Prevalence and predictors of post-traumatic stress symptoms following childbirth

To identify the prevalence and potential predictors of post-traumatic stress type symptoms following labour.

A large sample, within-participants design with initial assessment and postal follow-up was utilized.

Two hundred and sixty-four women who had 'normal' births were assessed within 72 hours on potential predictive measures and at 6 weeks post-partum for levels of symptoms of intrusions, avoidance and hyperarousal on a questionnaire derived from DSM-IV (American Psychiatric Association, 1994) criteria. Symptoms of depression and anxiety were also assessed.

Three per cent showed questionnaire responses suggesting clinically significant levels on all three post-traumatic stress dimensions and a further 24% on at least one of these dimensions. Forward stepwise regression analysis yielded models for predicting outcome variables. Perceptions of low levels of support from partner and staff, patterns of blame and low perceived control in labour were found to be particularly related to experience of post-traumatic stress symptoms. Personal vulnerability factors such as previous mental health difficulties and trait anxiety were also related to such symptoms as well as being relevant predictors for anxiety and depression.

A proportion of women reports all three aspects of post-traumatic stress type symptoms following childbirth with many more reporting some components. A broader conceptualization of post-partum distress which takes account of the impact of labour is required. There may be opportunities for prevention through providing care in labour that enhances perceptions of control and support.