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The Role of Labor Pain and Overall Birth Experience in the Development of Posttraumatic Stress Symptoms: A Longitudinal Cohort Study

Authors

  • Susan Garthus-Niegel PhD,

    Clinical Psychologist and Researcher, Corresponding author
    1. TU Dresden and at the Department of Psychosomatics and Health Behavior, Institute and Outpatient Clinics of Occupational and Social Medicine, Norwegian Institute of Public Health, Oslo, Norway
    • Address Correspondence to Susan Garthus-Niegel, PhD, Faculty of Medicine, Institute and Outpatient Clinics of Occupational and Social Medicine, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany.

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  • Cecilie Knoph PhD,

    Clinical Psychologist
    1. Mental Health Services, Akershus University Hospital, Lørenskog, Norway
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  • Tilmann von Soest PhD,

    Clinical Psychologist and Associate Professor
    1. Department of Psychology, University of Oslo, Norway
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  • Christopher S. Nielsen PhD,

    Clinical Psychologist and Senior Researcher
    1. TU Dresden and at the Department of Psychosomatics and Health Behavior, Institute and Outpatient Clinics of Occupational and Social Medicine, Norwegian Institute of Public Health, Oslo, Norway
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  • Malin Eberhard-Gran MD, PhD

    Medical Doctor and a Professor
    1. TU Dresden and at the Department of Psychosomatics and Health Behavior, Institute and Outpatient Clinics of Occupational and Social Medicine, Norwegian Institute of Public Health, Oslo, Norway
    2. Mental Health Services, Akershus University Hospital, Lørenskog, Norway
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  • The study was funded by the Norwegian Research Council, project number 191098.

Abstract

Background

The aim of this prospective study was to investigate the role of labor pain and overall birth experience in the development of posttraumatic stress symptoms in a comprehensive framework.

Methods

The study sample (N = 1893) comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort, which targeted all women scheduled to give birth at Akershus University Hospital in Norway. Questionnaires were given at three different stages: from pregnancy weeks 17 to 32, from the maternity ward, and from 8 weeks postpartum. Data were also obtained from the hospital's birth record. Using structural equation modeling, a prospective mediation model was tested.

Results

Posttraumatic stress symptoms were significantly related to both labor pain (r = 0.23) and overall birth experience (r = 0.39). A substantial portion (33%) of the effect of labor pain on posttraumatic stress symptoms was mediated by the overall birth experience.

Conclusions

Although the results of this study showed that both labor pain and overall birth experience played a role in the development of posttraumatic stress symptoms after childbirth, overall birth experience appeared to be the central factor. The women's birth experience was not only related to posttraumatic stress symptoms directly but also mediated a substantial portion of the effect of labor pain on posttraumatic stress symptoms. Future work should address which areas of birth experience confer protective effects on women to improve clinical care.

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