Adverse Childbirth Experiences - Results of an Online Survey of Woman During Their First Year Postpartum
Authors: Beck-Hiestermann Franziska Marie Lea , Gries Saskia , Mehl Stephanie , Stenzel Nikola , Erices Rainer , Gumz Antje 
Published: October 2023

Abstract
Background: Scientific research on the topic of "adverse childbirth experiences" is still lacking to date. Although most women experience the birth of a child as a positive event, various studies indicate that about one third of all women subjectively describe their experience as negative. A birth that is perceived by the mother as a negative or adverse experience is associated with various mental illnesses, such as for example, an increased risk of developing post-traumatic stress disorder (PTSD) or postpartum depression.
Objective: In addition to exploring the subjective frequency of the categories of incidents which lead to an overall perceived adverse childbirth experience, the present study examines some additional factors such as the timing of these incidents, the persons involved, and the correlation between the number of adverse incidents experienced during childbirth and postpartum depression or elevated posttraumatic stress disorder (PTSD) scores.
Methods: As part of an online cross-sectional survey embedded in a longitudinal study (LABOR - Longitudinal Analysis of Birth mode and Outcomes Related) from 29/01/2020 to 25/03/2020, women within their first year postpartum were asked to self-report about their sociodemographic factors, reproductive history, and their subjectively perceived adverse birth experiences. In addition, postpartum depression and PTSD scores were recorded (depression: EPDS; PTSD: PCL-5). The incidents contributing to these adverse childbirth experiences were recorded using four main categories: 1.) Physical, 2.) Psychological/verbal, 3.) Neglect, and 4.) Disruption of the mother-infant relationship. Furthermore, the participants were asked about the timing of the incidents and the persons involved. Finally, descriptive analyses as well as group comparisons were performed via ANOVAS.
Results: n = 1079 mothers participated in the survey. Approximately half of the respondents (49.9%) reported experiencing no adverse incidents during childbirth; however, n= 539 (50.1%) reported subjectively experiencing at least one negative incident. Of these individuals, 30.9% (n = 333) reported the incident as being physical in nature, 30.0% (n = 324) subjectively experienced neglect, 23.1% (n = 249) experienced adverse psychological or verbal abuse, and 19.1% (n = 206) perceived that the mother-infant bonding was negatively impacted (multiple responses were possible). Most of the incidents subjectively perceived as adverse predominantly occurred directly during delivery. There were significant differences in the groups of women without any negative incidents during the childbirth experience and those with at least one adverse incident during childbirth with regards to subsequent postpartum depression (F (4, 1067) = 29.637, p < .001, ƞp² = .09) and PTSD scores (F (4, 1067) = 118.142, p < .001, ƞp² = .31). Women with two, three, or four perceived negative incidents during childbirth also had significantly higher depression and PTSD scores than the women who reported only one negative incident occurring during the overall birthing experience.
Conclusion: In the present sample, approximately 50% of the women subjectively report having experienced adverse incidents during childbirth. These encounters were associated with increased postpartum depression and PTSD scores. Due to the study being a purely cross-sectional study, no conclusions can be drawn regarding the causality of these factors. Future studies should examine the potentially reciprocal associations between premorbid psychological distress, adverse birth experiences, and postpartum mental illness in a more nuanced manner in order to allow for long-term solutions.