INTERSECT conference showcases global findings on childbirth-related trauma

The recent International Survey of Childbirth‑Related Trauma (INTERSECT) Conference brought together researchers from all over the world for a full day of presentations highlighting the global prevalence, risk factors and consequences of childbirth‑related post‑traumatic stress disorder (CB‑PTSD).

Hosted virtually by City St George’s, University of London, the event marked a major milestone for the INTERSECT consortium, which has rapidly grown into one of the world’s largest collaborative studies of maternal mental health.

Investigating the prevalence, risk factors and symptom presentation of CB-PTSD

Being pregnant and having a baby is a time of huge physical, psychological and social changes for women. Although the birth of a baby is viewed positively in most cultures, research suggests that a significant proportion of women find childbirth traumatic, and birth trauma and PTSD have a substantial impact on women and their families.

The INTERSECT study aims to examine childbirth-related PTSD in an international context by collaborating with researchers across the world, with an emphasis on working with under-represented countries in South America, Asia and Africa.

As part of the consortium, there are principal investigators in over 70 countries who are conducting the INTERSECT survey with women after birth. As a result, the INTERSECT project provides cross-cultural information on the prevalence of postpartum PTSD, as well as cross-cultural variation in the causes and presentation of childbirth-related PTSD worldwide.

International papers reveal global patterns

The conference opened with a welcome from Professor Susan Ayers, Professor of Maternal and Child Health at City St George’s, followed by a series of international papers presenting headline findings from the INTERSECT dataset.

During the morning session, Professor Ayers spoke about “The prevalence of childbirth-related PTSD worldwide: the INTERSECT study” following an introduction from Dr Rebecca Webb, Research Fellow in the Centre for Maternal and Child Health Research at City St George’s, who chaired the session.

Professor Ayers proceeded to present the main results from their international dataset on childbirth-related trauma, and she spoke about how the events of pregnancy and birth can be stressful and exacerbate or trigger mental health problems. She said that it’s estimated that 20-30% of women experience birth as traumatic, and that current research has found 4% of women may develop post-traumatic stress disorder (PTSD) as a result. However, most of this research is carried out in higher income countries.

Professor Ayers also spoke about a new paper that used data collected between April 2021 and Jan 2024, including 11,302 participants from 31 countries. Participants completed the survey between 6 and 12 weeks postpartum, and the survey included measures of birth trauma, birth experience, trauma history, depression and obstetric and sociodemographic data. The average birth type was 64.3% vaginal, 6.2% instrumental vaginal birth, and 29.5% caesarean birth.

Speaking about the results, Professor Ayers said that there was a wide range of prevalence rates of traumatic birth and CB-PTSD, and many more participants reported that their symptoms caused distress and impairment than those who met diagnostic criteria. In particular, it was found that traumatic birth ranged from 7 to 69% with a mean of 23.3%, and that CB-PTSD ranged from 1 to 36% with a mean of 6.7%. Overall, the study highlights the importance of identifying and supporting women with sub-clinical symptoms.

There was also a wide range between countries which suggests that unique sociodemographic, cultural and healthcare factors in each country are having an influence on birth trauma and CB-PTSD rates, and Professor Ayers said that this highlights the need for tailored policy interventions that are relevant to each country’s context.

International themes

Following Professor Ayers’ talk, Dr Georgie Constantinou, Research Fellow in the Centre for Maternal and Child Health Research at City St George’s, then spoke about symptom presentation of childbirth-related PTSD in 31 countries.

Dr Constantinou said that the findings from INTERSECT showed that symptom severity varies worldwide, while symptom presentation is broadly consistent. The exceptions were when countries had high levels of symptoms, highlighting potential country level influences on symptom severity and expression.

It was also seen that hyperarousal is generally the most prominent symptom of CB-PTSD, and avoidance is the least common but most useful symptom for identifying CB-PTSD. As a result, the findings support international screening while recognising cultural differences.

Dr Webb then touched on the relationship between economic and gender inequalities and maternal postpartum mental health. She said that maternal health is a key indicator of health system performance and societal wellbeing, and a paper on this topic is currently being written and will likely be published by the end of the year.

Lastly, Professor Jonathan Handelzalts, Academic College of Tel Aviv, Israel, spoke about “Cross-country and between-country risk factors for childbirth-related PTSD: Findings from the INTERSECT study”. He said that negative birth experience is the strongest overall predictor of CB-PTSD, and that ongoing maternal complications, major infant complications, and perceived danger to self and infant also predicted CB-PTSD diagnoses and/or symptoms.

Sub‑group presentations highlight specific themes

After the morning talks, the conference moved on to the INTERSECT sub-group presentations, which focused on particular aspects of childbirth trauma. Presenters covered fear of childbirth (Paulina Pawlicka, University of Gdańsk, Poland), birth partners’ experiences (Lara Seefeld, Dalhousie University, Canada), maternal mistreatment (Raquel Costa, Lusofona University, Portugal), mother‑baby bonding (Gabija Jarašiūnaitė-Fedosejeva, Vytautas Magnus University, Kaunas, Lithuania), and models of maternity care (Dr Webb). Genesis Chorwe‑Sungani (Kamuzu University of Health Sciences, Malawi) also shared findings from INTERSECT Africa, and the breadth of topics underscored the consortium’s commitment to understanding trauma from multiple angles.

National prevalence and risk factors

The afternoon began with country‑specific analysis of CB‑PTSD prevalence and risk factors. Researchers from Malawi, Nigeria, Cyprus, Switzerland, and the UK presented national data, revealing both shared patterns and regional differences. One presentation examined how sexual violence, birth trauma, postnatal depression, and PTSD interact.

Social support, satisfaction, and depression

The final session featured INTERSECT consortium papers exploring social support, birth satisfaction, and postpartum depression. Croatian researchers presented work on partner support as a moderator of postpartum PTSD, as well as sociodemographic and psychosocial correlates of birth satisfaction. A Spanish team examined how income level shapes postpartum depression risk, while another Croatian researcher outlined a protocol for identifying subtypes of postpartum depression using INTERSECT data.

The conference closed with a talk from Professor Handelzalts.