Instrumental vaginal delivery
A meta-analysis of two studies found that IVD was associated with a
higher PTSD score than SVD (appendix S5) , again consistent with
the NMA findings. The small-to-medium difference (ES=0.38) was strongly
statistically significant (p<0.001).
Two studies subdivided instrumental vaginal deliveries into forceps and
ventouse deliveries . Creedy et al. found an association between
forceps and ventouse deliveries and PTSD symptoms . In contrast to this,
Lyons found no significant relationship between PTSD symptoms and mode
of delivery .
Five of the other studies combined instrumental vaginal births into one
variable. Furuta et al. found PTSD symptoms were more common with
IVD than SVD. Dekel et al. found greater PTSD symptoms in IVD
than in SVD and their separate category of natural VD (without
anaesthesia) . Ryding et al. did not directly compare IVD and
SVD, but found no significant difference between PTSD symptoms in those
who had IVD and those who had EmCS, which they found to be more related
to PTSD than both ElCS and SVD. Cohen et al. found no significant
differences between IVD, SVD and CS, Polachek et al. did not find
an association with any mode of birth and PTSD and Vossbeck-Elsebuschet al. found no statistically significant association between IVD
and PTSD.