Precursors and Risk Factors Associated with the Development of Traumatic Stress After Childbirth

• Main Author: Runnals, Jennifer
• Format: Others
• Published: VCU Scholars Compass 2010
• Subjects: Posttraumatic Stress Disorder; Childbirth; Psychology; Social and Behavioral Sciences
• Online Access: http://scholarscompass.vcu.edu/etd/2223; http://scholarscompass.vcu.edu/cgi/viewcontent.cgi?article=3222&context=etd

A prospective study of pregnant women was undertaken to provide an estimate of rates of Posttraumatic Stress Disorder after childbirth that takes into account pre-existing trauma; to explore risk factors associated with the development of traumatic stress after birth; and to better understand incidence and risk factors associated with fear of childbirth, which is thought to contribute to postpartum Posttraumatic Stress Disorder. Ninety participants in their last trimester of pregnancy completed questionnaires that included depression, trait anxiety, PTSD, anxiety sensitivity, childbearing fear, and self-efficacy for labor. Four weeks after delivery 73 of these women completed questionnaires concerning delivery, posttraumatic stress related to childbirth, and depression. Levels of childbearing fear were similar to studies of non U.S. women but did not predict traumatic reactions to childbirth. First-time mothers and those with prior miscarriage, traumatic birth, and childhood sexual assault were not more fearful of childbirth although women reporting repeat sexual victimization that started in childhood were. Women with comorbid Posttraumatic Stress Disorder and depression during pregnancy were significantly more fearful of childbirth. Higher trait anxiety and anxiety sensitivity, and lower labor self-efficacy predicted greater fear of childbirth. Women who underwent operative deliveries became more fearful of childbirth after delivery whereas women who underwent unassisted vaginal deliveries showed a reduction in fear. Five percent of women developed new cases of Posttraumatic Stress Disorder attributable to childbirth. An additional five percent who had received a trauma diagnosis during pregnancy met criteria for Posttraumatic Stress Disorder resulting from childbirth. Higher trait anxiety predicted postpartum trauma symptoms and greater self-efficacy for childbirth moderated this relationship. Women assigned a diagnosis of Posttraumatic Stress Disorder or co-morbid PTSD and depression during pregnancy, and women who underwent operative or instrument deliveries (i.e. caesarian section, forceps deliveries, or vacuum extraction), were significantly more likely to receive a diagnosis of PTSD or trauma-related Adjustment Disorder as a consequence of their experience of childbirth. Results suggest that increasing self-efficacy for labor and treating psychopathology present during pregnancy may be fruitful targets for efforts to prevent the development of traumatic reactions to childbirth.