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Pregnancy and childbirth

How are pregnancy and childbirth related to PTSD?

Exposure to at least one trauma is required for a diagnosis of PTSD. The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) determines direct traumas as threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Indirect traumas include witnessing the trauma, or learning that a relative or close friend was exposed to a trauma. Differences in trauma characteristics, including type and severity of exposure, can affect the risk of developing PTSD. Personal characteristics such as age and sex also influence risk.

What is the evidence for risk of PTSD following or during pregnancy and childbirth?

Moderate quality evidence found the prevalence of PTSD in community samples of prenatal women is around 3.3%, and postpartum PTSD was around 4%. Rates were higher in high-risk samples of women who had difficult births or pregnancies or had babies with fetal anomalies (prenatal PTSD = 18.95%, postpartum PTSD = 18.5%).

Moderate to high quality evidence found the pre-birth risk factors associated with PTSD (in descending order of effect) were; depression in pregnancy, fear of childbirth, history of PTSD, poor health or complications, receiving counselling for pregnancy/birth, having previous psychological problems, less education, less social support, history of sexual trauma, ethnicity, history of any trauma, higher parity, planned pregnancy, and younger age. At-birth risk factors associated with PTSD were negative subjective birth experiences, an operative birth, lack of support from staff, negative emotions, dissociation, infant-related complications, lack of control or agency, pain, and short length of labour. Post-birth risk factors associated with PTSD were depression after childbirth, poor coping and stress, poor mental health, anxiety, and physical complications. No associations were found with marital status, socio-economic status, emotional health, time since birth, or presence of partner/companion at birth.

August 2021

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Last updated at: 1:55 pm, 15th February 2022
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