Validation of the City Birth Trauma Scale to assess post-traumatic stress symptoms in maternity staff

Each year, 295,000 women die from pregnancy or childbirth complications, with many more women and babies experiencing severe complications. Maternity staff are often exposed to these events and can develop post-traumatic stress symptoms or disorder (PTSD). However, there are currently no tools to specifically identify and assess birth-related PTSD in maternity staff. This study therefore adapted and validated the City Birth Trauma Scale (City BiTS) for this purpose.

The City BiTS (Maternity staff) was completed by 396 maternity health professionals recruited in three waves between 2016 and 2023. Participants reported their experiences with traumatic birth events and completed the scale to assess PTSD symptoms. Psychometric analyses were used to determine internal consistency, factor structure, and construct validity.

Over half of participants had witnessed severe injuries (55.9 %) or deaths (41.4 %), and 30.7 % met PTSD diagnostic criteria (95 % CI 26.2 - 35.5). The scale demonstrated good internal consistency (α = 0.95) and construct validity. PTSD symptoms were associated with greater perceived trauma (rho 0.37, p<.001), poorer coping (-0.30., p<.001), and symptoms were greater after births involving maternal or infant deaths (Mann-Whitney U 18,609, p = .05). Both 2-factor and 3-factor structures were supported, with the main subscale of Birth-related symptoms accounting for most variance (53.82 %) in both analyses. Remaining items either grouped into one subscale of General symptoms (fixed 2-factor model) or split into Hyperarousal and Anhedonia & detachment subscales (3-factor model).

Traumatic births have a significant psychological impact on maternity staff. The adapted City BiTS (Maternity staff) shows promise for identifying PTSD symptoms in this group, though further refinement of its factor structure is recommended.