The associations of subjective appraisal of birth pain and provider-patient communication with postpartum-onset PTSD.

Childbirth-related PTSD is generally believed to result from multiple factors, including negative objective and subjective experiences and patient predisposing factors. There is conflicting evidence regarding whether severe childbirth pain affects development of PTSD. We hypothesize that a woman's retrospective subjective appraisal of birth pain is a greater predictor of postpartum-onset PTSD than medically documented measures of pain, and that a positive subjective experience communicating with medical providers during labor also reduces risk for postpartum-onset PTSD. A sample of 112 women, who screened positive for psychopathology within a year postpartum, were interviewed probing for their subjective labor experiences. Interviews were coded for subjective labor pain perception and quality of provider communication. Regression analyses tested associations between subjective labor pain perception and quality of provider communication with postpartum PTSD. Pain scores recorded during labor were not significantly associated to probable PTSD at any recorded time point up to 12 months postpartum. Positive perception of birth pain was associated with reduced risk of probable PTSD at 6 weeks postpartum (aOR = 0.34, p = 0.03). Positive provider communication was associated with reduced risk of probable PTSD at 6 months (aOR = 0.29, p = 0.02) and 12 months (aOR = 0.2, p = 0.03) postpartum. Pain recorded during childbirth is not necessarily a negative experience leading to trauma. For some women, even severe pain may be seen positively, and lacks traumatizing elements. Interventions to positively shift women's childbirth pain appraisal and educate medical workforce in patient-provider communication may reduce rates of postpartum PTSD. ClinicalTrials.gov Indentifier: NCT03004872.