Measuring post-traumatic stress after childbirth: a review and critical appraisal of instruments

ABSTRACT

Background

Addressing psychological trauma after childbirth requires accurate measurement of its prevalence, risk factors, and outcomes using validated instruments that distinguish perceptions of traumatic birth, subclinical post-traumatic stress (PTS) symptoms, and symptoms meeting a diagnostic threshold.

Objective

The purpose of this study was to review literature on psychological trauma following childbirth and appraise instruments that measure postpartum PTS.

Methods

In January 2020, the authors searched for and evaluated peer-reviewed studies that quantitatively measured PTS following hospital-based live births in the United States, United Kingdom, Canada, Australia, Norway, Sweden, and Switzerland; 37 articles were selected and evaluated.

Results

Levels of post-traumatic stress disorder were most commonly measured, followed by PTS symptoms. Diagnostic instruments suggested lower PTS prevalence estimates than those screening for or assessing PTS symptoms. Community samples yielded lower prevalence estimates than samples recruited from the internet or settings specifically addressing mental health. Measurement sooner after birth yielded higher estimates.

Conclusion

Study design, sample characteristics, instruments, and timing of measurements likely impact postpartum PTS prevalence estimates. Variation in these characteristics make it difficult to draw conclusions on the prevalence of postpartum PTS. Researchers should consider the appraisal of measurement tools presented here and use rigorous study methodology when studying traumatic birth experiences and evaluating interventions.

KEYWORDS:

• Posttraumatic stress
• childbirth
• traumatic birth
• postpartum
• birth trauma
• measurement

Acknowledgments

The authors thank public health informationist Donna Hesson, MLS, for her help in developing the search strategy for this paper. The corresponding author, Meagan Williams, would also like to express sincere gratitude toward Dr. Julia Seng at the University of Michigan for inspiring her to pursue this topic.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed here.

Notes

1. Authors’ note: The language used in this review will reflect the language and participants of the studies presented; the word ‘women’ used throughout the paper will refer to the birthing parent whose psychological state is being measured. The authors recognise and celebrate that not all birthing people identify as women or mothers.

Additional information

Funding

This work was supported in part by funding from The Maternal and Child Health Bureau (HHS) under Grant T76MC00003 and the National Institute on Minority Health and Health Disparities (1L60MD012089, Holliday).