Thoughts and emotions during traumatic birth: a qualitative study.

Background: Previous research shows that 1-9% of women will develop posttraumatic stress disorder following birth (1, 2). Aims: This study therefore examined thoughts and emotions during birth, cognitive processing after birth, and memories of birth that might be important in the development of postnatal posttraumatic stress symptoms. Method: Women with posttraumatic stress symptoms (n=25) and without (n=25) were matched for obstetric events in order to examine nonmedical aspects of birth that make it traumatic. Women were interviewed 3 months after birth. Results: Themes that emerged for all women were as follows: thoughts during birth included mental coping strategies, wanting labor to end, poor understanding of what was going on, and mental defeat. More negative emotions were described during birth than positive emotions; primarily feeling scared, frightened and upset. Postnatal cognitive processing included retrospective appraisal of birth, e.g. taking a fatalistic view, as well as focusing on the present, e.g. concentrating on the baby. Memories of birth included not remembering parts of the birth and forgetting how bad it was. Women with posttraumatic stress symptoms reported more panic, anger, thoughts of death, mental defeat, and dissociation during birth. After birth, women with symptoms reported fewer strategies that focused on the present, more painful memories, intrusive memories, and rumination. Conclusion: The results provide a useful first step towards identifying aspects of birth and postnatal processing that might determine whether women develop postnatal posttraumatic stress symptoms. However, further research is needed to address limitations of the current study and to broaden knowledge in this area.