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Factors associated with maternal birth-related posttraumatic stress symptoms (PTSS) in Brazil: The birth in Brazil national research study

Baldisserotto, M. L., Theme-Filha, M. M., Osório, F. D. L. , Nobre, A. A., Ayers, S. ORCID: 0000-0002-6153-2460, Pereira, A. P. E., da Gama, S. G. N. & Leal, M. D. C. (2025). Factors associated with maternal birth-related posttraumatic stress symptoms (PTSS) in Brazil: The birth in Brazil national research study. Midwifery, 149, article number 104544. doi: 10.1016/j.midw.2025.104544

Abstract

Introduction: A traumatic childbirth can lead some women to develop birth-related posttraumatic stress symptoms (PTSS), an emotional stress response associated with posttraumatic stress disorder (PTSD). This study aimed to identify factors associated with maternal birth-related PTSS in Brazil.

Method: Birth in Brazil I is a perinatal cohort study conducted between 2011 and 2012 with a nationally representative sample of 23,894 women. The first interview was conducted in the maternity ward, followed by two telephone interviews at 6 months and 18 months postpartum. PTSS was assessed using the Impact of Event Scale (IES). Associations between maternal sociodemographic characteristics, individual and obstetric factors and birth-related PTSS were analyzed using Zero-Inflated Poisson models.

Results: Maternal sociodemographic factors (geographic region, maternal age, years of schooling, and type of healthcare service), individual factors (postpartum depression symptoms), and obstetric factors (presence of a companion during birth, type of birth, obstetric emergencies during pregnancy and childbirth, newborn conditions, the use of non-pharmacological pain relief methods, poor quality of care, absence of respectful caregivers, lack of privacy, unclear information, being excluded from decision-making, and physical obstetric violence) were associated with birth-related PTSS.

Discussion/Conclusion: Sociodemographic, individual, and obstetric factors may affect the development of birth-related PTSS. A positive childbirth experience plays a key role in prevention, suggesting that improving the quality of childbirth care can reduce the risk of PTSS. These findings enhance understanding of birth-related PTSS and can support public policies aimed at prevention. Further research is needed to examine additional factors and their interactions with PTSS.

Publication Type: Article
Additional Information: © 2025. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/
Publisher Keywords: Birth-related posttraumatic stress, Maternal mental health, Traumatic childbirth
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RG Gynecology and obstetrics
Departments: School of Health & Medical Sciences
School of Health & Medical Sciences > Department of Nursing & Midwifery
SWORD Depositor:
[thumbnail of Baldisserotto et al 2025_text copy.pdf] Text - Accepted Version
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