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Cross-national risk factors for childbirth-related PTSD: Findings from the INTERSECT study

Jonathan E Handelzalts1, Susan Ayers2, Rebecca Webb2

  • 1School of Behavioral Sciences, https://ror.org/04cg6c004Academic College of Tel, Aviv-Yafo, Israel.

Psychological Medicine
|November 17, 2025
PubMed

Insights

Childbirth-related post-traumatic stress disorder (CB-PTSD) is influenced by pre-existing vulnerabilities, but negative birth experiences are the strongest predictors. Trauma-informed care should address these stressors and women's perceptions of childbirth.

Area of Science:

  • Perinatal mental health
  • Psychotraumatology
  • Global women's health

Background:

  • Childbirth-related post-traumatic stress disorder (CB-PTSD) is a significant but underrecognized condition impacting maternal and infant well-being.
  • Understanding risk factors is crucial for developing effective interventions and support systems.

Purpose of the Study:

  • To identify key risk factors for CB-PTSD symptoms using a stress-diathesis framework.
  • To investigate antenatal, birth-related, and postpartum predictors of CB-PTSD across diverse international settings.

Main Methods:

  • Cross-sectional survey (INTERSECT) of 11,302 women 6-12 weeks postpartum across 31 countries.
  • Assessed CB-PTSD diagnosis, symptom severity, and perceived traumatic birth using the City Birth Trauma Scale.
  • Analyzed multiple risk factors, including vulnerabilities and pregnancy, birth, and infant-related factors, adjusting for country-level variance.

Main Results:

  • Negative birth experiences were the strongest predictor of CB-PTSD diagnosis (OR=0.82).
  • Ongoing maternal complications (OR=1.61) and major infant complications (OR=1.63) significantly predicted CB-PTSD diagnosis and symptoms.
  • Perceived danger during birth was strongly linked to higher CB-PTSD symptoms and traumatic birth ratings (β=0.25).

Conclusions:

  • Findings support a stress-diathesis model, highlighting birth-related stressors as primary influences over pre-existing vulnerabilities.
  • Emphasizes the need for trauma-informed maternity care prioritizing birth experiences and women's subjective appraisals.
  • Suggests targeted interventions focusing on negative birth events and maternal/infant complications to mitigate CB-PTSD.
Abstract

Keywords:
ChildbirthPTSDPostpartumRisk Factors

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