Table 3. Study characteristics table.

Author	Country & Setting	Study Design No of Participants/ Interventions	Trauma Exposure	Intervention, Dosage & Timing	Comparison	Follow-up	Outcome Measures	Adverse Effects Participant Subjective Experience	Results	Comments
Abdollahpour (2019) [41]	Hospital Iran	RCT 3xarm Parallel design N = 193 Cont 86: CBT 53: De-Bf 54 PP Cntl = 81 CBT = 47 Debrief = 51	(Inc) Experienced a traumatic birth within the previous 48hrs, Qualified for PTSD criterion A DSM-5 as assessed by screening scale.	Face to Face Debriefing, cognitive behavioural counselling Dosage: 1 x 40-60min administered within first 48hrs following birth. Mother provided with counsellor’s phone number. Interventions delivered by midwife (MSc. midwifery counselling).	3 x groups Cognitive behavioural counselling, debriefing,. Control condition care as usual	4–6 wks 12 wks	IES-R (PTSD) Traumatic birth defined as criterion A of PTSD DSM_V.	None reported	Results in favour of CBT counselling and debriefing over control condition at 4–6 wks and 12 wks. Sig diff between all groups at 4–6 wks and 12 wks (p < 0.001). No significant difference between the two intervention groups 4–6 weeks after the intervention. CBT counselling better than face to face debriefing at 12 weeks in reducing post-traumatic stress symptoms	5 control, 6 CBT, 3 debriefing dropped out. Intervention content unclear.* DASS_21 (dep, anxiety, stress) Stress coping strategy scale utilized for inclusion. No secondary outcomes
Abdollahpour (2016) [42]	Hospital Iran	RCT N = 84 ITT 42:42 PP 39:39	Women who had experienced an immediate traumatic birth before facilitation of the intervention. Qualified for PTSD criterion A DSM-5 as assessed by 4 item scale.	Midwife facilitated baby’s natural instinctive response of 9 phases following birth. Intervention delivered in the hour following the traumatic birth event.	Care as usual	4-6wks 12wks	IES-R	None reported	Sig diff in favour of intervention at 12 wks Reduction of PTSD symptomology.	No secondary outcomes
Asadzadeh (2020) [43]	Hospital Persia	RCT N = 90 PP 44:43	Qualified for criterion A DSM-5 within 72hrs following birth. In the last trimester of pregnancy. Score over 10 Edinburgh PN Depression Scale	Midwife led counselling intervention based on Gamble’s counselling intervention Dosage: 1 x face-to-face counselling session and 1 x telephone counselling session 4 to 6 weeks after giving birth. 1st author/ PhD researcher trained in and provided the intervention. Administered within 72 hrs following birth.	Care as usual	4 wks 6 wks 12 wks	DSM-5-criterion A for the qualifying traumatic event “diagnosis of traumatic childbirth scale”. Scale developed by the authors PCL-5 EPDS Hamilton anxiety rating scale	None reported	Results in favour of Midwife led counselling over care as usual at 4-6wks and at 12 weeks in reducing post-traumatic stress symptoms, depression, and anxiety.
Chiorino (2019) [44]	Milan Italy Hospital setting	RCT N = 37 PP 19:18	(Incl) Women have subjective experience of traumatic childbirth experience assessed subjectively and objectively by clinician. Score ≥24 on the (IES-R);	Brief one to one EMDR intervention utilizing the Birth Trauma Protocol. Dosage: 1 x 90 min session 90min Conducted within first 72 hrs following traumatic birth experience. Intervention delivered by clinical perinatal psychologist.	Care as Usual Standard supportive Psychological consultation focusing on emotions experienced during childbirth difficulties with caregiving, breastfeeding and psycho-physical recovery. Dosage– 1 x 90 min session Performed by 4x psychotherapists at MSc level or higher with supervision.	6week and 12 week follow up by telephone.	PTSD symptoms IES-R Prevalence of participants asymptomatic IES-R score <23) PDEQ EPDS MIBS	None reported	Results in favour of intervention in reduced presence of flashbacks at 12 wks follow up (p = 0.042) Sig diff in overall PTSD symptoms in favour of intervention at 4- 6wks (p = 0.04) and 12 wk follow up (p = 0.03). Difference in number of women asymptomatic at 4–6 wks (p = 0.02) Cramers V = 0.408). No Diff at 12wks (p = 0.124)	MVAV suggests no interaction of outcome measures on effect size. Presence of flashbacks also measured.
Gamble (2005) [29]	Australia	RCT N = 103 PP 50:53	Women reporting a traumatic birth experience as determined by Criterion A DSM-IV	Debriefing/face to face counselling. Dosage: 1 x face to face session of 40–60 mins within 72hrs following birth 1 x telephone session 4-6wks post-partum. Intervention delivered by midwife	Care as Usual	4–6 weeks postpartum and 3 months postpartum	PTSD diagnosis and PTSD symptoms (MINI-PTSD) EPDS DASS-21, stress, anxiety	86% women rated intervention highly (above 8/10) 90% Women reported that opportunity to talk about birth should be within a few days following birth. The remaining favoured 4 wks post-partum and, 2 x reported during pregnancy as the best time to discuss.	Results in favour of intervention at 3 months follow up. Sig diff in PTSD total symptom scores at 3-month follow-up Sig diff in Depression scores at 3 months follow up on the EPNDS X2 [1] = 9.188, p = 0.002 Sig diff in depression scores at 3 months follow up on the DASS-21 13(X2 [1] = 7.549, p = 0.005). Sif diff in stress scores at 3 months follow up on DASS-21 when compared with the control group (X2 [1] = 4.478, p = 0.029)	No statistical difference between groups in number of women meeting PTSD diagnosis at either 4 to 6 wks postpartum or three months postpartum. No significant difference in PTSD symptoms between groups at 4 to 6 weeks.
Horsch (2017) [45]	Switzerland	RCT N = 56 ITT 29:27 PP 25:24	Mothers recruited on the ward following EmCS	Taking part in a computerised visuospatial cognitive task within 6 hours following emergency caesarean section. Dosage– 10-15minute of play and daily diary of intrusive memories. Intervention delivered by midwife	Care as usual	1 wk and 1 month	PTSD symptoms Posttraumatic Diagnostic Scale (PDS) ASDS stress HADS anxiety HADS depression Intrusive memories diary	Perceived to be acceptable by women. No reported harmful effects or serious incident was reported	No Sig diff between groups in post-traumatic stress disorder at one month (ITT) Sig diff favouring intervention in PDS avoidance cluster symptom count at 1 month (p = 0.05) Sig fewer intrusive traumatic memories at 1 week than control group (p = 0.017) Sig diff favouring intervention in reduced re-experiencing symptoms at 1wk ASDS (p = 0.06) No significant group differences in the ASDS total score or HADS Anxiety or Depression scores at 1wk or 1 month follow up.	Sig diff in PTSD diagnostic criteria at 1 month in per protocol analysis (p = 0.039)
Ryding (1998) [46]	Sweden	RCT N = 50: 49 completed	Women following EmCS recruited via a hospital obstetrics and gynaecology department No specific symptoms of PTSD	Counselling and psychoeducation intervention. Delivered between 8 days to 1-month post-partum. Delivered by Obstetrician with psychotherapy qualification. Dosage: 4 x sessions first consultation took ≥ 1 hour. The second to fourth meetings were 45 min.	Care as usual Discussion with midwife and Doctor who performed Em CS a few days after delivery.	6 months post-partum	IES Prevalence of PTSD symptoms: mild <20 moderate 20–30 and severe (PTSD probable) score over 30 W-DEQ 20 fear of childbirth SCL 35 mental distress	None reported	Neutral No sig diff between groups in post traumatic stress symptoms at 6 months post partum. Sig Diff between groups in general distress at 6 months post partum.	No reported ethical approval. Median scores reported SD not reported.
Ryding [47] (2004)	Sweden	RCT N = 162:147 available at initial follow up	Women following EmCS recruited via a hospital obstetrics and gynaecology department Severity criterion: No specific symptoms of PTSD	Group counselling and education. Delivered 1–2 months post-partum Delivered by Psychologist and ward midwife. 4–5 women per group Dosage: 2 x 2hr sessions with 2–3 wk interval.	Care as Usual Invited to individual consultation with midwife following birth.	6 months post-partum	IES Prevalence of post-traumatic stress symptoms IES>30 W-DEQ B EPNDS	Feedback from participants: Too few participants in the group. Needed additional sessions. Need to include fathers.	Neutral No sig diff between groups in childbirth experience, post traumatic stress or depression.	No reported ethical approval. Median reported No mean diffs or p reported. No baseline measures reported.
Shaw [48] (2013)	USA NICU	RCT N = 105 62:43	Women who had developed symptoms of trauma, anxiety or depression following preterm birth. Recruited from NICU Women who scored above the clinical cut off on any instrument (BDI-II score over 20; BAI score over 16; SASRQ score over 3 for the required number of questions in 2 or more of the symptom categories) were invited into the intervention phase	TF-CBT and techniques to enhance parenting confidence twice a wk over 3-4wks. 2 x sessions conducted at bedside in NICU 4 x sessions in NICU Session 1: developing rapport Psychoeducation. Session 2: Cognitive restructuring Session 3 Progressive muscle relaxation Session 4: psychoeducation TF_CBT, session 5: trauma narrative session 6: infant redefinition. Intervention conducted by unlicensed Doctoral candidates completing PsyD. Dosage: 6 x 45-55min sessions	Active comparison of psychoeducation	14 days following intervention, 4-5wks after birth, 6 months following birth.	DTS for DSM-IV SASRQ stress PSS:NICU BAI BDI Beck depression & anxiety Mini international neuropsychiatric interview (MINI-PTSD)	None reported	Sig moderate effect in favour of TF-CBT at 4–5 wk follow up in trauma symptoms [d = 0.41, p = 0.23] and depression [d = 0.59 p< .001]	Effect size between groups diffs before and after intervention not reported on. No power calculation Experimental and comparison groups unequal. SD not reported.
Slade (2020) [49]	UK Online	RCT N = 678 336: 342	Women who reported their current birth experience as traumatic assessed by DSM-V criterion A	Psychological Self-help materials: A brief info leaflet and a web link to a film. Administered less than 3 months post-partum	Care as Usual	6–12 weeks	Diagnostic and sub diagnostic PTSD CAPS-5 HADS anxiety & depression MPAS quality of attachment, hostility, pleasure in interaction DAS4	No adverse effects Women viewed intervention favourably	Neutral
ZelKowitz (2011) [50]	Montreal Canada Hospital and home Setting	RCT N = 121 48:50	Mothers singleton infant born weighing less than 1500 grams recruited from NICU. PTSD symptoms related to experience of premature birth. No specifier.	5x sessions in hospital (1–2 sessions per week over 3–5 wks) 1x telephone call 1 wk after discharge 1 x session at home 2–3 wks after discharge. Delivered by psychologist or nurse Total Dose 9–10 hrs Mother consents by 4th wk following birth	Usual Care and general information about caring for an infant	4–6 weeks 6 months	PPQ Perinatal PTSD Questionnaire Not primary outcomes	None reported	Neutral	48% of women intervention gp had PTSD scores in clinical range at baseline 52.5% women in CAU had PTSD scores within clinical range at baseline

ITT, Intention to Treat; PP, Per protocol; EmCS, Emergency Caesarean section; Los Angeles Symptom Checklist (LASC) The Perinatal Risk Inventory (PERI), Depression, Anxiety and Stress Scale (DASS_21), Davidson Trauma Scale (DTS), The Stanford Acute Stress Reaction Questionnaire (SASRQ), Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU), The Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Mini-International Neuropsychiatric Interview–Post-Traumatic Stress Disorder (MINI-PTSD), Post Traumatic Stress Diagnostic Scale(PDS, Acute Stress Disorder Scale (ASDS), Hospital Anxiety and Depression Scale (HADS), Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Perinatal PTSD Questionnaire (PPQ), Traumatic Event Scale (TES), Clinician Administered PTSD Scale for DSM-5 Diagnosis (CAPS-5). The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ form B), Impact of Event Scale & Impact of Event Scale Revised (IES & IES-R), Edinburgh Postnatal Depression Scale (EPDS), Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Mother to Infant Bonding Scale (MIBS), Symptoms Check List (SCL) Multidimensional Parental Attachment Scale (MPAS), Dyadic Adjustment Scale, (DAS4).