PB = 11.58% (RG-TB = 7.01%, CG = 1.1%). MANOVA revealed higher values of CB-PTSD symptoms and pain intensity in RG-PB compared to RG-TB and CG. Women with planned delivery mode reported a more positive birth experience. Path modeling revealed a good model fit. Explained variance was highest in RG-PB (R2 = 44.7%). Direct enhancing effects of trait anxiety and indirect reducing effects of planned delivery mode on CB-PTSD symptoms were observed in all groups. In both risk groups, CB-PTSD symptoms were indirectly reduced via support by medical staff and positive childbirth experience, while trait anxiety indirectly enhanced CB-PTSD symptoms via pain intensity in the CG. Especially in the RG-PB, a positive birth experience serves as protective factor against CB-PTSD symptoms. Therefore, our data highlights the importance of involving patients in the decision process even under stressful birth conditions and the need for psychological support antepartum, mainly in patients with PTB-risk and anxious traits.Trial registration number:NCT01974531 (ClinicalTrials.gov identifier).

Highlights

For expectant parents, childbirth is a joyous and challenging event
We found a higher proportion of spontaneous vaginal delivery in the risk group (RG)-TB and in the control group (CG) (53.54% and 51.11%, respectively) compared to the RG-PB (31.58%)
The percentage of caesarean sections was higher in the risk-group with preterm birth (52.63%) compared to the other two samples (RG-TB: 15.15%; CG: 24.44%)

Summary

Introduction

Childbirth is a joyous and challenging event. Previous research has already provided evidence that women are more vulnerable to develop mental health problems during the peripartum [1].In this regard, considerable research attention has been paid to the trauma of birth. Childbirth is a joyous and challenging event. Previous research has already provided evidence that women are more vulnerable to develop mental health problems during the peripartum [1]. In this regard, considerable research attention has been paid to the trauma of birth. Since 1994, the Diagnostic Statistical Manual (DSM) included childbirth as a potentially traumatic event [2]. De Graaff et al [3] showed that 9 to 44% of all mothers report at least traumatic aspects of the delivery situation, even if the symptoms significantly decrease within the first weeks after birth in the majority of women [4]

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