Associations Between Childbirth-Related Posttraumatic Stress Symptoms and Mother–Infant Bonding Difficulties: The Role of Maternal Stress and Perceived Infant Regulatory Difficulties

Background: Childbirth-related posttraumatic stress symptoms (CB-PTSS) have been associated with impaired mother–infant bonding, but the factors underlying this relationship remain unclear. This study examined whether maternal stress and perceived infant regulatory difficulties (PIRD) independently accounted for the association between CB-PTSS and mother–infant bonding difficulties in a statistical mediation model. Methods: This cross-sectional study included 542 Portuguese mothers of infants aged up to 24 months. Participants completed validated measures of CB-PTSS, maternal stress, perceived infant regulatory difficulties, and mother–infant bonding. Hierarchical regression and parallel mediation analyses were conducted. Results: Higher CB-PTSS were associated with greater maternal stress, more perceived infant regulatory difficulties, and greater bonding difficulties. Perceived infant regulatory difficulties explained additional variance beyond CB-PTSS and maternal stress. Both maternal stress and infant regulatory difficulties showed significant independent indirect effects, while the direct association between CB-PTSS and bonding difficulties remained significant, indicating partial mediation. Given the cross-sectional design, these findings should be interpreted as statistical associations rather than evidence of temporal or causal relationships. Longitudinal studies are needed to establish temporal ordering and directionality. Conclusions: Maternal stress and perceived infant regulatory difficulties may represent key statistical correlates linking traumatic childbirth to bonding difficulties and constitute promising targets for early screening and intervention.