Procedure and participants
This is a secondary analysis of a project on childbirth-related psychological outcomes(Dekel et al. 2019). Women who gave birth in the past 6 months to a live baby and were at least 18 years old were recruited via postpartum websites (e.g., Postpartum Progress) between November 2016 and April 2017. Consent was implied by completing the anonymous online survey. Partners (Mass Genral Brigham) Healthcare Human Research Committee’s granted the study exemption.
Sexual assault history was assessed using the Life Events Checklist for DSM-5 (LEC-5) pertaining to items of SA and determined based on reporting that the experience directly “happened to me.”
Childbirth-related acute distress during/immediately after childbirth was assessed using the well-validated Peritraumatic Distress Inventory (PDI) and Peritraumatic Dissociative Experiences Questionnaire (PDEQ). The PDI measures acute stress reactions to a specific trauma (here, recent childbirth) using 13 items (e.g., “feeling helpless”) (α = 0.89). The cutoff of ≥ 23 indicates clinically significant stress. The PDEQ assesses dissociative responses (here, to childbirth) with 10 items (e.g., event “seemed unreal to me”) (α = 0.91).
Childbirth-related PTSD was assessed with the PTSD Checklist for DSM-5 (PCL-5), which is the most commonly used self-report to measure 20 PTSD symptoms in regard to a specific event (“recent childbirth”) (α = 0.95). To conform with DSM-5 PTSD criteria, we classified individuals as endorsing probable CB-PTSD by having at least 1 intrusion, 1 avoidance, 2 alterations in cognitions and mood, and 2 reactivity and hyperarousal, with at least moderate severity.
Background information collected via single items included demographics (maternal age, primiparity, education, income, marital status, ethnicity), prior PTSD (report of PTSD before childbirth), and pregnancy history (i.e., miscarriages/premature deliveries/ stillbirths).
Information concerning recent childbirth was collected by self-report and pertained to labor and delivery pain, medication for pain and labor induction, duration of labor (i.e., time between contractions and birth), obstetric complications in labor/delivery (single item, yes vs no), prematurity (< 37 gestational week), and delivery mode.
Missing data was estimated using Little’s Missing Completely At Random (MCAR) test and handled using Multiple Imputation. Independent t-tests for continuous variables and chi-square, Fisher’s exact tests, and odds ratio (for effect sizes) for categorical variables were used to examine differences between women with and without SA history on main measures. One-tailed tests accorded with previous literature suggests of directional hypotheses (distress/dissociation, labor duration, labor/delivery pain, unscheduled cesarean, obstetrical complications, prematurity). Analyses of covariance (ANCOVA) were employed to examine group differences in traumatic stress controlling for background factors that differed between study groups and contribute to PTSD (i.e., age, income, education, prior PTSD)(Chan et al. 2020).