Publication related to RSI or an RSI staff member

The Association Between Doula Care and Childbirth-Related Post-Traumatic Stress Disorder Symptoms: The Mediating Role of Childbirth Experience.

INTRODUCTION: Although the benefits of doula care during childbirth are well-known, its impact on childbirth-related post-traumatic stress disorder (CB-PTSD) symptoms are less thoroughly characterized. This study aimed to explore the association between doula care and CB-PTSD symptoms and the potential mediating role of childbirth experience on this association. METHODS: A prospective cohort study was conducted in a hospital in China, enrolling women with singleton live vaginal births. The exposure and primary outcome factors of interest were doula care and CB-PTSD symptoms, with childbirth experience as a mediating factor. Questionnaires were administered to collect baseline data and childbirth experience at 3 days postpartum, and CB-PTSD symptoms from participants at 42 days postpartum. Linear regression analysis was used to analyze the relationship between doula care, childbirth experience, and CB-PTSD symptoms, while the mediating role of childbirth experience was analyzed using the SPSS (PROCESS) modeling tool. RESULTS: A total of 445 eligible women were included in the final analysis, including 120 who received doula care and 325 who did not. Linear regression analyses found that doula care was independently associated with CB-PTSD symptoms (beta = -0.11, p < 0.05) and childbirth experience (beta = 0.50, p < 0.001). Childbirth experience was significantly associated with CB-PTSD symptoms (beta = -0.17, p < 0.001). Childbirth experience mediated the association between doula care and CB-PTSD symptoms (indirect effect = -1.08, 95% CI -1.91 to -0.10), even after adjusting for potential confounders. CONCLUSIONS: Childbirth experience serves as a mediator of the association between doula care and CB-PTSD symptoms. By providing supportive care for women during childbirth, their childbirth experience could be improved, thereby reducing the risk of CB-PTSD symptoms.

Authors

  • Lai, Xiaolu, Lai X, School of Nursing, Southern Medical University, Guangzhou, China.

  • Chen, Jingfen, Chen J, School of Nursing, Southern Medical University, Guangzhou, China.

  • Lu, Demei, Lu D, Department of Obstetrics, Foshan Women and Children Hospital, Foshan, Guangdong, China.

  • Wang, Lu, Wang L, Department of Obstetrics, Foshan Women and Children Hospital, Foshan, Guangdong, China.

  • Lu, Xiafen, Lu X, Department of Obstetrics, Foshan Women and Children Hospital, Foshan, Guangdong, China.

  • Chen, Innie, Chen I, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; Department of Obstetrics & Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

  • Krewski, Daniel, Krewski D, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.; McLaughlin Centre for Population Health Risk Assessment, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.; Risk Science International, Ottawa, Ontario, Canada.

  • Wen, Shi Wu, Wen SW, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; Department of Obstetrics & Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

  • Xie, Ri-Hua, Xie RH, School of Nursing, Southern Medical University, Guangzhou, China.; Women and Children Medical Research Center, Department of Nursing, Foshan Women and Children Hospital, Foshan, Guangdong, China.

YEAR OF PUBLICATION: 2025
SOURCE: Birth. 2025 Jun;52(2):243-251. doi: 10.1111/birt.12874. Epub 2024 Sep 19.
JOURNAL TITLE ABBREVIATION: Birth
JOURNAL TITLE: Birth (Berkeley, Calif.)
ISSN: 1523-536X (Electronic) 0730-7659 (Linking)
VOLUME: 52
ISSUE: 2
PAGES: 243-251
PLACE OF PUBLICATION: United States
ABSTRACT:
INTRODUCTION: Although the benefits of doula care during childbirth are well-known, its impact on childbirth-related post-traumatic stress disorder (CB-PTSD) symptoms are less thoroughly characterized. This study aimed to explore the association between doula care and CB-PTSD symptoms and the potential mediating role of childbirth experience on this association. METHODS: A prospective cohort study was conducted in a hospital in China, enrolling women with singleton live vaginal births. The exposure and primary outcome factors of interest were doula care and CB-PTSD symptoms, with childbirth experience as a mediating factor. Questionnaires were administered to collect baseline data and childbirth experience at 3 days postpartum, and CB-PTSD symptoms from participants at 42 days postpartum. Linear regression analysis was used to analyze the relationship between doula care, childbirth experience, and CB-PTSD symptoms, while the mediating role of childbirth experience was analyzed using the SPSS (PROCESS) modeling tool. RESULTS: A total of 445 eligible women were included in the final analysis, including 120 who received doula care and 325 who did not. Linear regression analyses found that doula care was independently associated with CB-PTSD symptoms (beta = -0.11, p < 0.05) and childbirth experience (beta = 0.50, p < 0.001). Childbirth experience was significantly associated with CB-PTSD symptoms (beta = -0.17, p < 0.001). Childbirth experience mediated the association between doula care and CB-PTSD symptoms (indirect effect = -1.08, 95% CI -1.91 to -0.10), even after adjusting for potential confounders. CONCLUSIONS: Childbirth experience serves as a mediator of the association between doula care and CB-PTSD symptoms. By providing supportive care for women during childbirth, their childbirth experience could be improved, thereby reducing the risk of CB-PTSD symptoms.
COPYRIGHT INFORMATION: (c) 2024 Wiley Periodicals LLC.
LANGUAGE: eng
DATE OF PUBLICATION: 2025 Jun
DATE OF ELECTRONIC PUBLICATION: 20240919
DATE COMPLETED: 20250509
DATE REVISED: 20250509
MESH DATE: 2025/05/09 18:31
EDAT: 2024/09/22 20:51
STATUS: MEDLINE
PUBLICATION STATUS: ppublish
LOCATION IDENTIFIER: 10.1111/birt.12874 [doi]
OWNER: NLM

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Daniel Krewski

Chief Risk Scientist

Dr. Daniel Krewski is Chief Risk Scientist and co-founder of Risk Sciences International (RSI), a firm established in 2006 to bring evidence-based, multidisciplinary expertise to the challenge of understanding, managing, and communicating risk. As RSI’s inaugural CEO and long-time scientific...
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