Development and psychometric testing of a scale for assessing the psychological birth trauma

Psychometric properties of self-reported measures of psychological birth trauma in puerperae: A COSMIN systematic review

PURPOSE

To identify and evaluate the psychometric properties of available patient-reported outcome measures (PROMs) of psychological birth trauma (PBT) in postpartum women.

METHODS

A literature search was carried out across eight databases-PubMed, Embase, Web of Science, CINAHL, PsycINFO, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database for Chinese Technical Periodicals-covering studies published from the inception of each database up to 21 May 2024. English and Chinese language studies employing any research design and reporting at least one psychometric property of PBT in puerperae were included. Independent reviewers extracted data and followed the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines to evaluate three aspects of the included instruments: methodological quality, psychometric properties, and level of evidence assessed using the modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

RESULTS

Thirty-one studies with twelve PROMs were included, measurement error, cross-cultural validity, and responsiveness were not reported for most PROMs. Nine PROMs received a Class B recommendation, based on their measurement attribute ratings and overall evidence quality. In contrast, the CTI, IES-R, and PBTAS with high-quality evidence for insufficient measurement properties, so received a Class C recommendation.

CONCLUSIONS

This systematic review provisionally recommends the City BiTS as credible tool for assessing PBT in both clinical practice and research involving puerperae. However, further comprehensive studies are needed to conduct more comprehensive validations of the psychometric properties of existing PROMs.

Mediating role of childbirth readiness in the relationship between social support and psychological birth trauma in primiparous women: a nationwide cross-sectional study in China

OBJECTIVE

To examine the relationship between social support and psychological birth trauma among Chinese primiparous women and the mediating effects of childbirth readiness.

DESIGN

A cross-sectional study was conducted between November 2021 and March 2022.

SETTING

10 general tertiary hospitals and 3 specialised maternity hospitals in 7 provinces in China.

PARTICIPANTS

A total of 751 primiparous women were recruited for this study.

OUTCOME MEASURES

The questionnaires consisted of questions on demographic characteristics, the Birth Trauma Scale, the Chinese Mandarin version of the Medical Outcomes Study Social Support Survey and the Childbirth Readiness Scale. Hierarchical multiple regression was used to explore the associated factors and mediating role of childbirth readiness in the relationship between social support and psychological birth trauma. The mediating model was examined by the PROCESS macro for SPSS.

RESULTS

After adjusting for demographic variables, social support was negatively associated with psychological birth trauma (r=-0.242, p<0.01). Childbirth readiness had a positive correlation with social support (r=0.206, p<0.01) and a negative correlation with psychological birth trauma (r=-0.351, p<0.01). The hierarchical multiple regression model indicated that social support and childbirth readiness explained 3.9% and 7.7% of the variance in psychological birth trauma, respectively. Childbirth readiness partly mediated the association between social support and psychological birth trauma for primiparas.

CONCLUSIONS

Childbirth readiness plays a mediating role between social support and psychological birth trauma among primiparas. Strategies and interventions to enhance childbirth readiness levels may be expected to improve the impact of social support on women's psychological birth trauma.

The influence of sense of coherence on psychological birth trauma: a parallel mediation model based on health Salutogenesis theory

Background

Psychological birth trauma has been associated with a variety of negative consequences for mothers, partners, newborns, and midwives. While prior research has identified demographic and clinical factors that may contribute to the development of psychological birth trauma, interventions targeting these factors can prove challenging. Therefore, the aim of this study was to explore how psychological birth trauma is influenced by psychosocial factors including Sense of Coherence, Childbirth-related Fear, Social Support and Childbirth Readiness.

Methods

A cross-sectional study was conducted in 13 tertiary or secondary hospitals in mainland China from November 2021 to June 2022. One thousand three hundred and sixty-six women were recruited totally. Data regarding basic characteristics, Sense of Coherence (SOC, Sense of Coherence Scale-3), Childbirth-related Fear (CBRF, Fear of Childbirth Scale), Social Support (SS, Medical Outcomes Study Social Support Survey), Childbirth Readiness (CR, Childbirth Readiness Scale) and Psychological Birth Trauma (PBT, Psychological Birth Trauma Scale) were collected. Parallel mediation analysis was adopted to identify the underlying mechanisms between study variables.

Results

It was found that: (1) SOC has been found to have both direct and indirect effects on PBT. Women with higher level of SOC tend to report lower level of PBT; (2) the indirect effect of SOC on PBT was significantly exerted through CBRF, SS and CR; (3) CBRF was found to weaken the protective effect of SOC, whereas SS and CR were found to enhance it. No significant difference was found in contracts of the three specific indirect effects.

Conclusion

SOC, CBRF, SS, and CR should be paid enough attention when designing intervention programs for women who might experience PBT. Interventions targeting SOC and CR are more likely to yield positive outcomes.