Childbirth under prolonged and cumulative stress: The roles of perceived risk, self-compassion, and intolerance of uncertainty in predicting postpartum psychological well-being

Problem: Childbirth under prolonged cumulative stress and uncertainty conditions poses unique challenges to postpartum psychological well-being, but the underlying mechanisms remain unclear. Background: Under such extreme conditions, the relationship between perceived childbirth risk and maternal adjustment may be mediated through internal regulatory resources like self-compassion. Personality vulnerability factors such as intolerance of uncertainty may modulate these pathways. Aim: This study examined how perceived risk during childbirth, self-compassion, and intolerance of uncertainty interact to predict postpartum psychological well-being among women giving birth under extreme conditions. Methods: Ninety-six women who gave birth during the first year of a security emergency while evacuated from their homes completed validated measures. A moderated mediation model was tested, controlling for maternal age, income, and objective obstetric risk at childbirth. Findings: Higher perceived risk during childbirth was associated with lower self-compassion, which in turn predicted reduced postpartum psychological well-being. Self-compassion fully mediated the relationship between perceived risk and well-being. Critically, intolerance of uncertainty moderated this mediation pathway, as the indirect effect was significant only among women with high intolerance of uncertainty levels. Women with low or moderate intolerance of uncertainty showed no such relationships, suggesting greater resilience. Discussion: Self-compassion emerged as a key mechanism linking childbirth appraisals to postpartum adjustment under extreme conditions, while intolerance of uncertainty functioned as a vulnerability factor determining when perceived risk translates into compromised well-being. Conclusion: Screening for high intolerance of uncertainty during pregnancy may identify women at risk for postpartum difficulties, informing targeted interventions that strengthen self-compassion and address uncertainty intolerance.