Introduction
Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition whereby
individuals suffer flashbacks, anxiety and avoidance following exposure
to a traumatic event. Given that childbirth is usually a positive and
life-affirming event, only recently did the scientific community begin
to recognise that giving birth could be deeply traumatic for some women.
In 1997 the phenomenon was recognised widely enough that the first
large-scale study was carried out by a group in Sweden , which found
that 1.6% of postnatal women studied showed symptoms of PTSD. A recent
meta-analysis of 78 studies found the prevalence of postnatal PTSD to be
higher, at 3.1% in the community and 15.7% in at-risk populations .
Risk factors for postnatal PTSD may include nulliparity, increased
anxiety, feeling out of control and lack of social support. Another risk
factor is the impact of mode of birth, in particular caesarean section
(CS) .
Given the global increase in the proportion of women who deliver via CS
, an association between this mode of birth and postnatal PTSD could
have wide implications. This review is the first to analyse the impact
of mode of birth on maternal postnatal PTSD. The review aimed to
investigate whether onset of PTSD in the postnatal period is more common
following CS or other modes of birth, to raise awareness of the risks of
developing PTSD and encourage better recognition and treatment of the
condition. Three primary and four secondary review questions were
developed. For the purposes of the review, modes of birth were
categorised into elective caesarean section (ElCS), emergency caesarean
section (EmCS), spontaneous vaginal delivery (SVD) and instrumental
vaginal delivery (IVD). IVD was classified as the use of forceps and/or
vacuum extraction (ventouse) .
PRIMARY REVIEW QUESTIONS:
- Are women who have a CS more likely to experience PTSD postnatally
than women who have a VD?
- What are the views of women who have postnatal PTSD on the impact of
birth mode on their PTSD?
- What are the views of those who support women (i.e. family, peer
support groups, midwives and other healthcare staff) on the impact of
birth mode on development of PTSD?
SECONDARY REVIEW QUESTIONS:
- Is an EmCS more likely to trigger symptoms and signs of PTSD than an
ElCS?
- Is an IVD more likely to trigger symptoms and signs of PTSD than a
SVD?
- Does a previous history of postnatal PTSD impact on a woman’s
decision-making about her mode of birth in subsequent pregnancies?
- How do women who have PTSD perceive the impact of social/peer support
on their mental health outcomes?