Incidence and associated factors with traumatic childbirth in postpartum Brazilian woman


Carla Fonseca Zambaldi

Amaury Cantilino

Jacqueline Vasconcelos Farias

Gustavo Paranhos Moraes

Everton Botelho Sougey


Childbirth may be a traumatic experience for some women. This observational study aimed to describe the incidence of traumatic childbirth in two regional maternity services in Brazil. In addition, the study intended to determine characteristics that are associated with traumatic childbirth. A total of 328 women were interviewed, up to 72 hours postpartum, between July and November 2010. Women were screened for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMI-IV) criteria for traumatic event using the item A of SCID-I interview for PTSD. Socio-demographic and obstetrical variables, pain score, previous trauma and dissociative experiences in women with and without traumatic childbirth were compared. A total of 53 (16.2%) of the sample fulfilled the criteria for a traumatic event.  It observed that some socio-demographic and obstetrical variables may be considered as associated with traumatic childbirth, such as an intermediate level of schooling, high risk pregnancy, obstetrical complications during pregnancy, primiparity, a high pain score, forceps, episiotomy, prematurity, obstetrical complications at birth or with the baby, baby needing hospital care, dissociative experience peripartum, no satisfaction with maternity care, not being well informed of the progress of labor and previous trauma related to urban violence, sexual abuse or domestic violence. Childbirth may be a traumatic event for Brazilian. In this sample traumatic childbirth was associated with pain, previous trauma, dissociative experiences and some socio-demographic and obstetrical variables. Traumatic childbirth constitutes an important mental health problem and need more attention from health.


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Adewuya, A., Ologun, Y. & Ibigbami, O. (2013). Post-traumatic stress disorder after childbirth in Nigerian women: prevalence and risk factors. BJOG: An International Journal of Obstetrics & Gynaecology, 113(3), 284-288. doi:10.1111/j.1471-0528.2006.00861.x
Alcorn, K., O’Donovan, A., Patrick, J., Creedy, D. & Devilly, G. (2010). A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychological Medicine, 40(11), 1849-1859. doi:10.1017/S0033291709992224
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: Autor.
Ballard, C., Stanley, A. & Brockington, I. (1995). Posttraumatic stress disorder (PTSD) after childbirth. The British Journal of Psychiatry, 166(4), 525-528. doi:10.1192/bjp.166.4.525
Beck, C. (2004). Birth trauma: in the eye of the beholder. Nursing Research, 53(1), 28-35. Retrieved from
Birmes, P., Brunet, A., Benoit, M., Defer, S., Hatton, L., Sztulman, H. & Schmitt, L. (2005). Validation of the Peritraumatic Dissociative Experience Questionnaire self-report version in two samples of French-speaking individuals expoed to trauma. European Psychiatry, 20(2), 145-151. doi:10.1016/j.eurpsy.2004.06.033
Boudou, M., Séjourné, N. & Chabrol, H. (2007). Childbirth pain, perinatal dissociation and perinatal distress as predictors of posttraumatic stress symptoms. Gynécologie, obstétrique & fertilité, 35(11), 1136-1142. doi: 10.1016/j.gyobfe.2007.09.014
Bydlowski, M. & Raoul-Duval, A. (1978). Un avatar psychique méconnu de la puerperalité: la névrose traumatique post-obstetricale. Perspectives Psychiatriques, 4, 321-328.
Creedy, D., Shochet, I. & Horsfall, J. (2000). Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth, 27(2), 104-111. doi:10.1046/j.1523-536x.2000.00104.x
Czarnocka, J. & Slade, P. (2000). Prevalence and predictors of post-traumatic stress symptoms following childbirth. British Journal of Clinical Psychology, 39(1), 35-51. doi:10.1348/014466500163095
Downie, W., Leatham, P., Rhind, V., Wright, V., Branco, J. & Anderson, J. (1978). Studies with pain rating scales. Annals of the Rheumatic Diseases, 37(4), 378-381. Retrieved from
First, M., Williams, J., Spitzer, R. & Gibbon, M. (2007). Structure Clinical Interview for DSM-IV-TR Axis I Disorders, Clinical Trials version (SCID TR). New York: Biometrics Research.
Fiszman, A., Cabizuca, M., Lanfredi C. & Figueira, I. (2005). The cross-cultural adaptation to Portuguese of the Trauma History Questionnaire to identify traumatic experiences. Revista Brasileira de Psiquiatria, 27(1), 63-66. doi:10.1590/S1516-44462005000100014
Fiszman, A., Marques, C., Berger, W., Volchan, E., Oliveira, L., Coutinho, E., … & Figueira, I. (2005). Cross-cultural adaptation of the Peritraumatic Dissociative Experiences Questionnaire, Self-Report Version, to Brazilian Portuguese. Revista de Psiquiatria do Rio Grande do Sul, 27(2), 151-158. doi:10.1590/S0101-81082005000200005
Ford, E. & Ayers, S. (2011). Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms. Psychology & Health, 26(12), 1553-1570. doi:10.1080/08870446.2010.533770
Gamble, J., Creedy, D., Moyle, W., Webster, J., McAllister, M. & Dickson, P. (2005). Effectiveness of a counseling intervention after traumatic childbirth: a randomized controlled trial. Birth, 32(1), 11-19. doi:10.1111/j.0730-7659.2005.00340.x
Holditch-Davis, D. (2012). Posttraumatic Stress Symptoms in Mothers of Premature Infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(2), 161-171. doi:10.1177/0884217503252035
Hosmer, D. & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York: John Wiley & Sons, Inc.
Marmar, C., Weiss, D. & Metzler, T. (1998). Peritraumatic dissociative experiences questionnaire. In J. Bremner & C. Marmar (Ed.), Trauma, memory, and dissociation (pp. 249-252). Washington: American Psychiatric Publishing.
Menage, J. (1993). Post-traumatic stress disorder in women who have undergone obstetric and/or gynaecological procedures: A consecutive series of 30 cases of PTSD. Journal of Reproductive and Infant Psychology, 11(4), 221-228. doi:10.1080/02646839308403222
Moleman, N., van der Hart, O. & van der Kolk, B. (1992). The Partus Stress Reaction: A Neglected Etiological Factor in Postpartum Psychiatric Disorders. The Journal of Nervous and Mental Disease, 180(4), 271-272. Retrieved from
Nuttall, C. (2000). Caesarean section controversy. The caesarean culture of Brazil. British Medical Journal, 320, 1072-1074. doi:10.1136/bmj.320.7241.1072/a
Olde, E., van der Hart, O., Kleber, R., van Som, M., Wijnen, H. & Pop, V. (2005). Peritraumatic dissociation and emotions as predictors of PTSD sympoms following childbirth. Journal of Trauma & Dissociation, 6(3), 125-142. doi:10.1300/J229v06n03_06
Ryding, E., Wijma B. & Wijma, K. (1997). Posttraumatic stress reactions after emergency cesarean section. Acta Obstetricia et Gynecologica Scandinavica, 76(9), 856-861. doi:10.3109/00016349709024365
Söderquist, J., Wijma, B., Thorbert, G. & Wijma, K. (2009). Risk factors in pregnancy for post-traumatic stress and depression after childbirth. BJOG: An International Journal of Obstetrics and Gynaecology, 116(5), 672-680. doi:10.1111/j.1471-0528.2008.02083.x
Soet, J., Brack, G. & DiIorio, C. (2003). Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth, 30(9), 36-46. doi:10.3109/00016349709024365
van der Velden, P. & Wittmann, L. (2008). The independent predictive value of peritraumatic dissociation for PTSD symptomatology after type I trauma: a systematic review of prospective studies. Clinical Psychology Review, 28(6), 1009-1020. doi:10.1016/j.cpr.2008.02.006
van Son, M., Verkerk, G., van der Hart, O., Komproe, I. & Pop, V. (2005). Prenatal depression, mode of delivery and perinatal dissociation as predictors of postpartum posttraumatic stress: an empirical study. Clinical Psychology & Psychotherapy, 12(4), 297-312. doi:10.1002/cpp.446
Victora, C., Aquino E., do Carmo, M., Monteiro, C., Barros, F. & Szwarcwald, C. (2011). Maternal and child health in Brazil: progress and challenges. The Lancet, 377(9780), 1863-1876. doi:10.1016/S0140-6736(11)60138-4
Wijma, K., Söderquist, J. & Wijma, B. (1997). Posttraumatic stress disorder after childbirth: a cross sectional study. Journal of anxiety disorders. Journal of anxiety disorders, 11(6), 587-597. doi:10.1016/S0887-6185(97)00041-8
Zambaldi, C., Cantilino, A., Farias, J., Moraes, G. & Sougey, E. (2011). Dissociative experience during childbirth. Journal of Psychosomatic Obstetrics & Gynecology, 32(4), 204-209. doi:10.3109/0167482X.2011.626092