Aside from the expected postpartum depression that many women suffer from after childbirth, Anna N. Vossbeck-Elsebusch from the University of Münster encourages doctors to look out for signs of potential Post-traumatic Stress Disorder (PTSD) after childbirth. Of all the women who leave the delivery room, 34 percent report the experience of childbirth as traumatic. Seen in the September 2014 edition of BMC Psychiatry, Vossbeck-Elsebusch's latest study aimed to analyze the established predictors of postnatal PTSD, as well as identify cognitive variables associated with PTSD symptoms so that physicians can better predict mental health after childbirth. Her data reveals factors that physicians and women who plan to become a mother need to address throughout pregnancy and afterwards.

Analyzing the Childbirth Experience

Vossbeck-Elsebusch recruited 224 females who have given birth in the past one to six months. Of the survey sample, 162 were married, 58 were in a relationship but not married, and four were single. Vossbeck-Elsebusch also documented the types of births: 156 normal vaginal birth, 18 instrumental deliveries, 15 planned caesarean sections, 17 normal caesareans, and 18 emergency caesareans.

Conducted as an extensive online survey, Vossbeck-Elsebusch used the following instruments to collect data:

  • Posttraumatic Diagnostic Scale (PDS): A 49-item questionnaire identifying potentially traumatizing events, the person's role during the trauma, emotional response to the event, and problematic behaviors such as avoidance, re-experiencing, and numbing symptoms.
  • Peritraumatic Emotions Questionnaire (PEQ): A survey asking participants about any negative emotions, such as terror, humiliation, and anger, experienced during childbirth.
  • University of California, Los Angeles Social Support Inventory (UCLA-SSI-d): A 20-item questionnaire assessing the levels of support felt from friends, relatives, partners, and medical personnel during the prenatal period.
  • Peritraumatic Dissociative Experience Questionnaire (PDEQ): A 10-item questionnaire measuring dissociation during childbirth. Participants were asked to identify with statements such as, “What was happening seemed unreal to me, like I was in a dream or watching a movie or play."
  • Posttraumatic Cognitions Inventory (PTCI): A 29-item inventory documenting negative cognitions about one's self.
  • Responses to Intrusions Questionnaire (RIQ): A 13-item questionnaire assessing thought suppression and rumination, or dwelling on a thought.
  • Perseverative Thinking Questionnaire (PTQ): A 15-item questionnaire measuring levels of repetitive negative thinking.

The average time it took to complete the survey was 27 minutes when also accounting for collection of demographic data.

Results and Potential Predictors of PTSD

Vossbeck-Elsebusch found that age and well-being during pregnancy were significantly related to levels of PTSD symptoms—the older and less happy a woman, the stronger the PTSD symptoms. And those with a history of trauma also showed stronger signs of PTSD. The data also revealed that those who experienced an emergency cesarean section showed, by far, the most trauma after childbirth. These observations suggest that it may be beneficial “to develop and evaluate screening instruments that allow identifying women at risk for PTSD symptoms," notes Vossbeck-Elsebusch. By doing so, prenatal, perinatal, and postnatal experiences for women could be considerably improved.

Date of original publication:
Updated on: October 23, 2015



Anna N. Vossbeck-Elsebusch, Claudia Freisfeld, Thomas Ehring. Predictors of posttraumatic stress symptoms following childbirth. BMC Psychiatry, September 2014; DOI: 10.1186/1471-244X-14-200