Does attachment style shape trauma symptoms after childbirth?
How a mother's attachment style related to post-traumatic stress after childbirth depended on whether she had a history of interpersonal trauma.
Source
Maternal Attachment Style, Interpersonal Trauma History, and Childbirth-Related Post-traumatic Stress
Study at a glance
- Design
- Cohort — Prospective postpartum cohort (secondary analysis) with PTSD symptoms measured at 5 weeks, 2 months and 6 months; latent growth curve models with multi-group comparison of women with vs without interpersonal trauma history.
- N
- N=251 · 298 women recruited; 251 with complete data entered the growth models (40 with and 211 without a history of interpersonal trauma).
- Population
- Women who had just given birth at hospitals in Montreal, Canada, across four birth groups (vaginal, vaginal with NICU admission, planned caesarean, emergency caesarean).
- Outcome
- Childbirth-related post-traumatic stress symptoms (Perinatal PTSD Questionnaire): initial level at 5 weeks and rate of change to 6 months, predicted by attachment ratings and trauma history.
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
298 women were recruited shortly after giving birth in Montreal and followed to 6 months postpartum. Childbirth-related PTSD symptoms were measured at 5 weeks, 2 months and 6 months; interpersonal trauma history (childhood emotional abuse, unsupportive mother, or lifetime physical or sexual abuse) and psychosocial risk were measured at 2 months, and attachment style ratings (secure, fearful, preoccupied, dismissing) at 6 months. Latent growth curve models estimated each woman's starting symptom level and rate of decline, controlling for labour pain, birth experience and other risk factors, and compared women with and without trauma history.
What they found
Symptoms declined on average over time, and those above the clinical cut-off fell from 11.1% at 5 weeks to 6.2% at 6 months. Across the sample, psychosocial risk, more labour pain, a negative birth experience, lower secure attachment and trauma history predicted higher symptoms at 5 weeks, while mode of delivery did not. Among women without trauma history, higher secure attachment predicted fewer initial symptoms and faster decline, and fearful attachment predicted more initial symptoms. Among women with trauma history, secure attachment was not protective; instead preoccupied and dismissing attachment were linked to lower or faster-declining symptoms, contrary to the authors' predictions.
The limits
What it doesn't show
Attachment was measured at 6 months, after the symptoms it was used to predict, so the direction of influence cannot be established even though the authors cite evidence that attachment is fairly stable. The trauma-history group was small (40 women) and trauma was defined from a few questionnaire items, and all measures were self-report with only modest reliability for the attachment ratings (alpha = 0.60). Psychosocial risk was assessed only once, so later stressors were not controlled, and no prenatal measures were taken to separate pre-existing symptoms from childbirth-related ones. Some findings (e.g. dismissing attachment being protective) were unexpected and need replication.
Key terms
- Childbirth-related PTSD
- Post-traumatic stress symptoms such as intrusive memories, avoidance and hyperarousal that follow a birth experienced as traumatic.
- Attachment style
- A person's typical pattern of thinking, feeling and behaving in close relationships; here rated as secure, fearful, preoccupied or dismissing.
- Moderation
- When the strength or direction of a relationship between two variables depends on a third variable, here trauma history.
- Latent growth curve model
- A statistical model that estimates each person's starting level (intercept) and rate of change (slope) on a repeated measure and what predicts them.
- Interpersonal trauma
- Trauma inflicted by other people, such as childhood emotional abuse or physical or sexual abuse.
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Quiz yourself
Among women without a trauma history, which attachment rating predicted a faster decline in PTSD symptoms?
Common questions
Is secure attachment always protective?
In this study it was protective only for women without a history of interpersonal trauma; among women with trauma history it did not predict symptoms.
Did caesarean births cause more trauma symptoms?
No. Once pain, birth experience and psychosocial risk were controlled, mode of delivery did not predict initial symptom level or change.
Why might dismissing attachment help women with a trauma history?
The authors speculate that a self-reliant view of oneself and a tendency to suppress negative emotions may buffer distress, but this was not tested and contradicts some earlier work.
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