Nearly one in four new mothers described childbirth as traumatic in 31-country survey

A survey of 11,302 new mothers across 31 countries found that nearly one in four perceived their childbirth as traumatic. The study, published in The British Journal of Psychiatry, estimated that 23.3% experienced a traumatic birth on average, while 6.7% met the study’s criteria for childbirth-related post-traumatic stress disorder (CB-PTSD).

The results also showed that trauma-related difficulties extend beyond formal diagnoses. Across the participating countries, an average of 44.5% of women reported emotional distress and 34.1% said symptoms interfered with daily life, even when they did not meet the criteria for CB-PTSD.

For the study, childbirth was considered traumatic when a mother believed that she or her baby faced serious injury or death during labor, delivery, or the immediate postpartum period. The researchers assessed symptoms using the 29-question City Birth Trauma Scale, based on the criteria for PTSD in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

CB-PTSD required a traumatic birth alongside symptoms involving re-experiencing, avoidance, negative changes in mood or thinking, and hyperarousal. Symptoms also had to last at least one month and cause distress or impairment.

The survey was conducted between April 2021 and January 2024 in Australia, Brazil, Chile, Croatia, Cyprus, Czechia, Estonia, Germany, Iceland, Ireland, Israel, Italy, Lithuania, Malawi, Nepal, Nigeria, Norway, Pakistan, Poland, Portugal, Romania, Saudi Arabia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, the United Arab Emirates, and the United Kingdom. Participants were adults between six and 12 weeks postpartum.

Estimated rates of traumatic birth varied considerably. They ranged from 7% in the United Arab Emirates to 69% in Malawi. High rates were also reported in Chile, at 49%, Nepal at 41%, Saudi Arabia at 40%, and Spain and Turkey at 35% each.

The estimated prevalence of CB-PTSD ranged from 1% in Israel and 2% in several European countries, Nigeria, and the United Arab Emirates to 36% in Malawi and 33% in Saudi Arabia. Other relatively high estimates were recorded in Turkey, Estonia, Pakistan, and Nepal.

A traumatic birth did not lead to a formal PTSD-level response at the same rate in every country. In Saudi Arabia, 86% of the 97 respondents who described their birth as traumatic met the study’s criteria for CB-PTSD. The corresponding figures were 53% in Malawi, 22% in Nepal, and 17% in Chile.

The researchers also assessed dissociative symptoms, such as feeling detached or as if the surroundings were unreal. The dissociative subtype averaged 3.8% across countries. Acute CB-PTSD, in which symptoms met the criteria except for the required one-month duration, averaged 1.3%.

The study builds on earlier research that used different methods and often focused on high-income Western countries. The authors said that inconsistent measurement tools had made it difficult to compare birth trauma and CB-PTSD rates across nations. The International Survey of Childbirth-Related Trauma, known as INTERSECT, was designed to provide a more uniform assessment.

The findings suggest that cultural, socioeconomic, healthcare, and pandemic-related factors may contribute to differences between countries. However, the researchers also cautioned that recruitment methods, survey formats, and other methodological differences may have affected the results.

The study’s authors emphasized that many women experience meaningful symptoms without meeting the threshold for a diagnosis. Rebecca Webb, a co-author and research fellow at the Centre for Maternal and Child Health Research at City St George’s, University of London, said that “many women experienced significant distress and impairment even when they did not qualify for a formal CB-PTSD diagnosis.”

The researchers identified several limitations. Participants were recruited through selected maternity services, with social media also used in Norway and Slovenia, so the country samples were not necessarily nationally representative. The study relied on self-reported questionnaires rather than clinical interviews, and women from low- and middle-income countries represented just under one-third of the sample.

The authors said the findings support routine, trauma-informed assessment in perinatal mental healthcare, including support for women with substantial symptoms that fall below the diagnostic threshold. They also called for culturally tailored care and further research using national samples and clinical interviews.

A second wave of INTERSECT data collection is underway and is expected to run through December 2026. According to Webb, it is likely to include information from 30 additional countries, along with related research on birth partners, maternal mistreatment, and other aspects of childbirth-related trauma.

Sources: PsyPost.