Emergency caesarean section
Emergency caesarean section is considered to be the most traumatic mode of birth, probably due to the urgency and stress associated with needing emergency surgery, usually when a woman is in established labour . Six of the studies in the quantitative search found EmCS to be associated with an increased proportion of women showing symptoms of PTSD .
Meta-analysis of three studies comparing EmCS to SVD suggested a medium difference (ES=0.64) of PTSD symptoms between these groups (appendix S3) and was consistent with the NMA results. EmCS was worse, with the difference being the biggest observed of any comparisons in this paper (p<0.001).
Three studies found a significant difference in PTSD symptoms between EmCS and ElCS, and another three found a difference which was not significant .
A meta-analysis of three studies showed a small-to-medium difference between women who had EmCS and women who had ElCS (ES=0.36) (appendix S4) , consistent with the NMA. EmCS was associated with a higher score of PTSD symptoms, a statistically significant difference (p<0.001).
With respect to the qualitative studies, Tham et al. interviewed 84 women who had an EmCS, 42 of whom had gone on to develop symptoms of PTSD . They found that women who developed PTSD symptoms after an EmCS were more likely to feel unsupported by staff and not feel involved in the decision to proceed to a caesarean section than those who did not develop PTSD.