Birth satisfaction and symptoms of childbirth related PTSD among women in Iceland: A population-based study

• 5.7 % of participants indicated symptoms of CB-PTSD. • Increased satisfaction with care during labor and birth was strongly associated with less symptoms of CB-PTSD. • Primiparity, being single, a psychological diagnosis and operative birth were associated with increased CB-PTSD symptoms. • Anxiety, depression and lack of interest during pregnancy were factors significantly associated with symptoms of CB-PTSD • Emphasizing sense of control, effective communication and shared decision making during labor may reduce CB-PTSD symptoms. Given its complexity, childbirth can elicit both positive and negative psychological reactions and, in some cases, women may experience symptoms of childbirth-related post-traumatic stress disorder (CB-PTSD). Several risk factors for CB-PTSD have been identified previously, including history of mental health issues and childbirth related complications. The aim of our study was to explore the role of satisfaction with care in CB-PTSD symptoms. CB-PTSD was measured with the City Birth Trauma Scale (CityBiTS), a questionnaire with 29 items distributed according to DSM-5 diagnostic criteria. A CityBiTS score >28 points was defined as CB-PTSD symptoms. Birth satisfaction was measured with the Birth Satisfaction Scale-Revised (BSS-R), a self-report questionnaire. Logistic-regression was used to calculate odds ratios and 95 % confidence intervals for the association between birth satisfaction and CB-PTSD, adjusted for age, relationship status, education, income, parity, mode of birth, postpartum depression and maternal and infant health-related problems during pregnancy and birth. Of 600 participants, 34 (5.7 %) indicated symptoms of CB-PTSD. When adjusted for socio-demographic and pregnancy and birth-related factors, birth satisfaction was independently associated with symptoms of CB-PTSD. For each additional point on the BSS-R, the odds of having CB-PTSD symptoms decreased by 16%. Support during labor and birth, effective communication and shared decision making were factors significantly associated with CB-PTSD symptoms. Increased satisfaction with care was strongly associated with less symptoms of CB-PTSD. Emphasizing sense of control with support, effective communication and shared decision making may significantly improve the overall experience for women and possibly reduce CB-PTSD symptoms.