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Factors Associated with Posttraumatic Stress and Quality of Life in Puerperium

This cross-sectional study of 360 Turkish women found that while posttraumatic stress symptoms, particularly hyperarousal and numbing, negatively predict quality of life during the puerperium, planned pregnancy and immediate skin-to-skin contact serve as significant protective factors.

Original authors: Hilal Dalgıç, Sema Dereli Yılmaz, Yasemin Erkal Aksoy

Published 2026-07-02

📖 4 min read☕ Coffee break read

CC BY 4.0

Original authors: Hilal Dalgıç, Sema Dereli Yılmaz, Yasemin Erkal Aksoy

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the first six weeks after having a baby as a major life renovation project. The house (the mother's body and mind) has just undergone a massive construction event (childbirth). There's dust everywhere, the furniture is rearranged, and the residents are exhausted. This is the "puerperium."

This study, conducted by researchers in Turkey, went into 360 of these "houses" about a month after the renovation to check on two things:

The "Trauma Alarm": How many women were still hearing phantom noises or feeling like the construction site was about to collapse again? (This is Post-Traumatic Stress, or PTSD).
The "Happiness Meter": How satisfied were the residents with their new life, their health, and their relationships? (This is Quality of Life, or QoL).

Here is what they found, translated into everyday terms:

The Big Connection: The Alarm vs. The Meter

The researchers discovered a clear, inverse relationship between the two. Think of the Trauma Alarm and the Happiness Meter as being on opposite ends of a seesaw.

When the Trauma Alarm was ringing loudly (high PTSD symptoms), the Happiness Meter dropped significantly.
The study found that women who felt more stressed or traumatized by their birth experience felt their overall quality of life was much lower. They struggled more with daily tasks and felt less comfortable in their own skin.

The "Hyperarousal" Factor

The study broke PTSD down into two main types of symptoms. One was "intrusive thoughts" (unwanted memories popping up), and the other was "Hyperarousal and Numbing" (HNR).

HNR is like a car with a stuck gas pedal and a frozen steering wheel. The driver is jumpy, scared, and constantly on edge (hyperarousal), but at the same time, they feel emotionally numb or disconnected from the world (numbing).
The researchers found that this specific "stuck pedal/frozen wheel" feeling was the strongest predictor of a low Happiness Meter. If a woman felt this way, her quality of life suffered the most.

What Helped Raise the Happiness Meter?

The study looked at many factors to see what acted like "sunshine" for the new mothers. Three things stood out as having a positive impact:

Planned Pregnancy: When the arrival of the baby was expected and prepared for (like having a blueprint for the renovation), the mothers reported higher satisfaction. It seems being mentally ready helps you adapt faster.
Skin-to-Skin Contact: This is the practice of placing the naked baby on the mother's bare chest immediately after birth. The study found this was a powerful "comfort blanket." It was linked to higher quality of life, likely because it helped the mother feel connected and distracted her from any pain or stress from the delivery.
Spousal Support & Information: Having a partner who was there to help, and having a doctor who explained what to expect next, acted like a reliable guidebook. When women felt supported and informed, their happiness scores went up.

The Surprising Twist: The Birth Companion

Usually, we think having a friend or partner with you during labor is a good thing. However, this study found a strange result: women who had a companion during birth actually had higher trauma scores than those who didn't.

The Analogy: Imagine a friend standing next to you during a scary rollercoaster ride. If that friend is screaming in terror, their fear might actually make your fear worse.
The researchers suggest that perhaps in difficult or scary births, the companion was present because things were going wrong, or perhaps the companion's own panic transferred to the mother, making the experience feel more traumatic.

What Didn't Matter Much?

Interestingly, the study found that the method of delivery (whether it was vaginal, a C-section, or assisted) didn't significantly change the trauma or happiness scores on its own. It wasn't the type of birth that mattered most, but rather how the woman felt about it and how she was supported afterward.

The Bottom Line

The study concludes that for a new mother's "renovation project" to be successful, she needs to feel safe and connected.

If the Trauma Alarm (specifically the feeling of being jumpy and numb) is ringing, her Happiness Meter will be low.
To turn the meter up, the study suggests focusing on immediate skin-to-skin contact, ensuring the pregnancy was planned (or helping the mother feel prepared), and making sure she has supportive partners and clear information from doctors.

The researchers emphasize that if a mother's "Trauma Alarm" is ringing too loudly, she needs to be identified and helped, because a ringing alarm makes it very hard to enjoy the new life she has built.

Technical Summary: Factors Associated with Posttraumatic Stress and Quality of Life in Puerperium

Problem Statement
The puerperium (the first six weeks postpartum) is a critical period of physical and psychological adaptation. While becoming a mother is a significant life event, it carries risks for mental health disorders, particularly Posttraumatic Stress Disorder (PTSD) resulting from traumatic birth experiences. PTSD in this context is characterized by intrusive re-experiencing, avoidance, negative cognitive/mood alterations, and hyperarousal. Existing literature indicates that approximately one in ten women experience PTSD within four to six weeks postpartum. This condition is known to adversely affect a woman's ability to care for herself and her newborn, leading to significant reductions in Quality of Life (QoL). Despite the known prevalence of PTSD and its impact, there is a need to further investigate the specific relationship between PTSD symptom dimensions and QoL, as well as the sociodemographic and obstetric factors that influence these outcomes in the Turkish context.

Methodology
This study employed a cross-sectional, correlational design to investigate 360 women in the puerperium (4–6 weeks postpartum) residing in a central province of Türkiye. Participants were recruited from the neonatal outpatient clinic of a tertiary care teaching hospital between February 2025 and February 2026. Inclusion criteria required literacy, Turkish language proficiency, healthy singleton infants, and voluntary participation; women with psychiatric histories or those requiring intensive care for themselves or their infants were excluded.

Data collection utilized three instruments:

Personal Information Form: A 24-item researcher-developed questionnaire covering sociodemographic and obstetric variables (e.g., education, income, mode of delivery, planned pregnancy, skin-to-skin contact).
Perinatal Posttraumatic Stress Disorder Questionnaire-II (PPQ-II): A 13-item scale with two subscales: "Intrusive Thoughts and Avoidance" (ITA) and "Hyperarousal and Numbing of Responsiveness" (HNR). Scores range from 0 to 56, with a cutoff of >19 indicating a need for psychotherapeutic intervention.
Maternal Postpartum Quality of Life Questionnaire (MAPP-QOL): A 40-item scale assessing satisfaction and significance across five domains: relational-family-friends, socioeconomic, spouse, health, and psychological. Scores range from 0 to 30.

Statistical analysis was performed using IBM SPSS Statistics 27.0. Descriptive statistics, Student's t-tests, one-way ANOVA, correlation analysis, and multiple linear regression (using the ENTER method) were applied to examine relationships and identify predictors of QoL. Ethical approval was obtained, and participants scoring above the PPQ-II cutoff were referred to mental health services.

Key Results

PTSD and QoL Correlation: A weak but statistically significant negative correlation was found between total PTSD symptoms and QoL ( $r = -0.215, p < 0.001$ ). The HNR subscale of the PPQ-II demonstrated the strongest negative correlations with the health ( $r = -0.360$ ) and psychological ( $r = -0.302$ ) dimensions of QoL.
Sociodemographic and Obstetric Factors:
- PTSD Scores: Women who had a companion during labor had significantly higher PPQ-II scores ( $p=0.04$ ) compared to those without, a finding the authors discuss as potentially linked to high-risk deliveries or companion anxiety. No other sociodemographic variables significantly predicted PTSD scores.
- QoL Scores: Significant differences in QoL were observed based on educational level, income status, number of pregnancies, pregnancy planning, skin-to-skin contact, receipt of postpartum information from a physician, and spousal support ( $p < 0.05$ ). Specifically, planned pregnancies, skin-to-skin contact, and physician-provided information were associated with higher QoL.
Regression Analysis: The regression model explained 13.7% of the variance in total MAPP-QOL scores. Three variables emerged as significant predictors:
1. HNR Symptoms: The strongest predictor ( $\beta = -0.310, p < 0.001$ ), indicating that higher hyperarousal and numbing symptoms significantly reduce QoL.
2. Skin-to-Skin Contact: A significant positive predictor ( $\beta = 0.154, p = 0.006$ ).
3. Planned Pregnancy: A significant positive predictor ( $\beta = 0.116, p = 0.039$ ).
  Notably, while spousal support and physician information showed significance in bivariate analyses, they did not remain significant predictors in the multivariate regression model.

Key Contributions
The study provides empirical evidence quantifying the negative impact of PTSD symptoms, specifically the HNR dimension, on the quality of life of women in the puerperium. It identifies skin-to-skin contact and planned pregnancy as protective factors associated with better QoL. Furthermore, the research highlights a complex finding regarding birth companions: contrary to the general assumption that companionship is purely protective, the presence of a companion was associated with higher PTSD scores in this specific cohort, prompting a discussion on the quality of support and the context of high-risk deliveries.

Significance and Claims
The authors claim that their findings underscore the necessity of addressing PTSD and QoL simultaneously during postpartum care. The identification of HNR symptoms as the strongest predictor of reduced QoL suggests that clinical assessments should specifically target hyperarousal and emotional numbing. The study advocates for the integration of routine PTSD screening into postpartum follow-up care to facilitate early identification and referral to mental health services. Additionally, the results support the implementation of mother-infant-centered care practices, such as immediate skin-to-skin contact, and the provision of accurate postpartum information by healthcare professionals to enhance maternal well-being. The authors conclude that while their cross-sectional design limits causal inference, the data supports the need for holistic care approaches that include psychological assessment alongside physical care.