Introduction
Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition whereby individuals suffer flashbacks, anxiety and avoidance following exposure to a traumatic event. Given that childbirth is usually a positive and life-affirming event, only recently did the scientific community begin to recognise that giving birth could be deeply traumatic for some women. In 1997 the phenomenon was recognised widely enough that the first large-scale study was carried out by a group in Sweden , which found that 1.6% of postnatal women studied showed symptoms of PTSD. A recent meta-analysis of 78 studies found the prevalence of postnatal PTSD to be higher, at 3.1% in the community and 15.7% in at-risk populations . Risk factors for postnatal PTSD may include nulliparity, increased anxiety, feeling out of control and lack of social support. Another risk factor is the impact of mode of birth, in particular caesarean section (CS) .
Given the global increase in the proportion of women who deliver via CS , an association between this mode of birth and postnatal PTSD could have wide implications. This review is the first to analyse the impact of mode of birth on maternal postnatal PTSD. The review aimed to investigate whether onset of PTSD in the postnatal period is more common following CS or other modes of birth, to raise awareness of the risks of developing PTSD and encourage better recognition and treatment of the condition. Three primary and four secondary review questions were developed. For the purposes of the review, modes of birth were categorised into elective caesarean section (ElCS), emergency caesarean section (EmCS), spontaneous vaginal delivery (SVD) and instrumental vaginal delivery (IVD). IVD was classified as the use of forceps and/or vacuum extraction (ventouse) .
PRIMARY REVIEW QUESTIONS:
SECONDARY REVIEW QUESTIONS: