Emotional and dissociative responses to childbirth as predictors of postpartum PTSD symptoms: a prospective observational study

BACKGROUND: Postpartum post-traumatic stress disorder (PTSD) symptoms are a significant mental health concern. Although obstetric complications are often considered central, growing evidence suggests that women's emotional and subjective responses to childbirth may play a more decisive role in the development of trauma-related symptoms. OBJECTIVE: To estimate the prevalence of postpartum PTSD symptoms one month after childbirth and to identify the most relevant obstetric, psychological, and psychosocial risk factors, with a particular focus on emotional and dissociative responses. METHODS: A prospective observational study was conducted in a high risk maternity hospital between 2021 and 2024. Women completed validated self-report questionnaires one month postpartum, including the PTSD Checklist for DSM-IV (PCL-S), the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), the Peritraumatic Distress Inventory (PDI), and the Edinburgh Postnatal Depression Scale (EPDS). Clinically significant PTSD symptoms were defined by a PCL-S score ≥ 26. Multivariate logistic regression analyses were performed to identify independent predictors. RESULTS: Among 1,451 women included, 11.8% reported clinically significant PTSD symptoms at one month postpartum. In multivariate analyses, peritraumatic dissociation was the strongest predictor of PTSD symptoms (adjusted odds ratio [aOR] = 2.61), followed by fear of dying during childbirth (aOR = 2.34), stressful life events during pregnancy (aOR = 2.31), and early depressive symptoms (aOR = 1.16 per EPDS point). Obstetric complications, including emergency cesarean section and instrumental delivery, were not significantly associated with PTSD symptoms after adjustment. CONCLUSION: Emotional and dissociative responses to childbirth, particularly peritraumatic dissociation, are more strongly associated with postpartum PTSD symptoms than obstetric complications. These findings highlight the importance of early psychological screening using validated tools and support integrated psychoeducation and emotional support into routine perinatal care by somatic healthcare providers.