Birth Trauma: A mixed-methods investigation

Abstract

Approximately one-third of women appraise their childbirth experience as traumatic and many women experience symptoms of posttraumatic stress disorder (PTSD) as a result. Whilst earlier work concentrated on prevalence and risk factors of clinically significant trauma, recent research focuses on the large group of women who experience childbirth as traumatic but do not necessarily meet the threshold for PTSD. This thesis comprises a mixed-methods design to investigate predisposing factors associated with presentation of postnatal posttraumatic stress (PTS) symptoms and the appraisal of childbirth as a traumatic experience. Specifically, this thesis aims to address the following questions: What perinatal risk factors are associated with a traumatic appraisal of childbirth and postnatal PTS symptoms? What antenatal vulnerability factors are associated with PTS symptoms? and are there aetiological differences between postnatal trauma, depression and anxiety?

Firstly, findings from two large-scale survey studies reveal the subjective birth experience to be a stronger predictor of postnatal PTS compared to the obstetric experience. Significant subjective factors include low internal control, feeling dissociated and poor perceived staff support, which also presents as a mediator between obstetric intervention and PTS symptoms. Secondly, qualitative analysis provides a new thematic framework of contributory factors for women’s appraisals of childbirth as traumatic or non-traumatic in relation to women’s experience of feeling empowered or powerless during birth. Thirdly, a quantitative, longitudinal study presents pre-existing PTS and alexithymia symptoms during pregnancy as novel predisposing factors for postnatal PTS symptoms. Lastly, in comparison to postnatal depression and anxiety, birth trauma appears to have a distinct aetiological pathway. Collectively, these findings provide consistent evidence that a negative subjective birth experience contributes to a traumatic appraisal of childbirth and presentation of PTS symptoms, over and above obstetric experience. This thesis supports initiatives seeking to empower women during birth and offer antenatal and postnatal screening for birth trauma.