Peritraumatic dissociation in childbirth-evoked posttraumatic stress and postpartum mental health

A significant minority of women can suffer from postpartum posttraumatic stress disorder (PP-PTSD) following childbirth, in particular if involving obstetrical complications. While peritraumatic dissociation has been repeatedly shown to play a significant role in coping in the aftermath of trauma, little is known about peritraumatic dissociation in relation to positive adaptation following childbirth or failure thereof. We studied a large sample of 846 women who were on average 3 months postpartum. Participants completed an anonymous survey with psychometric measures pertaining to peritraumatic dissociation, PP-PTSD, postpartum depression, and other psychiatric symptoms. Women who had assisted vaginal deliveries or unscheduled Cesareans reported higher peritraumatic dissociation levels than those who had regular vaginal deliveries or scheduled Cesareans. Peritraumatic dissociation predicted PP-PTSD above and beyond premorbid and other childbirth-related factors. In contrast, we found that when controlling for PP-PTSD symptoms, higher levels of peritraumatic dissociation were associated with lower depression and other psychiatric symptom severity. Childbirth can evoke a dissociative response for some women. Rather than the mere focus on the mode of delivery and premorbid health, our findings highlight the role of the women's immediate emotional response in PP-PTSD. Screening women for dissociative responses immediately following childbirth may offer a tool for identifying women at risk for PP-PTSD. The multifaceted role of peritraumatic dissociation in psychological adaptation as potentially adaptive on the one hand, and maladaptive on the other, warrants future scientific attention.