Childbirth-related posttraumatic stress disorder: definition, risk factors, pathophysiology, diagnosis, prevention, and treatment

Research output: Contribution to journalReview articleContributedpeer-review

Contributors

  • Antje Horsch - , University of Lausanne, University Hospital of Lausanne (Author)
  • Susan Garthus-Niegel - , Institute and Policlinic of Occupational and Social Medicine, MSH Medical School Hamburg, Norwegian Institute of Public Health (Author)
  • Susan Ayers - , City, University of London (Author)
  • Prabha Chandra - , National Institute of Mental Health and Neuro Sciences (NIMHANS) (Author)
  • Katharina Hartmann - , Mother Hood e.V. (Author)
  • Edi Vaisbuch - , Kaplan Medical Center Israel, Hebrew University of Jerusalem (Author)
  • Joan Lalor - , Trinity College Dublin (Author)

Abstract

Psychological birth trauma and childbirth-related posttraumatic stress disorder represent a substantial burden of disease with 6.6 million mothers and 1.7 million fathers or co-parents affected by childbirth-related posttraumatic stress disorder worldwide each year. There is mounting evidence to indicate that parents who develop childbirth-related posttraumatic stress disorder do so as a direct consequence of a traumatic childbirth experience. High-risk groups, such as those who experience preterm birth, stillbirth, or preeclampsia, have higher prevalence rates. The main risks include antenatal factors (eg, depression in pregnancy, fear of childbirth, poor health or complications in pregnancy, history of trauma or sexual abuse, or mental health problems), perinatal factors (eg, negative subjective birth experience, operative birth, obstetrical complications, and severe maternal morbidity, as well as maternal near misses, lack of support, dissociation), and postpartum factors (eg, depression, postpartum physical complications, and poor coping and stress). The link between birth events and childbirth-related posttraumatic stress disorder provides a valuable opportunity to prevent traumatic childbirths and childbirth-related posttraumatic stress disorder from occurring in the first place. Childbirth-related posttraumatic stress disorder is an extremely distressing mental disorder and has a substantial negative impact on those who give birth, fathers or co-parents, and, potentially, the whole family. Still, a traumatic childbirth experience and childbirth-related posttraumatic stress disorder remain largely unrecognized in maternity services and are not routinely screened for during pregnancy and the postpartum period. In fact, there are gaps in the evidence on how, when, and who to screen. Similarly, there is a lack of evidence on how best to treat those affected. Primary prevention efforts (eg, screening for antenatal risk factors, use of trauma-informed care) are aimed at preventing a traumatic childbirth experience and childbirth-related posttraumatic stress disorder in the first place by eliminating or reducing risk factors for childbirth-related posttraumatic stress disorder. Secondary prevention approaches (eg, trauma-focused psychological therapies, early psychological interventions) aim to identify those who have had a traumatic childbirth experience and to intervene to prevent the development of childbirth-related posttraumatic stress disorder. Tertiary prevention (eg, trauma-focused cognitive behavioural therapy and eye movement desensitization and reprocessing) seeks to ensure that people with childbirth-related posttraumatic stress disorder are identified and treated to recovery so that childbirth-related posttraumatic stress disorder does not become chronic. Adequate prevention, screening, and intervention could alleviate a considerable amount of suffering in affected families. In light of the available research on the impact of childbirth-related posttraumatic stress disorder on families, it is important to develop and evaluate assessment, prevention, and treatment interventions that target the birthing person, the couple dyad, the parent-infant dyad, and the family as a whole. Further research should focus on the inclusion of couples in different constellations and, more generally, on the inclusion of more diverse populations in diverse settings. The paucity of national and international policy guidance on the prevention, care, and treatment of psychological birth trauma and the lack of formal psychological birth trauma services and training, highlight the need to engage with service managers and policy makers.

Details

Original languageEnglish
Pages (from-to)S1116-S1127
Number of pages12
JournalAmerican Journal of Obstetrics and Gynecology
Volume230
Issue number3
Publication statusPublished - Mar 2024
Peer-reviewedYes

External IDs

PubMed 38233316
ORCID /0000-0002-7472-674X/work/157319492

Keywords

Sustainable Development Goals

ASJC Scopus subject areas

Keywords

  • PTSD, delivery, dissociation, fear of birth, infant, mother, negative birth experience, obstetrical complications, operative birth, parent, poor coping, pregnancy, severe maternal morbidity, tokophobia, trauma informed care, traumatic birth, Parturition, Humans, Postpartum Period/psychology, Female, Infant, Newborn, Stress Disorders, Post-Traumatic/diagnosis, Premature Birth, Risk Factors, Pregnancy, Posttraumatic stress disorder, childbirth

Library keywords