The influence of women’s preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study

Garthus-Niegel, Susan; von Soest, Tilmann; Knoph, Cecilie; Simonsen, Tone Breines; Torgersen, Leila; Eberhard-Gran, Malin

doi:10.1186/1471-2393-14-191

Cited by 120Maternal and Perinatal Health InterventionsMaternal Mental Health During Pregnancy and PostpartumPregnancy-related medical research

The influence of women’s preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study

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Garthus-Niegel, Susan, von Soest, Tilmann, Knoph, Cecilie, Simonsen, Tone Breines, Torgersen, Leila, Eberhard-Gran, Malin·2014·BMC Pregnancy and Childbirth

DOI 10.1186/1471-2393-14-191PMC PMC4053555

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Abstract

BACKGROUND: This study aimed to examine whether a mismatch between a woman's preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth. METHODS: The study sample consisted of 1,700 women scheduled to give birth between 2009 and 2010 at Akershus University Hospital, Norway. Questionnaire data from pregnancy weeks 17 and 32 and from 8 weeks postpartum were used along with data obtained from hospital birth records. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Based on the women's preferred and actual mode of delivery, four groups were established: Match 1 (no preference for cesarean section, no elective cesarean section, N = 1,493); Match 2 (preference for cesarean section, elective cesarean section, N = 53); Mismatch 1 (no preference for cesarean section, elective cesarean section, N = 42); and Mismatch 2 (preference for cesarean section, no elective cesarean section, N = 112). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted to examine whether the level of post-traumatic stress symptoms differed significantly among these four groups. RESULTS: Examining differences for all four groups, ANOVA yielded significant overall group differences (F = 11.96, p < 0.001). However, Bonferroni post-hoc tests found significantly higher levels of post-traumatic stress symptoms only in Mismatch 2 compared to Match 1. This difference could be partly explained by a number of risk factors, particularly psychological risk factors such as fear of childbirth, depression, and anxiety. CONCLUSIONS: The results suggest increased post-traumatic stress symptoms in women who preferred delivery by cesarean section but delivered vaginally compared to women who both preferred vaginal delivery and delivered vaginally. In psychologically vulnerable women, such mismatch may threaten their physical integrity and, in turn, result in post-traumatic stress symptoms. These women, who often fear childbirth, may prefer a cesarean section even though vaginal delivery is usually the best option in the absence of medical indications. To avoid potential trauma, fear of childbirth and maternal requests for a cesarean section should be taken seriously and responded to adequately.

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Worldwide, self-requested cesarean birth (sCB) and epidural analgesia (EA) are strongly associated with a fear of childbirth (FOC) and a fear of pain.
“Worldwide, self‐requested CB (sCB) and EA are strongly associated with a fear of childbirth (FOC), 1 , 17 , 18 and a fear of pain. 4 , 5”
From Fear of childbirth, nonurgent obstetric interventions, and newborn outcomes: A randomized controlled trial comparing mindfulness‐based childbirth and parenting with enhanced care as usual. (2022) · cites this paper as [18]
The Background and Discussion (pages not available) link fear of childbirth to a preference for cesarean delivery, supporting that part of the cited claim. The paper does not establish a worldwide or strong association, and the passages found do not address epidural analgesia. The citing sentence places separate citations after fear of pain, so that part is not attributed to this source. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Untreated FOC is a risk factor for traumatic childbirth.
“Untreated FOC is a risk factor for traumatic childbirth, 18 , 21”
From Fear of childbirth, nonurgent obstetric interventions, and newborn outcomes: A randomized controlled trial comparing mindfulness‐based childbirth and parenting with enhanced care as usual. (2022) · cites this paper as [18]
The Results identify fear of childbirth as a psychological covariate of post-traumatic stress symptoms, and the Conclusion recommends treating it adequately to avoid potential traumatization. The paper does not establish that untreated fear, by itself, is a risk factor for traumatic childbirth; its central finding concerns women whose preferred and actual modes of delivery differed. (LLM, conf=0.84)
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Authors: Garthus-Niegel, S., von Soest, T., Knoph, C., Simonsen, T. B., Torgersen, L., & Eberhard-Gran, M.
Affiliations: Akershus University Hospital (NO)
Norwegian Institute of Public Health (NO)
ORCID: Simonsen, Tone Breines
Torgersen, Leila
Venue: BMC Pregnancy and Childbirth
Publisher: Springer Science and Business Media LLC
Published: 2014-06-05
Volume: 14
Issue: 1
Pages: 191-191
ISSN: 1471-2393 (ISSN-L)
DOI: 10.1186/1471-2393-14-191
PMC: PMC4053555
OpenAlex: W1999842561
Cited by: 120
References: 46
Citations by year: 2026: 5 · 2025: 9 · 2024: 10 · 2023: 8 · 2022: 12 · 2021: 26 · 2020: 12 · 2019: 10 · 2018: 9 · 2017: 11 · 2016: 6 · 2015: 2
FWCI: 6.74
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.springer.com/tdm (unspecified)
Locations: BMC Pregnancy and Childbirth (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
BIBSYS Brage (BIBSYS (Norway)) (submittedVersion)
NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Funders: Norges Forskningsråd (191098)
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
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
Keywords: posttraumatic stress symptoms, childbirth, mode of delivery, cesarean section, vaginal delivery, maternal preferences, fear of childbirth, depression, anxiety, psychological risk factors, postpartum period
MeSH terms: Neuroticism, Adolescent, Adult, Analysis of Variance, Anxiety, Anxiety Disorders, Cesarean Section, Depression, Fear, Female, Humans, Longitudinal Studies, Middle Aged, Norway, Pregnancy, Prospective Studies, Psychiatric Status Rating Scales, Surveys and Questionnaires, Risk Factors, Stress Disorders, Post-Traumatic, Elective Surgical Procedures, Parturition, Young Adult, Patient Preference

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The influence of women’s preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study

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