**5. Conclusions**

The present research evaluated vulnerability postpartum risk factors in Greek mothers who had an EMCS or ELCS in a University Hospital. Birth trauma experience was predictive with the PCL-5 for cesarean deliveries. The measure revised to reflect the new diagnostic demands and now is one of the few validated tools for PTSD. Mothers in this survey who met all the diagnostic criteria (re-experiencing, avoidance, negative thoughts and feelings, arousal, and reactivity) of DSM-5 may have a provisional diagnosis of postpartum PTSD or PTSD Profile. Direct exposure and witnesses to birth trauma were predictive with the adapted Criterion A for postpartum women after cesarean delivery. From this study, it has emerged that the major risk factors developing postpartum PTSD are: inclusion in the NICU, preterm birth, EMCS, a lack of breastfeeding, and a lack of support from a partner. Perinatal health professionals who are in contact with women during pregnancy or postpartum should inform them in order to reduce the above risk factors. However, more research needs to be conducted with the aim of identifying more risk factors and reducing the rates of PTSD OR PTSD Profile, especially in countries similar to Greece with high percentages of CS. Finally, it should be understood by healthcare providers and health policymakers that the postpartum mental disorders are only a part of short-term and long-term negative effects of cesarean deliveries worldwide.

### **Acknowledgements**

The authors would like to thank The Laboratory of Midwifery Care during Antenatal and Post natal period—Breastfeeding—L.M.C.A.P. – BF. of the University of West Attica.
