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Approximately 3%-4% of women experience childbirth-related posttraumatic stress disorder (CB-PTSD). The City Birth Trauma Scale (City BiTS) is a questionnaire developed to assess CB-PTSD, following the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders. The aim of the present study was to evaluate the psychometric properties of the Norwegian version of this questionnaire (City BiTS-Nor). A community sample of 1079 mothers completed a cross-sectional online survey. The survey included questions on sociodemographic and obstetric characteristics, the City BiTS-Nor, the Impact of Event Scale-Revised, the Edinburgh Postnatal Depression Scale, the 10-item anxiety subscale of the Hopkins Symptom Checklist, and the Bergen Insomnia Scale. Confirmatory factor analysis supported a bifactor model comprising Birth-related Symptoms and General Symptoms in CB-PTSD, along with a General CB-PTSD factor that explained 58.4% of the variance. The study found high internal consistency (≥0.90), and good convergent and divergent validity were shown. Discriminant validity was evaluated by examining factors such as mode of birth, maternal complications, infant complications, parity, history of traumatic childbirth, and previous traumatic experiences. Higher General and Birth-related scores were observed in women who experienced emergency cesarean sections or instrumental vaginal births. This trend was observed in primiparous women, cases involving pregnancy and birth complications, and individuals with prior traumatic experiences. The City BiTS-Nor presents appropriate psychometric properties for assessing CB-PTSD symptoms according to DSM-5 criteria. The findings suggest that using the total score, along with the individual subscale scores, is justified and enhances the comprehensive assessment of CB-PTSD symptoms. These findings support the clinical utility of the City BiTS-Nor as a screening tool for CB-PTSD, with potential to differentiate childbirth-related trauma from general psychopathology and to guide targeted interventions in perinatal care.

Postnatal depression is a global challenge for healthcare system, affecting a large number of mothers globally. The present study was designed to examine the role of obstetric factors such as delivery method, birth complications, perceived birth trauma, and satisfaction with childbirth in postnatal depression (PND) among Pakistani women. By adopting a cross-sectional research design, a purposive sampling technique was used to collect data from the 335 women within the postpartum period (42–84 days) from six public and private hospitals and clinics of Punjab, Pakistan. Age of the sample ranged between 18 and 47 years ( M  = 29.41, SD  = 5.32). Demographic and Birth Information sheet, Edinburgh Postnatal Depression Scale and Birth Satisfaction Scale-Revised were used to collect data for hypotheses testing. After assessing intercorrelations between the study variables, a hierarchical regression analysis was run by controlling age and education. The results showed that a significant amount of variance (R 2  = 0.39) in PND was accounted for by low birth satisfaction, mother birth complications, previous birth trauma, and birth trauma perception. The findings suggest that providing a secure, respectful, and supportive environment during childbirth can substantially reduce the risk of PND. Positive childbirth experiences—characterized by care, respect, and fulfillment of psychological needs—serve as protective factors against PND. Study has implications for researchers, midwives, and obstetricians.

Background Childbirth is a complex process, and midwives involved in assisting or witnessing it often experience psychological trauma, which can impact their well-being and professional performance. Psychological trauma in midwives is under-researched, despite its implications for their mental health and the quality of childbirth services. Addressing this issue is critical for ensuring safe and compassionate care. This study aimed to explore the psychological trauma experienced by midwives during childbirth and identify key influencing factors to enhance the safety and humanization of childbirth services. Methods This descriptive qualitative study involved in-depth interviews with 13 midwives selected based on preset criteria. Data were analyzed using a qualitative content analysis framework, and thematic analysis was applied to identify recurring themes from the data. Results Four primary themes emerged from the data. First, midwives reported persistent emotional trauma, including ongoing fear, guilt, and self-blame associated with traumatic childbirth experiences. Second, they faced multifaceted professional challenges, including high expectations and systemic pressures. Emotional exhaustion was more closely associated with persistent trauma and vicarious exposure, as reflected in other themes. Third, participants described feelings of helplessness and powerlessness when managing critical or life-threatening situations. Fourth, vicarious trauma was common, stemming from deep empathy and emotional engagement with laboring women and their families. Conclusion Strategies to address these challenges include strengthening midwives’ psychological resilience and professional competencies, optimizing team collaboration, and enhancing psychological and emotional support. Implementing these measures can safeguard the mental health of midwives, promote humanistic care, and improve childbirth safety. Trial registration ChiCTR2400088104 August 12th, 2024.

Background Psychological birth trauma exhibits a high incidence worldwide, resulting in a wide range of negative impacts on mothers, infants, couples, families and society at large through the maternal-centered ripple effect. However, there is currently limited research on psychological birth trauma in China. Social support and pregnancy stress are important influencing factors of psychological birth trauma. Consequently, this study aimed to explore predictors of pregnancy stress and psychological birth trauma in women undergoing vaginal delivery in China. Methods This cross-sectional study was performed at a single medical center between December 2021 and May 2022 in Hangzhou, China. Participants were selected using a convenience sampling technique. A total of 351 postpartum women within one week after vaginal delivery were included. Questionnaires were used to collect sociodemographic and obstetric characteristics and scores on the Pregnancy Stress Rating Scale (PSRS), City Birth Trauma Scale (City BiTS), Social Support Rating Scale (SSRS) and Family Adaptation Partnership Growth Affection and Resolve index (Family APGAR). Both univariate analysis and multiple linear regression analysis were conducted to assess predictors of pregnancy stress and psychological birth trauma. Results The median (IQR) of PSRS and City BiTS scores were 10.00 (14.00) and 3.00 (9.00), respectively. The incidence of postpartum posttraumatic stress disorder was 4.0% (14/351). Parity, social support, family support and level of education were predictors of pregnancy stress. Delivery complications, psychological traumatic event, pregnancy stress and family support were predictors of psychological birth trauma (P < 0.05). Conclusion Pregnancy stress is related to social support, family support and some sociodemographic and obstetric characteristics. Psychological birth trauma is correlated with delivery complications, psychological traumatic event, pregnancy stress and family support. Consequently, enhancing social support, especially family support, for pregnant women as a means of reducing pregnancy stress can effectively prevent psychological birth trauma.

Background Psychological birth trauma represents a significant global public health concern, with an estimated 45% of new mothers reporting such an experience. Researchers mostly focus on the impacts of postpartum mental health issues, such as postpartum post-traumatic stress disorder, minimal attention has been given to the antecedents of psychological birth trauma. This study seeks to investigate the correlation between fear of childbirth and psychological birth trauma among Chinese women who have undergone natural childbirth, as well as the mediating role of coping styles in the association between fear of childbirth and psychological birth trauma. Methods This cross-sectional study was conducted among 420 women who underwent natural childbirth between June and December 2021 in Shandong Province, China. Data were gathered using the Wijma Delivery Experience Questionnaire, Trait Coping Style Questionnaire, and Impact of Event Scale-Revised. The structural equation model (SEM) was employed to examine the relationships between variables and to develop the final model. Results The prevalence of psychological birth trauma among women who had experienced natural childbirth was recorded at 10.27%. The mean score and standard deviation of psychological birth trauma, fear of birth, positive coping (PC), and negative coping (NC) among these women were 19.7 ± 12.5, 76.9 ± 21.3, 35.66 ± 7.05, and 28.20 ± 7.99, respectively. Findings indicated that women’s fear of childbirth was directly (B = 0.340, p  = 0.001) and indirectly (B = 0.124, p  = 0.001) linked to women’s psychological birth trauma. Additionally, women’s PC was negatively associated with psychological birth trauma (B= -0.352, p  = 0.001), while NC was positively associated with psychological birth trauma (B = 0.199, p  = 0.001). Conclusions Chinese women who experienced natural childbirth encountered a moderate level of psychological birth trauma. Women’s coping style plays a pivotal mediating role in the connection between fear of childbirth and psychological birth trauma. Consequently, interventions aimed at diminishing women’s fear of childbirth and enhancing PC skills should be devised and implemented to alleviate women’s psychological birth trauma.

Background In clinical settings and research studies, childbirth experience is often measured using a single-item question about overall experience. Little is known about what women include in this rating, which complicates the design of adequate follow-up, as well as the interpretation of research findings based on ratings of overall childbirth experience. The aim of this study was to examine which known dimensions of childbirth experience women include in the rating on a single-item measure. Methods Ratings of overall childbirth experience on a 10-point numeric rating scale (NRS) from 2953 women with spontaneous or induced onset of labour at two Swedish hospitals were evaluated against the validated Childbirth Experience Questionnaire 2 (CEQ2), completed on one of the first days postpartum. The CEQ2 measures four childbirth experience domains: own capacity, perceived safety, professional support and participation. Internal consistency for CEQ2 was evaluated by calculating Cronbach’s alpha. NRS ratings were explored in relation to CEQ2 using empirical cumulative distribution function graphs, where childbirth experience was defined as negative (NRS ratings 1–4), mixed (NRS ratings 5–6) or positive (NRS ratings 7–10). A multiple linear regression analysis, presented as beta coefficients ( B ) and 95% confidence intervals (CI), was also performed to explore the relationship between the four domains of the CEQ2 and overall childbirth experience. Results The prevalence of negative childbirth experience was 6.3%. All CEQ2-subscales reached high or acceptable reliability (Cronbach’s alpha = 0.78; 0.81; 0.69 and 0.66, respectively). Regardless of overall childbirth experience, the majority of respondents scored high on the CEQ2 subscale representing professional support. Overall childbirth experience was mainly explained by perceived safety ( B  = 1.60, CI 1.48–1.73), followed by own capacity ( B  = 0.65, CI 0.53–0.77) and participation ( B  = 0.43, CI 0.29–0.56). Conclusions In conclusion, overall childbirth experience rated by a single-item measurement appears to mainly capture experiences of perceived safety, and to a lesser extent own capacity and participation , but appears not to reflect professional support . CEQ2 shows good psychometric properties for use shortly after childbirth, and among women with induced onset of labour, which increases the usability of the instrument.

Background Although guidelines exist for the diagnosis and treatment of those who have endured traumatic birth, the term itself is poorly defined and has no clear identifying criteria. Birth trauma has profound long-term health and quality of life sequelae. This study assessed how birth trauma was described by women who had experienced it and were followers of a public social media platform interested in the topic to help better characterize the term. Methods We posted an invitation on the Birth and Trauma Facebook Support Group website to English speaking people over age 18 years with personal experience with birth trauma to participate in an anonymous, beta-tested, IRB-approved, 18-question survey. The survey asked about demographic information, personal experiences with what the respondents perceived to be birth trauma, the settings in which it occurred and any longer-term impacts they may have noted. We calculated the percentage of participants' responses to objective questions and performed thematic analysis of the answers to the open-ended questions. Results From the approximately 6,000 online group followers, we received 1,362 responses (response rate = 22.7%). The average age of respondents was 25 years; 55% were multiparous, and half of those latter participants reported having suffered multiple episodes of traumatic birth. Most participants (73%) reported that trauma occurred during labor and delivery; 17% said it occurred at any time during pregnancy and 32.5% reported their trauma in the immediate postpartum period. Three major and two minor themes emerged to characterize their traumatic experiences. Physical trauma was the most common theme- pain, lacerations/incisions, surgical complications, hemorrhage, unplanned C-Sects.  (41.4%), but emotional - fear/anxiety about death, complications, judgment, infection, and feelings of disempowerment (21%) and unexpected adverse outcomes - premature births, intensive care stays, complications due to pre-existing chronic illness/history of infertility (17.6%) were also prevalent. Conclusion Respondents generalized “birth trauma” to include experiences throughout pregnancy. Our results suggest that many women are entering pregnancy unprepared for experiences that can have significant long-term impacts. Even multiparous women reported unexpected outcomes that they found traumatic. The themes derived from this survey provide insight into how multifaceted and complex birth trauma is, and how challenging it may be to tailor individual trauma-informed care.

Introduction Research exploring the mistreatment of birthing people in the United States is emerging rapidly within the context of increasingly poor maternal health outcomes that include unacceptable racial disparities. Previous research has explored overlap between psychological birth trauma and mistreatment using patient descriptions of birth experiences, but no previous studies have explored these issues from the perspectives of clinicians. The aim of this study was to explore whether maternity care providers’ descriptions of patient birth trauma overlap with categories of mistreatment from a globally accepted typology. Methods Content analysis was performed on a qualitative data set of 28 semi-structured interviews about patient birth trauma, completed in 2018–2019 with U.S. maternity care clinicians, including obstetricians, family physicians, midwives and labor/delivery nurses. The interviews were part of a larger study exploring maternity clinician perspectives and experiences of patient birth trauma. For this analysis Krippendorff’s method of categoric distinction was used, with categories from a globally recognized typology of maternity patient mistreatment. Results Clinicians’ descriptions of their experiences with patient birth trauma mapped onto all seven mistreatment categories, although no interview questions specifically asked about mistreatment. In more than 30 hours of interviews, transcribed to more than 800 pages, the word mistreatment appears only once, suggesting that some healthcare providers may use the phrase “birth trauma” as a euphemism to describe mistreatment. Eighteen of 28 interviews included at least one description that fit into a mistreatment category. “Failure to meet professional standards of care” was the category with the most mapped clinician statements, followed by “Stigma and discrimination” and “Poor rapport between women and providers.” Conclusions This study contributes new insight into maternity clinicians’ conceptualization of patient trauma and how their descriptions of birth trauma overlap with mistreatment. Clinicians implicitly connected mistreatment with some patient experiences of birth trauma, even when they were not specifically asked about mistreatment. Findings point to a need for further research into mistreatment, including routinized “everyday care” that may include mistreatment, particularly for marginalized and historically excluded birthing people. Future research also must explore the potential role of mistreatment in poor and inequitable U.S. birth outcomes. Plain language summary Many people giving birth in the United States experience poor health outcomes, and there is a wide racial disparity, with people of color more likely to experience poor outcomes. In recent research, birthing people reported that they were mistreated during their labor and delivery, including being shouted at, scolded, or threatened. Mistreatment accounts were more frequent among women of color. Previous research has looked at patient reports about their birth experiences to explore whether their descriptions of psychological trauma include overlap with mistreatment, but no other studies have looked at descriptions of birth trauma from the perspectives of medical clinicians. The objective of this study was to explore whether maternity care providers’ descriptions of patient birth trauma overlap with categories of mistreatment from a globally accepted list. This study analyzed the content of 28 semi-structured interviews about patient birth trauma, completed in 2018–2019 with obstetricians, family physicians, midwives and labor/delivery nurses. In the interviews, participant descriptions of patient birth trauma fit into all seven mistreatment categories. Participant descriptions included examples of patients receiving medical procedures or treatments without first giving consent, nurses avoiding the rooms of patients who do not speak English, and other forms of mistreatment. Participants were not asked specifically about mistreatment, but they described birth trauma by giving examples of mistreatment, which suggests that some healthcare providers may use the phrase “birth trauma” when talking about “mistreatment.” This study shows a need for further research into mistreatment, including routine “everyday care” that may include mistreatment.

Background Childbirth experience could be complicated and even traumatic. This study explored the possible risk factors for post-traumatic stress disorder following childbirth (PTSD-FC) in mothers and partners. Methods Through a cross-sectional online survey biographical, medical, psychological, obstetrical and trauma history data were collected. The PTSD-FC, postnatal depression, social support, and perceived mother-infant bond in 916 mothers and 64 partners were measured through self-reported psychometric assessments. Results Our findings highlight the possible impact of several risk factors such as emergency childbirth, past traumatic experiences and distressing events during childbirth on PTSD-FC. The difficulties in mother-infant bond and the postpartum depression were highly associated with the total score of PTSD-FC symptoms for mothers. While for partners, post-partum depression was highly associated with the total score of PTSD-FC. Conclusions Our study demonstrated significant links between psychological, traumatic and birth-related risk factors as well as the perceived social support and the possible PTSD following childbirth in mothers and partners. Given that, a specific attention to PTSD-FC and psychological distress following childbirth should be given to mothers and their partners following childbirth.

Adrenal hemorrhage due to birth trauma is a complication that can be seen in neonates. The most common symptoms are anemia, prolonged jaundice, and a palpable mass in the abdomen. It can rarely lead to hypertension secondary to the compression effect. The clinical manifestations of hypertension in neonates may sometimes be very difficult to detect. In this article, we present a case of hypertension that developed in a neonate who had a history of birth trauma and adrenal hemorrhage. It has been reported only a few cases in the English-language literature. Therefore, neonates who had a history of birth trauma, especially adrenal hemorrhage, should be monitored carefully for hypertension. [Natl J Physiol Pharm Pharmacol 2015; 5(2.000): 157-159]