Post-Traumatic Stress Disorder after childbirth and the influence of maternity team care during labour and birth: A cohort study

Objective: we examined the prevalence of Post-Traumatic Stress Disorder (PTSD) and the role of personal and obstetric risk factors, as well as the role of midwifery team care factors in a cohort of Flemish women. Design: prospective cohort study. Data collection was performed at two times post partum: During the first week, socio-demographic and obstetric data as well as information related to midwifery team care factors were assessed using self-report measures. To asses PTSD symptomatology, the Impact of Event Scale-Revised (IES-R) and the Traumatic Event Scale (TES) were used. At six weeks post partum, PTSD symptoms were reassessed either by telephone interviews or e-mail. Results were calculated in frequencies, means and standard deviations. Differences between week one and six were analysed using parametrical and non-parametrical statistics. Multiple and logistic regression was performed to determine risk factors for PTSD symptomatology. P-value was set at 0.05. Setting: maternity wards in Flanders, Belgium. Participants: the first (week 1) and follow-up (week 6) sample of the data collection consisted of 340 and 229 women respectively. Results: the prevalence of PTSD symptoms after childbirth ranged from 22% to 24% in the first week and from 13% to 20% at six weeks follow-up. Multiple regression analysis showed that Islamic belief, a traumatic childbirth experience, family income < 2500, a history of psychological or psychiatric consults and labour/birth with complications significantly predicted PTSD symptomatology at six weeks post-birth. Midwifery team care and the opportunity to ask questions, as well as experiencing a normal physiological birth were significantly associated with less postnatal PTSD symptoms. Key conclusions and implications for practise: the results of this study suggest that contextual factors such as religion, socio-economic status, and childbirth experience might be important factors to address by the midwifery team. Midwifery team care factors such as 'providing the opportunity to the mother to ask questions' and the 'perception of the midwife being in control' proved to be potential protective factors for postnatal PTSD symptoms. Despite its prevalence, PTSD symptoms after birth are not yet well understood by health care workers. Further research concerning the influence of midwifery team care factors on developing childbirth related PTSD is required. (C) 2015 Elsevier Ltd. All rights reserved.