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Childbirth, PTSD and Past Traumatic Experience: A Complex Relationship
Abstract Number: F 11
Abstract Type: Original Research
Background. Childbirth is a potentially traumatic event, with reports of approximately 2% women developing post traumatic stress disorder (PTSD) subsequently. Also experience of child sexual abuse (CSA) is associated with postnatal PTSD. We sought to examine experience of prior traumatic events on PTSD and depression symptom levels immediately following childbirth, in addition to peri-traumatic dissociation during the birth itself.
Methods. Anonymous cross-sectional self- completion questionnaire study, with IRB approval (0122-08-HMO). Participants were 12-48 hr postpartum women. Questionnaires included birth questionnaire constructed for this study, Peri-traumatic Dissociative Experiences Questionnaire, Beck Depression Inventory, Trauma history questionnaire and Posttraumatic symptom scale. Primary outcome was expression of PTSD symptoms in women reporting previous traumatic experiences. Sample size based on pilot data assumed that among 15% women reporting CSA, 25% will report PTSD symptoms, versus 5% without CSA, requiring 180 women to detect a difference, power of 80%, two-tailed significance level 5%. Chi squared and ANOVA tests were used to examine differences; p < 0.05 considered significant.
Results. Questionnaire completion rate was 185/382 (48.4%). Twenty-seven women (14.6%) reported CSA. Trauma History Questionnaire showed 53 women (30.8%) experienced one traumatic event, 59 (34.3%) two or more and 61 women (34.7%) reported no prior traumatic event.
Fifty-eight (26.5%) women reported birth-related traumatic event, 16 (27.6%) reporting current and 30 women (51.7%) reporting previous birth as traumatic; 12 (20.7%) reported both. Nine women (5.2%) reported experience both CSA and birth related trauma. Symptom levels of PTSD, depression and dissociation were compared by trauma type. Groups differed significantly in levels of depression and dissociation, but not PTSD, Table 1. Women with previous traumatic birth were significantly more likely to have decided prenatally on epidural than the other groups (75.9.3% (past birth traumatic) vs 33.3% (past & current birth traumatic) vs 46.7% (current birth traumatic) vs 57.5% (no birth traumatic), X2=7.6, p<0.05).
Conclusion. Previous experience of traumatic events should be sought among pregnant women as they may affect postpartum reactions. Birth related trauma may affect decisions regarding consequent birth plans.