Maternal mental health in the first 3-week postpartum: the impact of caregiver support and the subjective experience of childbirth – a longitudinal path model

Abstract

Objective: Acute stress reactions (ASR) and postpartum depressive symptoms (PDS) are frequent after childbirth. The present study addresses the change and overlap of ASR and PDS from the 1- to 3-week postpartum and examines the interplay of caregiver support and subjective birth experience with regard to the development of ASR/PDS within a longitudinal path model. Method: A total of 219 mothers completed questionnaires about caregiver support and subjective birth experience (Salmon’s Item List) at 48–6-h postpartum. ASR and PDS were measured for 1- and 3-week postpartum. The Impact of Event Scale (IES) was used to assess ASR, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess PDS. Results: ASR was frequent 1-week postpartum (44.7%) and declined till week 3 (24.8%, p <.001), while the prevalence of PDS was continuous (14.2% week 1; 12.6% week 3; p = .380). Favorable reports of caregiver support were related to better subjective childbirth experience, which was related to lower ASR and PDS (controlled for age, mode of delivery, parity, EDA and duration of childbirth). Conclusion: High quality of intrapartum care and positive birth experiences facilitate psychological adjustment in the first 3-week postpartum.

Keywords::

• Acute stress reaction
• postpartum depressive symptoms
• subjective birth
• experience
• caregiver support
• path model

Declaration of Interest: The authors report no conflicts of interest.

Current knowledge on this subject

• Acute stress reactions (ASR) and postpartum depressive symptoms (PDS) are two existing forms of maladaptive psychological adjustment after childbirth, and are risk factors for the development of posttraumatic stress disorder (PTSD) and postpartum depression (PPD).

• Research is unclear as to whether ASR and PDS are symptoms of the same disorder, or whether they are two separate maladaptive psychological phenomena, which can be detected shortly after childbirth.

What this study adds

• Acute stress reactions (ASR) and postpartum depressive symptoms (PDS) follow different courses in the first 3 weeks after childbirth: While the prevalence of PDS was generally stable, the prevalence of ASR decreased in the first 3 weeks postpartum. In addition, the course is also different in matters of the fluctuation, so that the comparable prevalence of PDS 1 and 3 weeks after childbirth consists of only half of the same women. Although ASR and PDS have overlapping symptoms, a substantial number of women suffer only from one of these two problematic phenomena.

• ASR and PDS in the first 3 weeks after childbirth are related to different dimensions of the subjective birth experience. Additional, the relation with PDS is limited on the 1st week after childbirth, whereat ASR and the subjective birth experience have a longer lasting association.

• During the clinical routine, caregivers should be aware of their impact on women’s subjective birth experience, which in turn is important for women’s development of ASR and PDS in the first 3-week postpartum.

• Methods of improving the subjective birth experience by specific skilled caregivers should be investigated in a clinical trial.