Study Intervention type Study sample Aims of study Methodology Outcome measures Important results Quality appraisal
Cohen, 2004 SVD11Spontaneous Vaginal Delivery, IVD22Instrumental Vaginal Delivery, CS33Caesarean Section N = 240 Discover the link between factors making for a difficult birth and postnatal PTSD symptoms. Longitudinal. Questionnaire (phone). Davidson Trauma Scale (DTS) No significant difference between PTSD symptoms across 3 modes of birth (Chi-squared P value 0.838). NOS: Medium
Creedy, 2000
SVD, forceps, vacuum, ElCS44Elective Caesarean Section, EmCS55Emergency Caesarean Section,
N = 592
Identify risk factors for psychological distress after childbirth.
Prospective longitudinal. Interview (phone).
Post-traumatic Stress Symptoms interview (PSS)
EmCS, forceps and vacuum deliveries associated with PTSD symptoms (β=0.196 P=0.0001, β=0.173 p=0.0001 and β=0.135 p=0.003).
NOS: Medium
Dekel, 2019
NAVD 66No Anaesthesia Vaginal Delivery, SVD, IVD, ElCS, EmCS
N = 685
Ascertain whether women who undergo different mode of deliveries also differ in regard to their mental health postnatally.
Longitudinal. Questionnaire (internet).
PTSD checklist for DSM-5 (PCL-5)
PCL-5 score EmCS> ElCS> IVD > SVD > NAVD. Delivery mode accounted for 13% of variance in symptoms severity (Pillai’s T= .13, F(36, 2700) = 2.48, p < .0001).
CEBM: 6/12
Fairbrother, 2007
VD77Vaginal Delivery, CS
N = 99
Examine psychological and obstetrical risk factors predicting postnatal PTSD symptoms.
Prospective longitudinal. Questionnaire.
PTSD Symptoms Scale Self-Report (PSS-SR)
Significant association between mode of birth (CS versus VD) and PTSD
NOS: Medium
Feeley, 2017
VD, ElCS, EmCS
N = 298
Investigating PTSD symptoms in 2 high-risk groups (Low birthweight infant who was admitted to a NICU, and EmCS) and 2 low-risk groups (VD and ElCS).
Longitudinal. Questionnaire & interview (visited at home).
Perinatal PTSD Questionnaire (PPQ)
PPQ mean score at 5 weeks NICU > EmCS > VD > ElCS (P=0.01). No significant difference between PPQ scores in clinical range at 5 weeks. EmCS did not have significantly greater PTSD symptoms than ElCS or VD.
NOS: Medium
Furuta, 2016 SVD, IVD, ElCS, EmCS N = 1824 Identify risk factors for PTSD in the postnatal period. Secondary analysis of cohort study. Impact of Event Scale (IES) PTSD symptoms more common in IVD (p =0.03 and 0.02 for symptoms of intrusion and avoidance, respectively) or EmCS (p < 0.001 for both intrusion and avoidance) compared with SVD. NOS: Medium
Lyons, 1998 SVD, forceps, ventouse, CS N = 42 Investigate symptoms of PTSD in a group of first-time mothers. Longitudinal. Questionnaire (post). IES Mode of delivery was not related to PTSD symptoms (Kruskal-Wallis, H(3) = 2.39, p= 0.5). NOS: Medium
Noyman-Veksler, 2015 SVD, EmCS, ElCS N = 142 Investigate protective factors against PTSD symptoms after EmCS. Longitudinal. Questionnaire. PDS No significant differences were found between the three modes of delivery. NOS: Medium
Polachek, 2012 SVD, IVD, ElCS, EmCS N = 102 Examine postnatal PTSD in women in Israel and examine risk and protective factors. Longitudinal. Questionnaire. PDS No significant association between mode of birth and PTSD. NOS: Medium
Ryding, 1998 SVD, IVD, ElCS, EmCS N = 354 Compare psychological symptoms in women after EmCS, ElCS, IVD and SVD. Longitudinal. Questionnaire (post). IES EmCS > ElCS (P = 0.01), EmCS > SVD (P<0.05). NOS: Medium
Söderquist, 2009
SVD, IVD, ElCS, EmCS
N = 508
Find risk factors in pregnancy for post-traumatic stress (PTS) and depression 1 month after childbirth.
Longitudinal. Questionnaire.
Traumatic Event Scale (TES)
PTSD symptoms related to mode of delivery (F(1, 432) = 4.9, P = 0.002). EmCS led to more PTSD symptoms than SVD or ElCS (P=0.01; P=0.03, Scheffé post hoc test).
NOS: Medium
Vossbeck-Elsebusch, 2014
SVD, IVD, ElCS, EmCS, 2°CS7
N = 521
Investigate risk factors for PTSD outlined in Ehlers and Clark’s (2000) model of PTSD.
Cross-sectional. Questionnaire (online).
PDS (German version)
PDS scores differed depending on mode of birth, F(4,219) = 7.07, p < 0.001, ηp2 = 0.11 (univariate ANOVA). Post-hoc Scheffé tests showed more symptoms in EmCS (M = 16.17, SD = 11.04, p = 0.001) than SVD (M = 7.04, SD = 7.56).
CEBM: 5/12