Childbirth experience and its relationship with postpartum depression and anxiety: a cross-sectional study from Gaza
File(s)
Published version
Author(s)
Ismail, Alaa M
Afifi, Tayseer
Elejla, Sewar A
Samaan, Mosab
Hirst, Jane
Type
Journal Article
Abstract
Background
The quality of childbirth experience has a profound effect on maternal mental health. Negative experiences during labour, including poor communication, lack of informed consent, and obstetric maltreatment, can increase the risk of postpartum depression (PPD) and postpartum anxiety (PPA). This study explores women’s perspectives on the childbirth experience in Gaza and its associations with PPD and PPA.
Aims
To explore women’s perspectives on the childbirth experience and its relationship with the development of postpartum depression and anxiety. The study included women who gave birth at Gaza hospitals between 2017 and 2021.
Methods
This cross-sectional study surveyed 722 women who gave birth between January 2017 and December 2021 in Gaza’s public and private hospitals. Data were collected via a self-administered online questionnaire shared via social media and working groups. The tool included five sections: sociodemographics, childbirth experience (pain score, satisfaction, communication, procedures maltreatment practices, and postpartum mental health, which were assessed via the PHQ-2 and GAD-2 screening tools).
Results
The mean participant age was 27.7 years (SD ± 5.37). Most births occurred in governmental hospitals (70.3%), with normal vaginal delivery being most common (74.4%). While 87.1% had regular antenatal care, 49% reported inadequate information on labour, and 29.6% received no explanation regarding vaginal exams. A majority (68.6%) were unaware of episiotomy before the procedure, and 66.9% underwent unconsented episiotomies, often without local anaesthesia (30.6%). Obstetric maltreatment was an unfamiliar term for 41.5% of the women. Inadequate analgesia was the most reported form (63.4%). Compared with those not exposed (n = 422, 58.4%) (p = 0.001), women exposed to any form of maltreatment (n = 300, 41.5%) were at increased risk for PPD or PPA. Among those who were exposed to maltreatment, 78.7% (n = 236) reported PPD and PPA. Instrumental vaginal delivery (AOR = 3.25; p = 0.00, 95% CI = 2.04–4.24) and elective caesarean section (AOR = 2.01; p = 0.001, 95% CI = 1.84–5.17) significantly increased the risk of PPD. Similarly, PPA was more prevalent among women who had elective CS (AOR = 9.16; p = 0.001, 95% CI = 6.32–17.24) and IVDs (AOR = 3.71; p = 0.001, 95% CI = 2.17–5.68). Women who reported being aware of obstetric maltreatment were less likely to develop PPD (AOR = 0.46; p = 0.04, 95% CI = 0.21–0.87) and PPA (AOR = 0.36; p = 0.01, 95% CI = 0.17–0.76).
Conclusion
PPD and PPA were associated with negative childbirth experiences, particularly maltreatment and lack of informed care. Promoting respectful maternity care and improving patient education may reduce these mental health risks.
The quality of childbirth experience has a profound effect on maternal mental health. Negative experiences during labour, including poor communication, lack of informed consent, and obstetric maltreatment, can increase the risk of postpartum depression (PPD) and postpartum anxiety (PPA). This study explores women’s perspectives on the childbirth experience in Gaza and its associations with PPD and PPA.
Aims
To explore women’s perspectives on the childbirth experience and its relationship with the development of postpartum depression and anxiety. The study included women who gave birth at Gaza hospitals between 2017 and 2021.
Methods
This cross-sectional study surveyed 722 women who gave birth between January 2017 and December 2021 in Gaza’s public and private hospitals. Data were collected via a self-administered online questionnaire shared via social media and working groups. The tool included five sections: sociodemographics, childbirth experience (pain score, satisfaction, communication, procedures maltreatment practices, and postpartum mental health, which were assessed via the PHQ-2 and GAD-2 screening tools).
Results
The mean participant age was 27.7 years (SD ± 5.37). Most births occurred in governmental hospitals (70.3%), with normal vaginal delivery being most common (74.4%). While 87.1% had regular antenatal care, 49% reported inadequate information on labour, and 29.6% received no explanation regarding vaginal exams. A majority (68.6%) were unaware of episiotomy before the procedure, and 66.9% underwent unconsented episiotomies, often without local anaesthesia (30.6%). Obstetric maltreatment was an unfamiliar term for 41.5% of the women. Inadequate analgesia was the most reported form (63.4%). Compared with those not exposed (n = 422, 58.4%) (p = 0.001), women exposed to any form of maltreatment (n = 300, 41.5%) were at increased risk for PPD or PPA. Among those who were exposed to maltreatment, 78.7% (n = 236) reported PPD and PPA. Instrumental vaginal delivery (AOR = 3.25; p = 0.00, 95% CI = 2.04–4.24) and elective caesarean section (AOR = 2.01; p = 0.001, 95% CI = 1.84–5.17) significantly increased the risk of PPD. Similarly, PPA was more prevalent among women who had elective CS (AOR = 9.16; p = 0.001, 95% CI = 6.32–17.24) and IVDs (AOR = 3.71; p = 0.001, 95% CI = 2.17–5.68). Women who reported being aware of obstetric maltreatment were less likely to develop PPD (AOR = 0.46; p = 0.04, 95% CI = 0.21–0.87) and PPA (AOR = 0.36; p = 0.01, 95% CI = 0.17–0.76).
Conclusion
PPD and PPA were associated with negative childbirth experiences, particularly maltreatment and lack of informed care. Promoting respectful maternity care and improving patient education may reduce these mental health risks.
Date Issued
2026-04-03
Date Acceptance
2026-02-19
Citation
Reproductive Health, 2026, 23 (1)
ISSN
1742-4755
Publisher
BMC
Journal / Book Title
Reproductive Health
Volume
23
Issue
1
Copyright Statement
© The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1186/s12978-026-02291-3
Subjects
Childbirth experience
Obstetric maltreatment
Postpartum depression and anxiety
Gaza
Palestine
Publication Status
Published
Article Number
ARTN 69
Date Publish Online
2027-02-27