Gamble J. & Creedy D. (2005). British Journal of Midwifery, 13(4), 218-224.

Psychological trauma symptoms may develop as a consequence of childbirth experiences. Research and clinical observations indicate that a traumatic birthing experience can overwhelm a woman's normal ability to cope with stress, and carries the potential risk of intensifying into posttraumatic stress disorder. However, little is known about the occurrence of trauma symptoms following operative childbirth. This study examined the relationship between type of birth and symptoms of psychological trauma. Four hundred Australian women in the last trimester of pregnancy were recruited from three public antenatal clinics. Participants were interviewed, and they completed a questionnaire that included demographic information and details of their reproductive history. At 72 hours postpartum (or before discharge) women were interviewed about birthing events. At 4-6 weeks postpartum telephone interviews were conducted to assess symptoms of psychological trauma.

Findings showed that at 4-6 weeks postpartum, 102 women reported a distressing birth experience, as well as a range of psychological trauma symptoms such as re-experiencing the event, concerted efforts to avoid thinking about the birth, and hypervigilance towards the baby. Type of birth was associated with the development of trauma symptoms at 4-6 weeks postpartum. Women who had an emergency cesarean delivery or operative vaginal delivery were more likely to meet the diagnostic criteria for posttraumatic stress disorder than women who had an elective cesarean birth or normal spontaneous vaginal deliveries. Results of this study provide evidence that obstetric procedures during childbirth contribute to the presence of acute trauma reactions in the postpartum. Healthcare providers including perinatal nurses need to be aware of possible adverse psychological consequences of obstetric procedures, and to realistically prepare women for labor and birth, including giving information about common interventions. This study also underscores the importance of discussing emergency procedures during the antenatal period to lessen the impact of unexpected events and enable women to better understand and participate in the decision-making process if such an emergency should arise during labor.

Arwa Oweis