A model of risk for perinatal posttraumatic stress symptoms

Existing research suggests that childbirth may be a significant trigger of posttraumatic stress symptoms (PTSS). The current study examined whether subjective birthing experiences and objective childbirth characteristics mediated the association between predisposing psychosocial factors measured during pregnancy (e.g., fear of childbirth, history of trauma, and social support) and PTSS during the postpartum period. Women were recruited during pregnancy from a large Midwestern hospital. Symptoms of posttraumatic stress, obsessive compulsive disorder (OCD), and depression, as well as PTSS-related risk factors, including social support, lifetime trauma exposure, fear of childbirth, subjective perceptions, and objective characteristics of childbirth, were measured during pregnancy and 4, 8, and 12 weeks postpartum. A path model revealed that subjective perceptions of childbirth mediated the association between fear of childbirth and PTSS at 4 weeks postpartum. Objective childbirth characteristics mediated the association between fear of childbirth and PTSS at 8 weeks postpartum, and there was a direct association between fear of childbirth and PTSS. Subjective perceptions of childbirth also mediated the effect of fear of childbirth on PTSS at 4 weeks postpartum when controlling for OCD symptoms. Further, the direct effect of fear of childbirth on PTSS at 8 weeks postpartum remained significant when controlling for OCD symptoms. The current study emphasizes the importance of fear of childbirth and subjective and objective birthing experiences in predicting postpartum psychopathology. Future research should examine these models in diverse and at-risk samples. Valid assessments and effective interventions for perinatal PTSS should be explored.