Predictors of Postpartum Post-Traumatic Stress Disorder Following Traumatic Birth: The Influence of Lifetime Trauma, Violence, and Coping Strategies—A Prospective Study

Background/Objectives: Childbirth, although generally a positive life event, can sometimes be experienced as traumatic, leading to postpartum post-traumatic stress disorder. Emergency caesarean section and operative vaginal delivery are associated with elevated psychological distress, while factors such as lifetime trauma, domestic violence, anxiety, and coping strategies may further increase vulnerability. Methods: This prospective cohort study included 113 postpartum women who delivered via emergency caesarean section (73.5%) or operative vaginal delivery (26.5%) in two tertiary hospitals in Athens, Greece (March–July 2023). Data were collected at three time points: the second postpartum day, six weeks postpartum, and three months postpartum. Descriptive statistics were used to summarize sample characteristics. Chi-square tests were performed for categorical variables and independent sample t-tests for continuous variables. Multivariate logistic regression analyses were conducted to identify predictors of postpartum post-traumatic stress disorder, with results expressed as odds ratios (OR) and 95% confidence intervals (CI). Results: At six weeks postpartum, 14.2% of participants met full diagnostic criteria for P-PTSD. Postpartum post-traumatic stress was strongly associated with higher state and trait anxiety, fewer positive coping strategies, and exposure to domestic violence (lifetime, during pregnancy, and in the past year). Women with traumatic childbirth experiences had a 14.7-fold higher risk of developing P-PTSD. Lifetime trauma, particularly physical or sexual abuse and exposure to disasters, further increased vulnerability. Over the last three months, 50% of those initially diagnosed continued to meet the diagnostic criteria. Multivariate analysis identified traumatic childbirth, state anxiety, and domestic violence during pregnancy as significant predictors of postpartum post-traumatic stress. Conclusions: Postpartum post-traumatic stress is a significant and underestimated consequence of high-risk deliveries. Screening for domestic violence and trauma history during pregnancy, assessing perinatal anxiety, and providing trauma-informed psychological support are critical to reducing maternal psychiatric morbidity and promoting maternal-infant well-being.