A global study involving more than 11,000 new mothers across 31 countries has found that around a quarter perceive childbirth as traumatic, and about 7% develop childbirth-related post-traumatic stress disorder, or CB-PTSD. The findings are published in The British Journal of Psychiatry and form part of the INTERSECT project led by experts from City, University of London.
The researchers defined a traumatic birth as one in which the person giving birth believes she or her baby faced serious injury or death during labour, delivery, or immediately afterwards. With roughly 140 million births occurring worldwide each year, the study emphasises that the immediate perinatal period can involve emergencies or mistreatment, and that distress can extend far beyond those meeting formal criteria for PTSD.
CB-PTSD emerges when a traumatic birth is accompanied by persistent symptoms such as intrusive memories, avoidance, negative mood or cognition, and hyperarousal for more than a month, according to DSM-5 criteria. The condition is linked to postpartum depression, fear of future births, breastfeeding challenges, strained relationships and potential difficulties with mother‑infant bonding.
Historically, estimates of how often CB-PTSD occurs have varied due to differing methodologies. A pair of meta-analyses from earlier years suggested notably wide ranges: a 2017 synthesis found about 4.0% in general samples and 18.5% in high-risk groups, while a 2022 review reported 4.7% meeting full criteria and 12.3% with substantial subthreshold symptoms.
Even the lower end of those estimates implies a substantial global burden, though much prior research drew from high-income Western settings. The INTERSECT study sought uniform measurement across nations by applying the City Birth Trauma Scale, a 29-question tool aligned with DSM-5 criteria, and conducting analysis with multilevel logistic regression to produce country-specific estimates.
Lead author Susan Ayers and co-author Rebecca Webb, a research fellow at City, St George’s, University of London, explained that cross-country comparisons have been hampered by inconsistent measures and contexts. Webb told PsyPost that previous work suggested 20–40% of women find birth psychologically traumatic, and about 3–4% will develop CB-PTSD, but much of that research was in higher-income countries using varied methods, making comparisons difficult. “Therefore, the INTERSECT study aimed to look at prevalence, symptoms and risk factors for birth trauma and childbirth-related PTSD across the world, using consistent measures of childbirth-PTSD.”
Between April 2021 and January 2024, the cross‑sectional survey recruited 11,302 adult women who were 6 to 12 weeks postpartum, with samples ranging from 127 participants in Chile to 1,644 in Germany. Participants were recruited via routine maternity services and, in some countries, social media or fixed clinics, and responses were collected online, on paper or by phone.
Across the 31 participating countries, the study found that traumatic birth was present in an average of 23.3% of cases (95% CI 22.4% to 24.0%), with roughly half the nations falling between 14% and 27%. Some countries reported markedly higher or lower rates, from 7% in the United Arab Emirates to 69% in Malawi, and notably high figures in Chile (49%), Nepal (41%), Saudi Arabia (40%), Spain (35%) and Turkey (35%).
CB-PTSD, the study’s primary clinical outcome, averaged 6.7% across countries (95% CI 3.7% to 9.7%), with the middle half of nations clustering between 3% and 7%. By contrast, rates of childbirth-related PTSD varied markedly: 1% in Israel and 2% in several European countries, Nigeria and the UAE, up to 36% in Malawi and 33% in Saudi Arabia, followed by Turkey (14%), Estonia (10%), Pakistan (10%) and Nepal (9%).
Beyond full PTSD, the researchers found that distress and impairment were even more common. On average, 44.5% of women reported distress and 34.1% reported impairment, though these figures ranged from 5% to 82% across different countries. The study also identified a dissociative subtype, present in about 3.8% of cases on average, and acute CB-PTSD in 1.3% of respondents, with higher levels in Nepal and Turkey.
When possible medical factors were excluded as alternate explanations, the prevalence of CB-PTSD remained largely unchanged in most countries, though some rates fell notably in Pakistan, Nepal, Saudi Arabia and Turkey. The authors suggest that the observed cross-country differences may reflect cultural and healthcare factors, as well as maternity ward restrictions during the COVID-19 pandemic and methodological differences across sites.
Framing the implications, Webb noted that many mothers experience significant distress and daily impairment even without meeting formal diagnostic thresholds. A companion analysis within the same dataset highlighted risk factors that most strongly predict CB-PTSD: a negative birth experience, ongoing maternal health complications, and major infant complications, underscoring the need for both emotional and physical support in perinatal care.
Another facet of the research examined how symptoms present across countries. Webb said that while the severity of CB-PTSD varies by nation, the pattern of symptoms is similar. “Avoidance symptoms (e.g. avoiding things that remind women of the birth) were the best at predicting whether someone had CB-PTSD or not.”
The study’s authors caution that the clinics used for recruitment and uneven response rates limit national representativeness, and wide confidence intervals reflect statistical uncertainty. Self-reported questionnaires, rather than clinical interviews, mean the figures reflect symptomatology rather than formal clinician diagnoses. Around a third of participants hailed from lower- and middle-income countries, leaving those regions underrepresented, and some measures were developed in English, potentially missing culturally specific expressions of trauma in non-Western settings.
Looking ahead, the researchers advocate national sampling frames, clinical interviews, and targeted follow-up in countries with unusually high or low trauma rates to tease apart contextual and methodological influences. They stress the need for routine perinatal mental healthcare to incorporate trauma-informed assessment and culturally tailored support for both diagnostic and subthreshold symptoms.
The INTERSECT consortium is already planning a second wave of data collection, with wave two expected to run through December 2026 and potentially include about 30 additional countries. Webb described ongoing sub-studies and groups within INTERSECT, including measures of CB-PTSD in fathers or birth partners and qualitative work, as well as ongoing PhD projects linked to the programme.
