Women's cognitive appraisals of their birth experience as predictive and maintaining factors of postpartum posttraumatic stress symptom severity
Empirical support has accumulated for evidence of posttraumatic stress symptoms following approximately 30% of childbirth experiences (Olde, van der Hart, Kleber, & van Son, 2006). Researchers have suggested that there is a complex relationship among predisposing, precipitating, and maintaining factors that impact postpartum PTSD (Slade, 2006). Anxiety, perception of support, and negative cognitions are such factors that have been shown to significantly correlate with PTSD symptoms (Foa & Rothbaum, 1998; Olde et al., 2006; Soet, Brack, & Dilorio, 2003), but have not been studied together in relation to PTSD associated with traumatic birth. The current study controlled for trait anxiety to examine the effect of negative cognitions following birth on the perception of medical staff support. It was hypothesized that perceptions of poor medical staff support and negative cognitions regarding the self and the world would be positively correlated with postpartum PTSD symptoms. It was also hypothesized that specific negative cognitions about the self and the world would moderate and mediate the relationship between the perception of poor medical staff support and symptoms of postpartum PTSD. Results indicated that perceptions of poor medical staff support and negative cognitions about the self and the world were significantly and positively correlated with greater PTSD symptom severity. Additionally, negative cognitions about the self and the world both moderated and partially mediated the relationship between poor staff support and greater PTSD symptom severity. Research on identifying negative cognitions uniquely associated with postpartum PTSD and improving ways to lessen the impact of event characteristics such as poor medical staff support would be beneficial as a means of preventing or minimizing stress reactions in perinatal women. Given that a traumatic birth experience can have far-reaching, long-lasting, and grim consequences for women and their families, the optimal psychological health of perinatal and postnatal women should be an area of judicious attention for medical and mental health professionals.