The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework
Open accessAbstract
There is evidence that 3.17% of women report post-traumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis–stress model of its aetiology. Systematic searches were carried out on PsycINFO, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least 1 month after birth. In all, 50 studies ( n = 21 429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy ( r = 0.51), fear of childbirth ( r = 0.41), poor health or complications in pregnancy ( r = 0.38), and a history of PTSD ( r = 0.39) and counselling for pregnancy or birth ( r = 0.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences ( r = 0.59), having an operative birth (assisted vaginal or caesarean, r = 0.48), lack of support ( r = −0.38) and dissociation ( r = 0.32). After birth, PTSD was associated with poor coping and stress ( r = 0.30), and was highly co-morbid with depression ( r = 0.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis–stress model of the aetiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care.
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Compared to elective cesarean section or natural birth, EmCS is more likely to be perceived as traumatic childbirth, which can subsequently lead to psychological trauma.
“Compared to elective cesarean section or natural birth, EmCS is more likely to be perceived as traumatic childbirth, which can subsequently lead to psychological trauma [2–4].”
From The traumatic childbirth experience of mothers after emergency cesarean section(EmCS) in China: a descriptive qualitative study (2025) · cites this paper as [4]
Women who undergo EmCS experience sudden physiological changes and high psychological stress reactions due to the intricacy, risks, and urgency.
“Women who undergo EmCS experience sudden physiological changes and endure high psychological stress reactions due to the intricacy, risks, and urgency associated with this condition.”
From The traumatic childbirth experience of mothers after emergency cesarean section(EmCS) in China: a descriptive qualitative study (2025) · cites this paper as [4]
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- Authors
- Ayers, S., Bond, R., Bertullies, S., & Wijma, K.
- Affiliations
- City, University of London (GB)
- University of Sussex (GB)
- Linköping University (SE)
- Corresponding author
- Ayers, S.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2016-02-16
- Volume
- 46
- Issue
- 6
- Pages
- 1121-1134
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2329935182
- Cited by
- 685
- References
- 12
- Citations by year
- 2026: 104 · 2025: 99 · 2024: 76 · 2023: 69 · 2022: 74 · 2021: 66 · 2020: 101 · 2019: 34 · 2018: 37 · 2017: 18 · 2016: 6 · 2015: 1
- FWCI
- 5.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- post-traumatic stress disorder, childbirth, postpartum PTSD, etiology, diathesis-stress model, risk factors, pregnancy complications, fear of childbirth, childbirth experience, cesarean section, operative birth, social support, dissociation, depression, coping, comorbidities, obstetric care
- MeSH terms
- Adaptation, Psychological, Female, Humans, Pregnancy, Risk Factors, Stress Disorders, Post-Traumatic, Stress, Psychological, Comorbidity, Depression, Postpartum, Parturition, Postpartum Period
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