Strengths and limitations
To the best of our knowledge, this is the first comprehensive systematic review/meta-analysis on the incidence of PTSD following traumatic childbirth. The consistent findings from subgroup and sensitivity analyses indicated the robustness of the estimated incidence of postpartum PTSD.
Several limitations to this systematic review should be acknowledged. First, only 9 studies were included in the meta-analysis, and the number of studies within some subgroup analyses was further reduced. Second, traumatic birth events and PTSD were ascertained at the same time in the included studies, exaggerating the PTSD rate as women with traumatic events may have poorer moods and therefore more likely to report PTSD related symptoms. However, the sensitivity analysis excluding one study at a time yielded almost identical results. Third, it was difficult to isolate the effect of emergency cesarean section on the incidence of PTSD after traumatic childbirth, because emergency cesarean section and traumatic delivery might overlap.