Introduction
Childbirth is generally considered a natural process. However, 19.74% ~ 45.03% of women think it as a trauma[1]. Beck [2,3]believed that traumatic childbirth could be defined as delivery with a feeling of intimidating damage or serious harm, or even death to the mother, baby, or both, during labor, including physiological trauma and psychological trauma. Greenfield et al [4]indicated that psychological trauma was the necessary condition of childbirth trauma, namely, childbirth trauma included either psychological and physical trauma or just psychological trauma. Previous studies[5,6] focused on physiological trauma caused by mechanical factors in a mother, fetus, or newborn during childbirth. Gradually, the focus of childbirth trauma shifted from physiological trauma to psychological trauma which was a subjective painful birth experience[4] . A systematic review[7] with 13studies revealed that the incidence of psychological distress experienced by childbirth trauma was 9% to 44%. Traumatic childbirth experiences could affect the mother-child bond, the general adaptability[3, 8-10], as well as the partnership[2, 11, 12], and also negatively impact the decision to have more children[2,11, 13-15]. Moreover, a traumatic childbirth experience also has adverse effects on postpartum woman’s mental health. A prospective longitudinal study[16] reported that PTSD could result from a traumatic birth experience, and develop symptoms of PTSD at 4–6 weeks after traumatic birth events.
PTSD has three distinct types of symptoms consisting of re-experiencing the event, avoidance of reminders of the event, and hyperarousal, which must be presented together for at least one month to meet the diagnostic criteria for PTSD[17].
PTSD is one of the common mental health disorders in women after birth. A systematic review[18] including 21 studies with 8,511 general postpartum women showed that childbirth-related PTSD was 4.0%. Birth trauma may be a key risk factor for postpartum PTSD. Beck[8] indicated that the psychological trauma of childbirth might lead to postnatal PTSD. Ford et al[19] also showed that negative post-traumatic cognition appeared a predictive factor of the early development of PTS symptoms after childbirth. However, no systematic review on the incidence of postpartum PTSD in women who have experienced traumatic childbirth has been conducted. Thus, the aim of this study is to estimate the incidence of PTSD following traumatic childbirth through a systematic review and meta-analysis.