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Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans. Therefore, this study aimed to examine if the mismatch between women\u2019s planned birth and actual birth experiences during COVID-19 was associated with women\u2019s postpartum PTSS. Women in the postpartum period (up to 6\u00a0months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors, and PTSS (PTSD checklist DSM-5 version) using self-report questionnaires (ClinicalTrials.gov: NCT04595123). More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans. All changes were significantly associated with PTSS scores. Participants with one and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes (Exp(\u03b2)\u2009=\u20091.12; 95% CI [1.06\u20131.19]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 and Exp(\u03b2)\u2009=\u20091.38; 95% CI [1.29\u20131.48]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In addition, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida (Exp(\u03b2)\u2009=\u20090.86; 95% CI [0.77\u20130.97]; <jats:italic>p<\/jats:italic>\u2009=\u20090.014). Changes to women\u2019s childbirth plans during the COVID-19 pandemic were common and associated with women\u2019s postpartum PTSS score. Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health.<\/jats:p>","DOI":"10.1007\/s00737-023-01403-3","type":"journal-article","created":{"date-parts":[[2023,12,16]],"date-time":"2023-12-16T04:24:34Z","timestamp":1702700674000},"page":"393-403","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Changes to women\u2019s childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study"],"prefix":"10.1007","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9635-2355","authenticated-orcid":false,"given":"Ana","family":"Mesquita","sequence":"first","affiliation":[]},{"given":"Raquel","family":"Costa","sequence":"additional","affiliation":[]},{"given":"Pelin","family":"Dikmen-Yildiz","sequence":"additional","affiliation":[]},{"given":"Susana","family":"Faria","sequence":"additional","affiliation":[]},{"given":"Gabriela","family":"Silvestrini","sequence":"additional","affiliation":[]},{"given":"Vera","family":"Mateus","sequence":"additional","affiliation":[]},{"given":"Eleni","family":"Vousoura","sequence":"additional","affiliation":[]},{"given":"Claire A.","family":"Wilson","sequence":"additional","affiliation":[]},{"given":"Ethel","family":"Felice","sequence":"additional","affiliation":[]},{"given":"Erilda","family":"Ajaz","sequence":"additional","affiliation":[]},{"given":"Eleni","family":"Hadjigeorgiou","sequence":"additional","affiliation":[]},{"given":"Camellia","family":"Hancheva","sequence":"additional","affiliation":[]},{"given":"Yolanda","family":"Contreras-Garc\u00eda","sequence":"additional","affiliation":[]},{"given":"Sara","family":"Dom\u00ednguez-Salas","sequence":"additional","affiliation":[]},{"given":"Emma","family":"Motrico","sequence":"additional","affiliation":[]},{"given":"Isabel","family":"Soares","sequence":"additional","affiliation":[]},{"given":"Susan","family":"Ayers","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,12,16]]},"reference":[{"issue":"1","key":"1403_CR1","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1186\/s12884-022-04637-8","volume":"22","author":"E Aydin","year":"2022","unstructured":"Aydin E, Glasgow KA, Weiss SM, Khan Z, Austin T, Johnson MH, Barlow J, Lloyd-Fox S (2022) Giving birth in a pandemic: women\u2019s birth experiences in England during COVID-19. 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Participants gave their informed consent via online, and protection of personal data was ensured by adherence to guidelines and regulations in each country.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}