Childbirth, trauma and the family: Traumatic childbirth and the quality of mother-baby bond and marital relationship

Introduction: Childbirth is a major life event which is associated with increased vulnerability to maternal mental illness, such as postnatal depression. In the past two decades research has also found evidence of PTSD following childbirth. The subjective experience of childbirth has been highlighted as crucial in determining maternal postnatal mental health. Postnatal psychopathological symptoms may adversely effect women’s interpersonal relationships. Attachment theory is used as the theoretical model in this study, since attachment is linked to the subjective appraisal of stress, coping with trauma, and utilization of support. Also, styles of attachment are fundamental to the formation of interpersonal relationships and have proven detrimental to the mother-baby bond process and couple relationship quality.

The present study examined how the subjective experience of childbirth, posttraumatic symptoms, attachment style, and postnatal depression relate to the quality of relationships within the family, focusing on the mother-baby bond and the couple’s relationship in light of attachment theory.  

Method: This cross-sectional study sampled 228 women with a partner who had given birth up to a year before the study. A convenience sample was used combined with purposive and snowball sampling.  Delivery experience, PTSD symptoms, depression, attachment style, quality of the couple’s relationship and mother-baby bond disorders were measured using a self-report on-line questionnaire. 

Research hypotheses: The main research hypotheses were: that higher levels of PTSD and depression will be associated with mother-baby bond disorders; PTSD will be associated with lower quality of couple relationship and have a mediating effect of depression; attachment style will be associated with the woman’s perception of the birth and women with an insecure attachment style would be more likely to perceive the birth as frightening and anxiety provoking; negative birth perception will be associated with PTSD and depression symptoms. Finally, we hypothesized that negative birth perception will be associated with bonding disorders and reduced couple relationship quality, with a mediating role for PTSD symptoms. 

Results: The study showed that women with higher PTSD and postnatal depression reported more bond disorders with their baby. However, symptoms of postnatal depression fully mediated the association between PTSD and quality of couple relationship as hypothesized. Women who perceived the birth as fearful or anxiety provoking had higher chances of developing symptoms of PTSD and postnatal depression. Fearful and anxious birth perception was positively associated with mother-baby bond disorders; this association was partly mediated by PTSD symptoms. This was not confirmed in the case of couple relationship quality. Also, contrary to the hypothesis, insecure attachment style was not found significantly associated with fearful or anxious childbirth perceptions.

Discussion  and Conclusions: The study has important implications. Subjective childbirth experiences clearly play a key role in women’s overall birth perceptions, their mental health and welfare following birth, and their bonding process with their baby. This is a valuable insight for practitioners who work with women during childbirth. Adjusting medical policies and educating practitioners could promote more positive birth experiences and improve the welfare of women and their families. Also, women who seem to have objective or subjective negative or traumatic birth experiences should be targeted and closely observed for psychopathologies and offered treatment. Finally, our findings note that both PTSD and postnatal depression affect women’s mental health and baby bond, suggesting that PTSD should be routinely screened for, alongside depression.