Childbirth is commonly considered a happy event but also represents a period of psychological vulnerability for women. The role of peritraumatic dissociation (PD) in promoting psychological adaptation is unclear. We investigated PD during childbirth and its relationship with postpartum posttraumatic stress (PP-PTS). We studied an international sample of 846 postpartum women and a prospective sample of 160 pregnant women delivering at Massachusetts General Hospital followed until early postpartum. We assessed for PD and various mental health outcomes including PP-PTS. In the prospective sample, more than half perceived their childbirth as traumatic and a third reported some degree of PD. In the international sample, degree of PD and levels of PP-PTS significantly differed between delivery modes with higher levels of PD and PP-PTS following emergency C-sections and assisted vaginal deliveries than planned C-sections or vaginal deliveries. Nonetheless, around 20% of women who reported high PD reported no elevated PP-PTS. Our findings underscore that childbirth can be stressful enough to trigger a traumatic response and that delivery environment is implicated in psychological adaptation, and are in line with the notion of a PD adaptiveness threshold. On a broader level, investigations of PP-PTS offer a prospective model to study PTSD immediately following exposure.
Additional authors: Sharon Dekel and Gabriella Dishy