The influence of women’s preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study

BMC Pregnancy and Childbirth

Malin Eberhard-Gran⁵  Leila Torgersen⁵  Tone Breines Simonsen⁴  Cecilie Knoph²  Tilmann von Soest³  Susan Garthus-Niegel¹ 

[1] Institute and Outpatient Clinics of Occupational and Social Medicine, TU Dresden, Faculty of Medicine, Fetscherstr. 74, Dresden 01307, Germany;Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway;Department of Psychology, University of Oslo, Oslo, Norway;Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway;Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Oslo, Norway

关键词: Akershus birth cohort;    Mismatch;    Mode of delivery;    Post-traumatic stress symptoms following childbirth;   

Others  :  1127247
DOI  :  10.1186/1471-2393-14-191

 received in 2013-06-12, accepted in 2014-05-30,  发布年份 2014

【 摘 要 】

Background

This study aimed to examine whether a mismatch between a woman’s preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth.

Methods

The study sample consisted of 1,700 women scheduled to give birth between 2009 and 2010 at Akershus University Hospital, Norway. Questionnaire data from pregnancy weeks 17 and 32 and from 8 weeks postpartum were used along with data obtained from hospital birth records. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Based on the women’s preferred and actual mode of delivery, four groups were established: Match 1 (no preference for cesarean section, no elective cesarean section, N = 1,493); Match 2 (preference for cesarean section, elective cesarean section, N = 53); Mismatch 1 (no preference for cesarean section, elective cesarean section, N = 42); and Mismatch 2 (preference for cesarean section, no elective cesarean section, N = 112). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted to examine whether the level of post-traumatic stress symptoms differed significantly among these four groups.

Results

Examining differences for all four groups, ANOVA yielded significant overall group differences (F = 11.96, p < 0.001). However, Bonferroni post-hoc tests found significantly higher levels of post-traumatic stress symptoms only in Mismatch 2 compared to Match 1. This difference could be partly explained by a number of risk factors, particularly psychological risk factors such as fear of childbirth, depression, and anxiety.

Conclusions

The results suggest increased post-traumatic stress symptoms in women who preferred delivery by cesarean section but delivered vaginally compared to women who both preferred vaginal delivery and delivered vaginally. In psychologically vulnerable women, such mismatch may threaten their physical integrity and, in turn, result in post-traumatic stress symptoms. These women, who often fear childbirth, may prefer a cesarean section even though vaginal delivery is usually the best option in the absence of medical indications. To avoid potential trauma, fear of childbirth and maternal requests for a cesarean section should be taken seriously and responded to adequately.

【 授权许可】

   
2014 Garthus-Niegel et al.; licensee BioMed Central Ltd.

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