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.