1. Home
  2. Vol 29, No 10 (2025)
  3. Ma

Association between postpartum post-traumatic stress disorder, maternal functioning, and self-efficacy in women after cesarean section

Lili Ma(1), Jiaqi Lu(2), Mei Chan Chong(3), Wan Ling(4), Mengling Wu(5),


(1) Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; School of Nursing, Henan University of Science and Technology, Luoyang, Henan, China
(2) School of Nursing, Henan University of Science and Technology, Luoyang, Henan, China
(3) Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
(4) Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
(5) School of Nursing, Henan University of Science and Technology, Luoyang, Henan, China
Corresponding Author

Abstract


Childbirth, particularly cesarean delivery, can trigger postpartum post-traumatic stress disorder (PTSD), impairing maternal functioning and self-efficacy. Although self-efficacy is crucial for patient outcomes, its mediating role between postpartum PTSD and maternal functioning remains unclear. This study addressed these gaps by investigating the association between postpartum PTSD and maternal functioning, with a specific focus on exploring the mediating role of self-efficacy. Data were collected during a 42-day postpartum follow-up of 307 women post-cesarean section using the Barkin Index of Maternal Functioning, General Self Efficacy Scale, and Post-Traumatic Stress Disorder Checklist-Civilian version. Non-parametric tests and Spearman rank correlation were analyzed using SPSS 26.0 and the mediating effect using SmartPLS 4. Median scores for maternal functioning, self-efficacy, and postpartum PTSD were 70.00 (60.00, 77.00), 24.00 (22.00, 26.00), and 26.00 (23.00, 32.00), respectively. Spearman's correlation analysis revealed a significant positive correlation between maternal functioning and self-efficacy (r = 0.532, p < 0.01), and a negative correlation between maternal functioning and postpartum PTSD (r = -0.301, p < 0.01). We conclude that self efficacy fully mediated the association between postpartum PTSD and maternal functioning. Therefore, enhancing self-efficacy and addressing postpartum PTSD are crucial for improving maternal functioning in post-cesarean women.

References


Cai X and Chu Y. Correlations among subjective well-being,

breast-feeding self-efficacy, maternal role adaptation

in puerpera after cesarean section. Chinese journal of

Modern Nursing. 2019;25(30):3908-3912.

doi:10.3760/cma.j.issn.1674-2907.2019.30.015

Lu J and Wu X. Study on the main influcing factors of

cesarean section behavior of women-verification

based on 2017 national fertility sample survey. Chin

J Fam Plann. 2021;29(05):873-876.

Wang Y. Application of narrative nursing in breast feeding

after cesarean section. Master's degree. Lanzhou

University; 2019.

Sys D, Kajdy A, Nizniowska M, Baranowska B,

Raczkiewicz D and Tataj-Puzyna U. The Experience

of Women Giving Birth after Cesarean Section-A

Longitudinal

Observational

Healthcare.

Jun

Study.

;11(12):16.

doi:10.3390/healthcare11121806

Article.

Li LX, Wan WL and Zhu C. Breastfeeding after a cesarean

section: A literature review. Review. Midwifery. Dec

;103:13.

doi:10.1016/j.midw.2021.103117

Barkin JL. Editorial: Perinatal mood symptoms and

postpartum maternal functioning: Describing the

evidence related to effective and ineffective

interventions. Editorial Material. Front Psychiatry.

Jul

;13:3.

doi:10.3389/fpsyt.2022.975078

Trevethan R. The Barkin Index of Maternal Functioning: an

evaluation and foundations for a new parental

functioning scale. Article. Health Serv Outcomes Res

Methodol.

Sep

;22(3):416-434.

doi:10.1007/s10742-022-00269-9

Mirghafourvand M, Barkin JL, Jafarabadi MA, Karami F

and Ghanbari-Homayi S. The psychometric

properties of the Barkin index of maternal

functioning (BIMF) for the Iranian population.

Article. BMC Womens Health. Dec 2019;19(1):8.

doi:10.1186/s12905-019-0859-2

Barkin JL, Beals L, Bridges CC, et al. Maternal Functioning

and Depression Scores Improve Significantly With

Participation in Visiting Moms® Program. Article. J

Am Psych Nurses Assoc. Jan 2021;27(1):54-63.

doi:10.1177/1078390319877444

Chamgurdani FK, Barkin JL, Curry CL and

Mirghafourvand M. Comparison of Maternal

Functioning between Iranian Mothers with and

without Depressive Symptoms: A Case-Control

Study. Article. Int J Environ Res Public Health. May

;17(10):11. 3350. doi:10.3390/ijerph17103350

De Schepper S, Vercauteren T, Tersago J, Jacquemyn Y,

Raes F and Franck E. Post-Traumatic Stress Disorder

after childbirth and the influence of maternity team

care during labour and birth: A cohort study. Article.

Midwifery.

Jan

doi:10.1016/j.midw.2015.08.010

;32:87-92.

Ertan D, Hingray C, Burlacu E, Sterlé A and El-Hage W.

Post-traumatic stress disorder following childbirth.

Article. BMC Psychiatry. Mar 2021;21(1):9. 155.

doi:10.1186/s12888-021-03158-6

Malaju MT, Alene GD and Bisetegn TA. Longitudinal

mediation analysis of the factors associated with

trajectories

of posttraumatic stress disorder

symptoms among postpartum women in Northwest

Ethiopia: Application of the Karlson-Holm-Breen

(KHB) method. Article. PLoS One. 2022;17(4):23.

e0266399. doi:10.1371/journal.pone.0266399

Isbir GG, Inci F, Bektas M, Yildiz PD and Ayers S. Risk

factors

associated with post-traumatic stress

symptoms following childbirth in Turkey. Article.

Midwifery.

Oct

doi:10.1016/j.midw.2016.07.016

;41:96-103.

Takegata M, Haruna M, Matsuzaki M, Shiraishi M,

Okano T and Severinsson E. Aetiological

relationships between factors associated with

postnatal traumatic symptoms among Japanese

primiparas and multiparas: A longitudinal study.

Article. Midwifery. Jan 2017;44:14-23.

doi:10.1016/j.midw.2016.10.008

Dai L, Zeng T, Yuan M, Wu M and Peng C. Research

progress of female childbirth trauma. Chinese

Journal of Nursing. 2019;54(02):311-315.

Asadzadeh L, Jafari E, Kharaghani R and Taremian F.

Effectiveness of midwife-led brief counseling

intervention on post-traumatic stress disorder,

depression, and anxiety symptoms of women

experiencing a traumatic childbirth: a randomized

controlled trial. Article. BMC Pregnancy Childbirth.

Mar 2020;20(1):9. 142. doi:10.1186/s12884-020

-1

Vignato J, Georges JM, Bush RA and Connelly CD. Post

traumatic stress disorder in the perinatal period: A

concept analysis. Review. J Clin Nurs. Dec

;26(23-24):3859-3868. doi:10.1111/jocn.13800

Chen Y. Studies on the correlation between postpartum

post-traumatic stress disorder and cesarean section.

Master's degree. Southern Medical University; 2021.

Vahidi F, Mirghafourvand M, Naseri E and Ghanbari

Homaie S. Birth-related posttraumatic stress disorder

and negative childbirth experience related to

maternal functioning among adolescent mothers: a

cross-sectional study. Article. BMC Pregnancy

Childbirth. May 2023;23(1):9. 371.

doi:10.1186/s12884-023-05717-z

Duprez V, Van Hooft SM, Dwarswaard J, van Staa A, Van

Hecke A and Strating MMH. The development and

psychometric validation of the self-efficacy and

performance in self-management support (SEPSS)

Instrument. Article. J Adv Nurs. Jun

;72(6):1381-1395. doi:10.1111/jan.12918

Shi H, Chen L, Zhou L and Wang L. Ｍediating effect of

positive coping style between self-efficacy and

kinesophobia among postoperative breast cancer

patients. Ｍil Nurs. 2023;40(03):59-62.

Zhang X, Huang X, Peng Y, Huang L, Lin L, Chen L and

Lin Y. Mediating effects of general self-efficacy on

social support and quality of life in patients after

surgical aortic valve replacement. Article. Nurs

Open.2023;10(10):6935-6944. Oct doi:10.1002/nop2.1947

Abarashi Z, Tahmassian K, Mazaheri MA, Panaghi L and

Mansoori N. Parental self-efficacy as a determining

factor in healthy mother-child interaction: a pilot study in iran. Iran J Psychiatry Behav Sci. Spring

;8(1):19-25.

Jia Q, Li X and Cheng X. Correlation analysis of maternal

function with self-efficacy and subjective well-being

in primiparas. Journal of nursing science.

;38(08):13-16.

Palanci A and Aktas S. The effect of maternal functional

and postpartum depression status on breastfeeding

self-efficacy of the mothers: A cross-sectional study.

Article; Early Access. Health Care Women Int. 2021

Aug 2021:15. doi:10.1080/07399332.2021.1973008

Huang T, Ding M, Ou Yang Q, Qiu R, Liu D, He Y,

Huang R and Wang X. The correlation between post

traumatic stress disorder and self-efficacy in parents

of children with malignant tumor. Journal of Gannan

Medical University. 2022;42(02):177-181.

Wang Y, Bao YJ, Liu L, Ramos A, Wang YJ and Wang

L. The mediating effect of self-efficacy in the

relationship between social support and post

traumatic stress disorder symptoms among patients

with central system tumors in China: a cross

sectional

study. Article. Psycho-Oncol. Dec

;24(12):1701-1707. doi:10.1002/pon.3838

Barkin JL, Wisner KL, Bromberger JT, Beach SR, Terry

MA and Wisniewski SR. Development of the Barkin

Index of Maternal Functioning. J Womens Health

(Larchmt).

Dec

doi:10.1089/jwh.2009.1893

;19(12):2239-46.

Ansariniaki M, Lamyian M, Ahmadi F, Rahimi

Foroushani A, Curry CL and Barkin JL. Persian

version of the Barkin Index of Maternal Functioning

(BIMF):

a

cross-cultural

adaptation

and

psychometric evaluation. Article. BMC Pregnancy

Childbirth.

Jan

;21(1):10.

doi:10.1186/s12884-021-03556-4

Yu R and Li K. Reliability and validity of Chinese version

of Barkin Index of Maternal Functioning in

parturients. Chin J Mod Nurs. 2021;27(33):4555

doi:10.3760/cma.j.cn115682-20210408

.32. Wang C, Hu Z and Liu Y. Evidences for reliability and

validity of the Chinese version of General Self

Efficacy Scale. Chinese Journal of Applied

Psychology. 2001;7(1):37–40.

Lu JC, Yu YY, Wang B, Zhang Y, Ji H, Chen X, Sun M,

Daun Y, Pan Y, Chen Y, Yi Y, Dou X and Zhou L.

The mediating role of self-efficacy between

workplace violence and PTSD among nurses in

Liaoning Province, China: A cross-sectional study.

Article. Front Psychol. Feb 2023;14:8. 1090451.

doi:10.3389/fpsyg.2023.1090451

Gelaye B, Zheng Y, Medina-Mora ME, Rondon MB,

Sánchez SE and Williams MA. Validity of the

posttraumatic stress disorders (PTSD) checklist in

pregnant women. BMC Psychiatry. May 12

;17(1):179. doi:10.1186/s12888-017-1304-4

Chen Y, Xie R, Li M, Hu W and Liang Y. Risk factors of

postpartum posttraumatc stress disorder. Journal of

Nursing Science. 2021;36(10):14-16+29.

Chen Y, Li J, Ou L, Zou H, Gan M and Wang W.

Mediating effects of career outcome expectations

between perceived social support and professional

commitment in masters of nursing. Journal of

Nursing（China）. 2023;30(16):7-11.

Shamasbi SG, Barkin JL, Ghanbari-Homayi S,

Eyvazzadeh O and Mirghafourvand M. The

Relationship between Maternal Functioning and

Mental Health after Childbirth in Iranian Women.

Article. Int J Environ Res Public Health. Mar

;17(5):11. 1558. doi:10.3390/ijerph17051558

Martin RCB and Brock RL. The importance of high

quality partner support for reducing stress during

pregnancy and postpartum bonding impairments.

Article.

Arch Womens Ment Health. Apr

;26(2):201-209.

doi:10.1007/s00737-023

-z

James KF, Smith BE, Robinson MN, Tobin CTS, Bulles

KF and Barkin JL. Factors Associated with

Postpartum Maternal Functioning in Black Women:

A Secondary Analysis. Article. J Clin Med. Jan

;12(2):12. 647. doi:10.3390/jcm12020647

Chen J, Lai X, Zhou L, Retnakaran R, Wen SW, Krewski

D, Huang L, Li M and Xie RH. Association between

exclusive breastfeeding and postpartum post

traumatic stress disorder. Article. Int Breastfeed J.

Nov 2022;17(1):8. 78. doi:10.1186/s13006-022

-z

Xie RH, Guo X, Li M, Liao Y, Gaudet L, Walker M, Lei

H and Wen SW. Risk factors and consequences of

undiagnosed cesarean scar pregnancy: a cohort study

in China. Article. BMC Pregnancy Childbirth. Oct

;19(1):6. 383. doi:10.1186/s12884-019-2523-0

Chen Y, Yang X, Guo C, Liao Y, Guo L, Chen W, Chen

I, Krewski D, Wen SW and Xie RH. Prevalence of

Post-Traumatic Stress Disorder Following Caesarean

Section: A Systematic Review and Meta-Analysis.

Review. J Womens Health. Feb 2020;29(2):200-209.

doi:10.1089/jwh.2019.7750

Yildiz PD, Ayers S and Phillips L. The prevalence of

posttraumatic stress disorder in pregnancy and after

birth: A systematic review and meta-analysis.

Review. J Affect Disord. Jan 2017;208:634-645.

doi:10.1016/j.jad.2016.10.009

Han LL, Zhang J, Yang JX, Yang XY and Bai H. Between

Personality Traits and Postpartum Depression: The

Mediated Role of Maternal Self-Efficacy. Article.

Neuropsychiatr

Dis Treat. 2022;18:597-609.

doi:10.2147/ndt.S346327

Zhou T, Guan RY and Sun LQ. Perceived organizational

support and PTSD symptoms of frontline healthcare

workers in the outbreak of COVID-19 in Wuhan:

The mediating effects of self-efficacy and coping

strategies. Article. Appl Psychol-Health Well Being.

Nov 2021;13(4):745-760. doi:10.1111/aphw.12267

Gil S. Coping style in predicting posttraumatic stress

disorder among Israeli students. Article. Anxiety

Stress Coping. Dec 2005;18(4):351-359.

doi:10.1080/10615800500392732


Full Text: PDF

Article Metrics

Abstract View : 428 times
PDF Download : 294 times

Refbacks

  • There are currently no refbacks.