The traumatic childbirth experience of mothers after emergency cesarean section(EmCS) in China: a descriptive qualitative study

May combine two claims.

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].”

• cites [2] Benton M, Salter A, Tape N, Wilkinson C, Turnbull D. Women’s psychosocial outcomes following an emergency caesarean section: a systematic literature review. BMC Pregnancy Childbirth. 2019;19(1):535. sourceSupported
• cites [3] Zanardo V, Soldera G, Volpe F, Giliberti L, Parotto M, Giustardi A, Straface G. Influence of elective and emergency cesarean delivery on mother emotions and bonding. Early Hum Dev. 2016;99:17–20. sourceNot checked — no full text of the source
• cites [4] Ayers S, Bond R, Bertullies S, Wijma K. The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychol Med. 2016;46(6):1121–34. sourceNot checked — no full text of the source

May combine two claims.

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.”

• cites [2] Benton M, Salter A, Tape N, Wilkinson C, Turnbull D. Women’s psychosocial outcomes following an emergency caesarean section: a systematic literature review. BMC Pregnancy Childbirth. 2019;19(1):535. sourcePartly supported

  The Introduction describes EmCS as typically urgent and says its complexity and rapid psychological adjustments may be distressing. The Results (Key outcomes, Traumatic stress) report that EmCS contributes to post-traumatic stress symptoms. The paper does not describe sudden physiological changes in women undergoing EmCS; its reference to rapid changes concerns psychological adjustments. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [3] Zanardo V, Soldera G, Volpe F, Giliberti L, Parotto M, Giustardi A, Straface G. Influence of elective and emergency cesarean delivery on mother emotions and bonding. Early Hum Dev. 2016;99:17–20. sourceNot checked — no full text of the source
• cites [4] Ayers S, Bond R, Bertullies S, Wijma K. The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychol Med. 2016;46(6):1121–34. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Women who have unintended pregnancies often face heightened psychological stress and may be physically and emotionally unprepared, which increases the risk of traumatic childbirth.

“Women who have unintended pregnancies often face heightened psychological stress and may be physically and emotionally unprepared, which increases the risk of traumatic childbirth [51].”

• cites [51] Maghalian M, Nikanfar R, Nabighadim M, Mirghafourvand M. The prevalence of unintended pregnancy and its influence on pregnancy experience in Tabriz, Iran, 2023: a cross-sectional study. Reprod Health. 2024;21(1):9. sourcePartly supported

  The Discussion (page not provided) reports psychological pressures and physical and emotional unpreparedness among women with unintended pregnancies. It does not say that these factors increase the risk of traumatic childbirth. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The City Birth Trauma Scale (CBTS) is a validated measure developed by Ayers et al., grounded in DSM-5 PTSD diagnostic criteria, and includes 29 items primarily used to identify women at risk of developing PTSD following childbirth.

“Another widely used tool is the City Birth Trauma Scale (CBTS), a validated measure developed by Ayers et al. [52], which is also grounded in DSM-5 PTSD diagnostic criteria. The CBTS includes 29 items and is primarily used to identify women at risk of developing PTSD following childbirth.”

• cites [52] Ayers S, Wright DB, Thornton A. Development of a measure of Postpartum PTSD: the City Birth Trauma Scale. Front Psychiatry. 2018;9:8. sourcePartly supported

  The Abstract describes the City Birth Trauma Scale as a 29-item measure of birth-related PTSD based on DSM-5 criteria. But the Discussion (Limitations) says the study does not offer full validation and calls for further research on predictive validity. The paper presents the scale as measuring PTSD symptoms after childbirth, not primarily identifying women at risk of developing PTSD. (LLM, conf=0.91)

  Experimental — accuracy not yet measured

May combine two claims.

The study identified limited family support: the forgotten mothers, husbands' emotional absence.

“Limited family support (the forgotten mothers, husbands’ emotional absence)”

May combine two claims.

Medical staff displayed a lack of empathy, engaged in inappropriate interactions with mothers, and failed to provide adequate understanding and psychological support.

“Medical staff displayed a lack of empathy, engaged in inappropriate interactions with mothers and fail to provide adequate understanding and psychological support to the mothers.”

May combine two claims. The quote only partly states this claim.

Thematic analysis of interviews with 16 women who underwent EmCS in the past year yielded four themes and ten sub-themes.

“Four themes and ten sub-themes were extracted from the data”

• Also stated in: § Results · plain

  “This study identified four main themes with ten sub-themes, as shown in Fig. 1.”

May combine two claims.

This emotional neglect made the mother feel forgotten, unable to receive the care and support she deserved.

“This emotional neglect made the mother feel “forgotten,” unable to receive the care and support she deserved.”

The quote only partly states this claim.

The emotional processing and adjustment phase typically lasts between 3 and 6 months.

“Our study identified that this phase typically lasts between 3 and 6 months.”

May combine two claims.

While families often prioritize the expectant mother's well-being during pregnancy, their focus frequently shifts to the newborn after delivery.

“While families often prioritize the expectant mother’s well-being during pregnancy, their focus frequently shifts to the newborn after delivery.”

May combine two claims.

The family's focus completely shifted to the newborn, while the mother's own physical discomfort and emotional needs were ignored.

“The family’s focus completely shifted to the newborn, while her own physical discomfort and emotional needs were ignored.”

The quote only partly states this claim.

Mothers undergoing EmCS often experience prolonged unbearable pain before and after surgery.

“Mothers undergoing EmCS often experience prolonged pain before and after surgery.”

• Also stated in: § Unbearable pain · plain

  “Unbearable pain”

Probably not a substantial claim: may not pass S3 (load-bearing).

In the reaction phase, individuals may exhibit both physical and psychological symptoms, including fatigue, irritability, reduced self-efficacy, and other psychosomatic responses.

“In the reaction phase, individuals may exhibit both physical and psychological symptoms, including fatigue, irritability, reduced self-efficacy, and other psychosomatic responses.”

May combine two claims.

The stress phase following an EmCS lasts 4-24 h and is marked by intense fear, pain, and despair.

“The stress phase following an EmCS, lasting 4–24 h, is marked by intense fear, pain, and despair.”

May combine two claims.

Some husbands were unaware of the importance of their support, and consequently the support new mothers received from their husbands was sometimes quite limited.

“Some of the husbands were unaware of the importance of their support. Consequently, the support that the new mothers received from their husbands was sometimes quite limited.”

May combine two claims.

This lack of empathy heightened the mother's anxiety, discomfort, isolation, and helplessness.

“This lack of empathy heightened her anxiety, discomfort, isolation, and helplessness.”

May combine two claims.

During the emotional processing and adjustment phase, participants' physical recovery was largely complete, though they still experienced occasional painful emotions; most found their emotions generally stable through self-adjustment and seeking support.

“During this phase, participants indicated that their physical recovery was largely complete, though they still experienced occasional painful emotions. Through self-adjustment and seeking support, most found their emotions to be generally stable.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The stabilization and reconstruction phase marks psychological recovery following traumatic childbirth, where mothers restore emotional balance and experience positive emotions and personal growth.

“The stabilization and reconstruction phase marks the psychological recovery following traumatic childbirth, where mothers restore emotional balance and experience positive emotions and personal growth.”

May combine two claims. The quote only partly states this claim.

During the stabilization and reconstruction phase, mothers experience post-traumatic growth (PTG) and enhanced psychological resilience.

“Post-traumatic growth (PTG)”

• Also stated in: § Post-traumatic growth (PTG) · plain

  “This theme highlights the PTG and enhanced psychological resilience that new mothers experienced after childbirth.”

The quote only partly states this claim.

During the reaction phase, mothers experience postpartum decline in self-efficacy and self-doubt.

“Postpartum decline in self-efficacy and self-doubt”

May combine two claims.

Most participants felt limited by the health knowledge provided during the perinatal period, particularly in the prenatal phase, leading to feelings of insecurity and a desire for more comprehensive health education.

“Most participants felt limited by the health knowledge provided during the perinatal period, particularly in the prenatal phase. This lack of information led to feelings of insecurity and a desire for more comprehensive health education to feel empowered.”

May combine two claims.

The study confirmed Cullberg's four-phase trauma recovery model, but the first phase is better termed 'stress phase' rather than 'shock phase' because postpartum women primarily experience stress reactions such as pain, despair, and fear, rather than numbness or unreality.

“Our study has also confirmed this; however, we refer to the first phase as the “stress phase” rather than shock phase. During this period, postpartum women primarily experience stress reactions such as pain, despair and fear, rather than numbness or a sense of unreality typically associated with shock responses.”

The quote only partly states this claim.

During the reaction phase, mothers experience sensitivity and irritability.

“Sensitivity and irritability”

May combine two claims.

Women in this period experienced a range of negative emotions, they were lacking in sufficient health education, good communication between healthcare professionals and adequate family support.

“Women in this period experienced a range of negative emotions, they were lacking in sufficient health education, good communication between healthcare professionals and adequate family support.”

May combine two claims.

The study identified barriers between patient-professional communication in healthcare: breaking the silence: needs to address ineffective communication, beyond the diagnosis: needs for empathy in healthcare.

“The barriers between patient-professional communication in healthcare (breaking the silence: needs to address the ineffective communication, beyond the diagnosis: needs for empathy in healthcare)”

The quote only partly states this claim.

During the stabilization and reconstruction phase, mothers become more willing to share their experiences with others to assist and support them.

“After navigating through challenges, the mothers have been more willing to share their experiences with others, hoping to assist and support them.”

May combine two claims.

This lack of communication left women both physically and psychologically confused and stressed, without receiving the necessary care or understanding.

“This lack of communication left women both physically and psychologically confused and stressed, without receiving the necessary care or understanding.”

May combine two claims.

Women who have undergone traumatic childbirth tend to reflect on these experiences, reassess the meaning of life, strengthen their inner resilience, and consequently experience growth, even improving intimate relationships.

“Women who have undergone traumatic childbirth tend to reflect on these experiences, reassess the meaning of life, strengthen their inner resilience, and consequently experience growth, even improving intimate relationships.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The processing and adjustment phase following childbirth may involve minor emotional fluctuations, and these responses are normal adjustment reactions.

“The processing and adjustment phase following childbirth may involve minor emotional fluctuations. These responses are normal adjustment reactions that individuals experience while adapting to new situations.”

May combine two claims.

The study identified several factors contributing to traumatic childbirth experiences: insufficient prenatal health education, the unexpected nature of EmCS, poor communication between healthcare providers, inadequate postpartum family support, and gender-related pressures within the family.

“Our study closely aligns with these stages, identifying several factors that contribute to traumatic childbirth experiences, including insufficient prenatal health education, the unexpected nature of EmCS, poor communication between healthcare providers, inadequate postpartum family support, and gender-related pressures within the family.”

May combine two claims.

During the processing and adjustment phase, emotions are manageable and stable, partly due to coping mechanisms such as seeking social support and practicing self-adjustment.

“During this phase, emotions are manageable and stable, partly due to the use of coping mechanisms such as seeking social support and practicing self-adjustment.”

The quote only partly states this claim.

Data saturation was achieved with sixteen participants.

“Cessation of sampling depended on data saturation.”

• Also stated in: § Participants · plain

  “Finally, sixteen mothers were selected as interviewees.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Transferability was supported by a detailed account of research design, participant recruitment, data collection, and analysis.

“To support transferability, a detailed account of the research design, participant recruitment, data collection, and analysis processes was provided.”

Classified as probably not a substantial claim. May combine two claims.

Traumatic experiences can lead to feelings of extreme fear, helplessness, loss of control, and impotence, which can significantly affect the mother's life after delivery.

“The traumatic experiences can lead to feelings of extreme fear, helplessness, loss of control, and impotence, which can significantly affect the mother’s life after delivery [7].”

• cites [7] Beck CT. Post-traumatic stress disorder due to childbirth: the aftermath. Nurs Res. 2004;53(4):216–24. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The study obtained ethics approval from the tertiary hospital in Luoyang, Henan Province (2023-0068).

“This study has obtained the ethics approval of the tertiary hospital in Luoyang, Henan Province (2023-0068).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Traumatic childbirth can lead to several psychiatric issues, including postpartum depression and post-traumatic stress disorder (PTSD).

“Previous studies have found that traumatic childbirth can lead to several psychiatric issues, including postpartum depression and post-traumatic stress disorder (PTSD).”

• cites [10] Lai XL, Chen JF, Li HQ, Zhou LP, Huang QY, Liao Y, Krewski D, Wen SW, Zhang LL, Xie RH. The incidence of post-traumatic stress disorder following traumatic childbirth: a systematic review and meta-analysis. Int J Gynecol Obstet. 2023;162(1):211–21. sourceNot checked — no full text of the source

May combine two claims.

The lack of involvement and education for spouses may limit their understanding of the precautions, challenges, and responsibilities involved in pregnancy and childbirth, thereby affecting the emotional and practical support they can provide.

“The lack of involvement and education for spouses may limit their understanding of the precautions, challenges, and responsibilities involved in pregnancy and childbirth, thereby affecting the emotional and practical support they can provide during this critical period.”

Probably not a substantial claim: may not pass S3 (load-bearing).

According to Johan Cullberg's crisis model, the trauma recovery process is divided into four stages: shock, reaction, processing, and reconstruction.

“According to Johan Cullberg’s crisis model [9], the trauma recovery process is divided into four stages: shock, reaction, processing, and reconstruction.”

• cites [9] Turunen T. Trauma recovery after a school shooting. The role of theory-based psychological care and attachment in facilitating recovery. University of tampere; 2014.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Quantitative studies have established prevalence rates of traumatic childbirth, but primarily rely on subjective self-reports or postpartum PTSD scales, which may vary widely and lack standardized assessment tools tailored to the specific experiences of traumatic childbirth.

“While quantitative studies have established prevalence rates of traumatic childbirth, these studies primarily rely on subjective self-reports or postpartum PTSD scales, which may vary widely and lack standardized assessment tools tailored to the specific experiences of traumatic childbirth [14, 15].”

• cites [14] Watson K, White C, Hall H, Hewitt A. Women’s experiences of birth trauma: a scoping review. Women Birth. 2021;34(5):417–24. sourceNot checked — no full text of the source
• cites [15] Harris R, Ayers S. What makes labour and birth traumatic? A survey of intrapartum ‘hotspots’. Psychol Health. 2012;27(10):1166–77. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Dependability was ensured by maintaining detailed documentation of the analysis and reflective journals, alongside peer discussions.

“Dependability was ensured by maintaining detailed documentation of the analysis and reflective journals, alongside peer discussions.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The interview guide was drafted based on literature, evaluated by five experts, and pretested on three participants.

“An interview guide was drafted based on review of literature, and five experts related to psychology, obstetrics, or qualitative research field were invited to evaluate the interview guide. After revising, the initial interview guide was pretested on three participants.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The researcher's insider status was addressed through reflexive practices such as keeping a reflexive journal and discussions with other researchers.

“Notably, LM has experienced two cesarean deliveries, positioning herself as an “insider” researcher [21]. To address this issue effectively during the analysis, LM adopted reflexive practices, such as keeping a reflexive journal and engaging in discussions with other researchers during the coding and analysis process [22].”

• cites [21] Berger R. Now I see it, now I don’t: researcher’s position and reflexivity in qualitative research. Qual Res. 2015;15(2):219–34. sourceNot checked — no full text of the source
• cites [22] Braun V, Clarke V. Conceptual and design thinking for thematic analysis. Qualitative Psychol. 2022;9(1):3–26. sourceNot checked — no full text of the source

May combine two claims.

Eligibility screening used four questions based on DSM-5 diagnostic criteria that have been validated in previous studies.

“four questions based on the DSM-5 diagnostic criteria were used to identify women who had traumatic childbirth experience [25]”

• Also stated in: § Data collection · plain

  “The questions have been validated in previous studies [26, 27].”

• cites [25] Abdollahpour S, Khosravi A, Bolbolhaghighi N. The effect of the magical hour on post-traumatic stress disorder (PTSD) in traumatic childbirth: a clinical trial. J Reproductive Infant Psychol. 2016;34(4):403–12. sourceNot checked — no full text of the source
• cites [26] Abdollahpour S, Khosravi A, Motaghi Z, Keramat A, Mousavi SA. Effect of brief cognitive behavioral counseling and debriefing on the Prevention of post-traumatic stress disorder in traumatic birth: a Randomized Clinical Trial. Community Ment Health J. 2019;55(7):1173–8. sourceNot checked — no full text of the source
• cites [27] Moghadam MF, Shamsi A, Moro FH. The prevalence of post-traumatic stress disorder among women with normal vaginal delivery in Zahedan city. Archives Psychiatry Psychother. 2015;17(1):15–9. sourceNot checked — no full text of the source

May combine two claims.

Credibility was achieved by validating the interview guide with five experts and employing a dynamic, iterative data analysis process.

“Credibility was achieved by validating the interview guide with five experts and employing a dynamic, iterative data analysis process.”

Classified as probably not a substantial claim.

Cullberg's model suggests that the trauma recovery process consists of four phases: shock, reaction, processing, and reconstruction.

“This finding is highly relevant to Johan Cullberg’s model mentioned in the introduction [9], which suggests that the trauma recovery process consists of four phases: shock, reaction, processing, and reconstruction.”

• cites [9] Turunen T. Trauma recovery after a school shooting. The role of theory-based psychological care and attachment in facilitating recovery. University of tampere; 2014.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Previous studies proposed that traumatic childbirth can negatively affect the mother-infant relationship.

“Previous studies we mentioned above proposed that traumatic childbirth can negatively affect the mother-infant relationship [8].”

• cites [8] Beck CT. Middle Range Theory of traumatic childbirth: the ever-widening Ripple Effect. Glob Qualit Nurs Res. 2015;2:13.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

According to Brewin's theory, social support among post-traumatic factors is a critical element influencing the development of PTSD.

“According to Brewin’s theory, social support among post-traumatic factors is a critical element influencing the development of PTSD [42].”

• cites [42] Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000;68(5):748–66. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

A previous study showed that maternal psychological issues are most common during the first 4-6 weeks after giving birth.

“A previous study showed that maternal psychological issues are most common during the first 4–6 weeks after giving birth [47]; this is the time when most mothers go back to their families again.”

• cites [47] Gjerde LC, Eilertsen EM, Hannigan LJ, Eley T, Røysamb E, Reichborn-Kjennerud T, Rijsdijk FV, McAdams TA, Ystrom E. Associations between maternal depressive symptoms and risk for offspring early-life psychopathology: the role of genetic and non-genetic mechanisms. Psychol Med. 2021;51(3):441–9. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Peeler et al. found that most women with postpartum PTSD had difficulty expressing their emotions.

“Peeler et al. [32] studied women with postpartum PTSD and found that most of these women had difficulty expressing their emotions.”

• cites [32] Peeler S, Stedmon J, Chung MC, Skirton H. Women’s experiences of living with postnatal PTSD. Midwifery. 2018;56:70–8. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Brewin's study identified risk factors for PTSD emerging at three stages: pre-trauma vulnerabilities, immediate responses to trauma, and post-trauma factors.

“Brewin’s study [42] identified risk factors for PTSD emerging at three stages: pre-trauma vulnerabilities (such as a family history of mental illness, gender, and lower educational levels), immediate responses to trauma, and post-trauma factors (such as social support).”

• cites [42] Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000;68(5):748–66. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Research indicates that involving spouses in interventions positively influences maternal mental health.

“Additionally, research indicates that involving spouses in interventions positively influences maternal mental health [44], possibly by increasing husbands’ understanding of the perinatal period, thus enabling them to offer better psychological support to their partners.”

• cites [44] Ngai F, Wong PWC, Chung KF, Chau PH, Hui PW. Effect of couple-based cognitive behavioural intervention on prevention of postnatal depression: multisite randomised controlled trial. BJOG. 2020;127(4):500–7. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The quotations from interviewees were translated from Chinese to English, which may introduce potential misinterpretations when presenting the results.

“Lastly, the quotations from the interviewees cited in the study have been translated from Chinese to English, which may introduce potential misinterpretations when presenting the results.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Molloy et al. found that women who had experienced traumatic childbirth suffered from physical pain and anxiety, had weakened bonds with their infants, and lacked confidence in their decision-making.

“Molloy et al. [35] conducted a qualitative study on the parenting abilities of women who had experienced traumatic childbirth, revealing that these women suffered from physical pain and anxiety, had weakened bonds with their infants, and lacked confidence in their decision-making.”

• cites [35] Molloy E, Biggerstaff DL, Sidebotham P. A phenomenological exploration of parenting after birth trauma: mothers perceptions of the first year. Women Birth. 2021;34(3):278–87. sourceNot checked — no full text of the source