Garthus-Niegel Susan, Knoph Cecilie, von Soest Tilmann, Nielsen Christopher S, Eberhard-Gran Malin
TU Dresden and at the Department of Psychosomatics and Health Behavior, Institute and Outpatient Clinics of Occupational and Social Medicine, Norwegian Institute of Public Health, Oslo, Norway.
Birth. 2014 Mar;41(1):108-15. doi: 10.1111/birt.12093.
The aim of this prospective study was to investigate the role of labor pain and overall birth experience in the development of posttraumatic stress symptoms in a comprehensive framework.
The study sample (N = 1893) comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort, which targeted all women scheduled to give birth at Akershus University Hospital in Norway. Questionnaires were given at three different stages: from pregnancy weeks 17 to 32, from the maternity ward, and from 8 weeks postpartum. Data were also obtained from the hospital's birth record. Using structural equation modeling, a prospective mediation model was tested.
Posttraumatic stress symptoms were significantly related to both labor pain (r = 0.23) and overall birth experience (r = 0.39). A substantial portion (33%) of the effect of labor pain on posttraumatic stress symptoms was mediated by the overall birth experience.
Although the results of this study showed that both labor pain and overall birth experience played a role in the development of posttraumatic stress symptoms after childbirth, overall birth experience appeared to be the central factor. The women's birth experience was not only related to posttraumatic stress symptoms directly but also mediated a substantial portion of the effect of labor pain on posttraumatic stress symptoms. Future work should address which areas of birth experience confer protective effects on women to improve clinical care.
这项前瞻性研究的目的是在一个综合框架内调查分娩疼痛和总体分娩经历在创伤后应激症状发展中的作用。
研究样本（N = 1893）包括经阴道分娩的女性，取自阿克什胡斯出生队列，该队列针对所有计划在挪威阿克什胡斯大学医院分娩的女性。在三个不同阶段发放问卷：妊娠第17至32周、在产科病房时、产后8周。数据还从医院的出生记录中获取。使用结构方程模型对一个前瞻性中介模型进行了检验。
创伤后应激症状与分娩疼痛（r = 0.23）和总体分娩经历（r = 0.39）均显著相关。分娩疼痛对创伤后应激症状的影响中有很大一部分（33%）是由总体分娩经历介导的。
尽管本研究结果表明分娩疼痛和总体分娩经历在产后创伤后应激症状的发展中都起作用，但总体分娩经历似乎是核心因素。女性的分娩经历不仅与创伤后应激症状直接相关，还介导了分娩疼痛对创伤后应激症状影响的很大一部分。未来的工作应关注分娩经历的哪些方面对女性具有保护作用，以改善临床护理。
