PTSD post-childbirth: a systematic review of women’s and midwives’ subjective experiences of care provider interaction

Objective: To review primary research from within the literature regarding PTSD Post-Childbirth (PTSD-PC), that focussed on Quality of Provider Interaction (QPI) from either the perspective of women who have developed PTSD-PC, or midwives.Background: Up to 45% of women find childbirth traumatic. PTSD-PC develops in 4% of women (18% in high-risk groups). The woman’s subjective experience of her childbirth has been shown to be the most important risk factor in the development of PTSD-PC, within which perceived QPI is key. Methods: A systematic search was performed for PTSD-PC literature. Papers that focussed on either women’s subjective experiences of childbirth, particularly QPI, or midwives’ perspectives on QPI, were included. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tools, and a narrative synthesis of findings produced.Results: 14 studies met inclusion criteria. Three overarching features of QPI contribute towards developing PTSD-PC: (1) interpersonal factors; (2) midwifery care factors; and (3) lack of support. The importance of ‘how care is provided’ is emphasised over ‘what happens’. Conclusion: QPI is a significant factor in the development of PTSD-PC and the identified key features of QPI have potential to be modified by midwives. The development of guidelines for midwives needs to be grounded on evidence highlighted in this review, along with further high quality qualitative research exploring QPI from the perspective of women with PTSD-PC, but also midwives’ knowledge and needs regarding their role within QPI