Changes to women’s childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study

A considerable number of women giving birth during COVID-19 pandemic reported being concerned about changes to their childbirth plans and experiences due to imposed restrictions. Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans. Therefore, this study aimed to examine if the mismatch between women’s planned birth and actual birth experiences during COVID-19 was associated with women’s postpartum PTSS. Women in the postpartum period (up to 6 months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors, and PTSS (PTSD checklist DSM-5 version) using self-report questionnaires (ClinicalTrials.gov: NCT04595123). More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans. All changes were significantly associated with PTSS scores. Participants with one and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes (Exp(β) = 1.12; 95% CI [1.06–1.19]; p < 0.001 and Exp(β) = 1.38; 95% CI [1.29–1.48]; p < 0.001). In addition, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida (Exp(β) = 0.86; 95% CI [0.77–0.97]; p = 0.014). Changes to women’s childbirth plans during the COVID-19 pandemic were common and associated with women’s postpartum PTSS score. Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health.
Open access funding provided by FCT|FCCN (b-on). This publication is based upon work from COST Action Research Innovation and Sustainable Pan-European Network in Peripartum Depression Disorder (Riseup-PPD), CA18138 and DEVoTION: Perinatal Mental Health and Birth-Related Trauma: Maximising best practice and optimal outcomes, CA18211 both supported by COST (European Cooperation in Science and Technology). EPIUnit – UIDB/04750/2020, ITR – LA/P/0064/2020, and HEILab – UIDB/05380/2020 are supported by Portuguese fundings through FCT – Fundação para a Ciência e a Tecnologia, IP. RC has a postdoctoral grant supported by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016; RC postdoctoral fellowship). The work developed by ProChild CoLAB was supported by (i) NORTE-06-3559-FSE-000044, integrated in the invitation NORTE59-2018-41, aiming to hire Highly Qualified Human Resources, cofinanced by the Regional Operational Programme of the North 2020, thematic area of Competitiveness and Employment, through the European Social Fund (ESF) and (ii) Mission Interface Program from the Resilience and Recuperation Plan, notice nº 01/C05-i02 /2022, aiming to guarantee public core funding to strengthen the network of interface institutions, as defined in the legal regime in force, approved by DecreeLaw no. 63/2019, of May 16th, as well as in its 1st review on “Technology and Innovation Centres – CTI” and “Collaborative Laboratories – CoLABs,” approved by Decree-Law no. 126-B/2021, of December 31st. The Psychology Research Centre - CIPsi (PSI/01662), School of Psychology, University of Minho, was supported by the Foundation for Science and Technology (FCT) through the Portuguese State Budget (Ref.: UIDB/PSI/01662/2020). Bulgarian national data collection supported by national co-funding of COST Actions, № KP-06-KOST/14 from 16.12.2020, FNI. CAW is funded by the UK’s National Institute for Health and Care Research (NIHR) as an Academic Clinical Lecturer.