Factors Associated with Obstetric Violence Implicated in the Development of Postpartum Depression and Post-Traumatic Stress Disorder: A Systematic Review

Abstract

Postpartum depression (PPD) and post-traumatic stress disorder (PTSD) continue to be prevalent, and disabling women with mental disorders and obstetric violence (OV) may be a trigger for them, particularly during maternity. We aimed to analyze the association between manifestations of OV with the development of PPD and PTSD during pregnancy, childbirth, and postpartum. This systematic review was based on the PRISMA 2020 statement and explored original articles published between 2012 and 2022. A total of 21 articles were included in the analysis, and bias was assessed by the Effective Public Health Practice Project's Quality Assessment Tool. The highest rate of PPD symptoms appeared in women under 20 years old, multiparous, and with low education levels. The higher PTSD ratio was present in women under 35 years, primiparous, and with secondary studies. The mode of labor (instrumental or C-section) was identified as a major risk factor of PPD, being mediator variables of the informal coercion of health professionals and dissatisfaction with newborn healthcare. Instead, partner support during labor and high satisfaction with healthcare during birth were protective factors. Regarding PTSD, the mode of labor, several perineal tears, and the Kristeller technique were risk factors, and loss of autonomy and coercion modulated PTSD symptomatology. The protective factors for PTSD were respect for the labor plan, adequate communication with health professionals, social support during labor, and the skin-to-skin procedure. This systematic review provides evidence that OV contributes to PPD and PTSD, being important in developing standardized tools to prevent it. This study recommends changes in maternal healthcare policies, such as individualized healthcare assistance, humanized pregnancy protocols, and women's mental health follow-up, and improvements in the methodological quality of future research.

Keywords: maternal mental health; obstetric violence; obstetric vulnerability; post-traumatic stress disorder; postpartum depression; women’s health.

Figure 1

Flow chart of the selection process of the analysis units according to the PRISMA guidelines 2020; MeSH, medical subject headings; n, number of analysis.

Figure 2

Screening of the articles regarding (A) the year of the publication, (B) expertise of knowledge, and (C) worldwide allocation.

Figure 3

Risk-of-bias assessment by the Qualitative Assessment Tool for Quantitative Studies. (A) Weighted bar plot shows the proportion of biased judgment separately for each domain in the assessment tool. (B) The traffic light plot with every judgment in a matrix, with the domain of the tool (D1–6) and each study down the vertical [33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53].