Perceived control and support during childbirth and their association with postpartum mental health outcomes: a cross-sectional study

Background: The perinatal period is a highly vulnerable stage for maternal mental health, during which anxiety, postpartum depression (PPD), postpartum post-traumatic stress disorder (PTSD) and suicide risk may arise. Perceived maternal control and support during childbirth are important dimensions of the childbirth experience and may be associated with postpartum mental health outcomes. Objective: To analyze the association between perceived control and support during childbirth and the suicide risk, PPD, anxiety, and PTSD in Spanish women in the postpartum period. Method: A cross-sectional study was conducted with 302 women who had given birth in the last 6 months. Validated instruments were used: The Support and Control in Birth (SCIB) scale to assess the degree of support and control; the Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) to measure PTSD; the Edinburgh Postnatal Depression Scale (EPDS) to identify PPD; the Generalized Anxiety Disorder Scale (GAD-7) to assess anxiety; and the Paykel Scale to estimate suicide risk. Bivariate and multivariate analyses were performed using logistic regression, estimating odds ratios (OR) and adjusted odds ratios (aOR) and 95% confidence intervals. Results: Higher SCIB scores were associated with lower odds of PTSD (aOR = 0.97; 95% CI: 0.96-0.99). Failure to respect the birth plan was associated with higher odds of PTSD (aOR = 3.11; 95% CI: 1.23-7.89). Multiparity was associated with lower odds of postpartum PTSD symptoms (aOR = 0.32; 95% CI: 0.13-0.80), while early initiation of breastfeeding was associated with lower odds of postpartum PTSD symptoms (aOR = 0.37; 95% CI: 0.18-0.78). Conversely, health problems during pregnancy were associated with higher odds of PPD symptoms (aOR = 2.03; 95% CI: 1.00-4.12). No significant associations were found between SCIB and risk of suicide, PPD, or anxiety. Suicide risk was linked to a history of abortion and neonatal ICU admission, PPD to recent stressful events, and anxiety to gestational problems and a history of mental health treatment. Conclusion: Higher perceived control and support during childbirth were independently associated with lower odds of postpartum post-traumatic stress disorder symptoms. No independent associations were observed between SCIB scores and suicide risk, postpartum depression or anxiety. These findings suggest that perceived support and control during childbirth may be relevant dimensions of the postpartum psychological experience, particularly in relation to postpartum post-traumatic stress symptoms.