**7. Prevention of postpartum PTSD**

Prevention measures for postpartum PTSD can be implemented on all three levels. Primary prevention would keep the disorder from happening (by timely identification of risk factors). Secondary prevention includes early identification of the disorder and the outset of treatment, and tertiary prevention includes rehabilitation of mothers who have already developed this disorder. The initial and basic step in the implementation of preventive measures is the education of health workers about the possibility of PTSD, risk factors, and the clinical course of postpartum PTSD, while the health workers in contact with women in labor [26] are expected to take on a more proactive role.

Primary prevention includes adequate psychophysical preparation of a pregnant woman for childbirth, as well as providing her with necessary information about the course of childbirth, possible obstetric complications, and medical interventions, making that information available at all times. Screening and identification of vulnerability factors take place during the procedure of obtaining detailed anamnestic data about previous pregnancies and their outcomes, previous traumatic experiences, and possible psychological disorders. Targeted screening is carried out if there is information about traumatic stress after childbirth. In that case, further steps should be adapted according to the ongoing and individual circumstances of each mother [27]. If there are real risk factors that could indicate the possibility of postpartum PTSD, a possible solution would be to offer those pregnant women a cesarean section as a way to end the pregnancy, noting in the medical documentation, as a mandatory sidenote, information about the special needs of such women during childbirth, with the possibility of providing additional care and support. In addition, it is important to provide women at risk with adequate pain control during labor. Satisfactory social support is an important factor in the prevention of postpartum PTSD [9, 10, 28].

Secondary prevention includes timely identification of traumatic stress disorder symptoms, acute stress disorder symptoms, or PTSD and providing adequate, evidence-based treatment. It is important to avoid psychiatrization, and attribute of the usual symptoms of fatigue, e.g. irritability, sleep disturbances, to PTSD symptoms. A woman who has recently given birth should be encouraged to talk about her experiences during childbirth.

Tertiary level of prevention is possible if traumatized mothers were to be monitored for a longer period of time with the aim of establishing a diagnosis of chronic PTSD and the need for further treatment [9].
