Dr Myriam de Senarclens Prize 2022

Susan Ayers, Professor of Maternal & Child Health, School of Health & Psychological Sciences, City St George’s, University of London

INTERSECT- INTERNATIONAL SURVEY OF CHILDBIRTH-RELATED TRAUMA

Summary

Evidence before this study

Traumatic births and childbirth-related post-traumatic stress disorder (CB-PTSD) are significant yet often overlooked conditions affecting childbearing women worldwide. While PTSD is recognised as a serious psychiatric disorder, CB-PTSD remains under-recognised. This oversight is critical, given that CB-PTSD has far-reaching impacts on women, co-parents, and possibly infants, both immediately and over time. Meta-analytic estimates of the prevalence of CB-PTSD suggest 3·1 to 4·7% of childbearing women are affected, but estimates are predominantly based on research from Western countries. Available studies from low and middle-income countries suggest prevalence rates tend to be higher. However, variations in prevalence may be due to differences in risk factors, maternity care, or research methods and measurement. Standardised data collection is essential to establish the worldwide burden of birth trauma and CB-PTSD, and inform maternity care policies and practices.

Added value of this study

This research is the first to provide worldwide prevalence estimates of traumatic birth, CB-PTSD, and CB-PTSD subtypes through the International Survey of Childbirth-Related Trauma (INTERSECT, edition 1, 2024) of 11,302 women in 31 countries. Significant variation in the rates of traumatic birth and CB-PTSD were found, as well as in CB-PTSD subtypes. Many women who experienced traumatic birth reported distress and impairment even without meeting full diagnostic criteria for CB-PTSD. Excluding cases with possible differential diagnoses did not alter prevalence rates in most countries, validating previous research where such women were included in estimates. Findings suggest prevalence rates are influenced by cultural and healthcare factors unique to each country.

Implications of all the available evidence

Findings highlight the need for improved global maternity care policies and practices, particularly in countries with high rates of birth-trauma and CB-PTSD. Findings emphasise the importance of supporting women after traumatic births, regardless of whether they meet criteria for CB-PTSD. Learning from countries identified as having low rates of birth trauma and CB-PTSD can be used to reduce or prevent birth trauma in countries with high rates.

Papers reporting primary INTERSECT findings:

1.     Ayers S, Handelzalts J, Webb R, Constantinou G, Grollman C, Lucas G, et al. International prevalence of childbirth-related post-traumatic stress disorder: the INTERSECT study. JAMA Psychiatry, Under review.

2.     Handelzalts J, Ayers S, Webb R, Constantinou G, Lucas G, Grollman C et al. Cross-national risk factors for childbirth-related PTSD: Findings from the INTERSECT study. Psychological Medicine, Under review.

3.     Constantinou G, Ayers S, Handelzalts J, Webb R, Wright DB, Grollman C, et al. International symptom profiles of childbirth-related PTSD. JAMA Network Open. Under review.

4.     Webb R, Ayers S, Handelzalts J, Constantinou G, Grollman C, Wright DB. International variation in risk factors associated with childbirth-related PTSD. In preparation.

5. Ayers S, Wright DB, Caparros-Gonzalez R, Ciuffo G, Constantinou G, Dikmen Yildiz P, et al. A brief international screening tool for traumatic birth and childbirth-related PTSD: The City BiTS-Short Form. BMJ Global Health, 2025;10:e019216

For more information see the project website at www.intersectstudy.org