Heterogeneity in maternal perceptions of psychological birth trauma: a latent profile analysis and predictor study

The heterogeneity in maternal childbirth trauma perception remains poorly understood, hindering the development of targeted prevention strategies. Identifying distinct risk subgroups and their associated modifiable factors is crucial for informing early interventions aimed at reducing the risk of Postpartum Post-Traumatic Stress Disorder (PP-PTSD).

To identify heterogeneous classes of maternal perceived childbirth trauma and to examine their cross-sectional correlates and short-term longitudinal associations with the development of PP-PTSD symptoms from 3 to 42 days postpartum.

This prospective longitudinal study enrolled 300 women following vaginal delivery at a tertiary hospital in Chongqing between February and April 2024. Participants were assessed at two time points: 3 days and 42 days postpartum.

The primary outcome was childbirth trauma perception, measured using the Birth Trauma Perception Scale for Women During Vaginal Delivery (BTPS-WVD). PP-PTSD symptoms were assessed with the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version (PCL-C). Associated factors examined included perineal pain, breast engorgement, mother-infant separation, and partner support, collected via structured questionnaires.

Latent profile analysis identified four trauma perception classes based on changes in perception scores between the two time points: severe (C1, 13.67%), high (C2, 20.67%), moderate (C3, 48.33%), and low (C4, 17.33%). Factors associated with a lower likelihood of belonging to the high-risk classes (C1/C2) included laboring in shared rooms (OR = 0.362), abnormal fetal heart rate during labor (OR = 0.314), and having the husband as the primary caregiver (OR = 0.410). Factors associated with a higher likelihood included severe breast engorgement affecting mood (OR = 7.084), perineal pain lasting >2 days (OR = 4.019), pain interfering with daily life (OR = 4.899), and mother-infant separation (OR = 4.600). Notably, PTSD symptom scores showed a significant increase from 3 to 42 days postpartum in the severe and high trauma perception classes (C1 and C2) compared to the moderate and low classes (C3 and C4; P < 0.05), suggesting that early trauma perception class membership is associated with subsequent symptom worsening.

Maternal childbirth trauma perception exhibits four distinct classes, characterized by different patterns of early postpartum change. Postpartum physical discomfort and mother-infant separation emerged as key modifiable associated factors, while a supportive intrapartum environment and partner involvement appeared protective. The observed association between high-risk trauma perception classes and subsequent worsening of PTSD symptoms highlights the potential value of early identification. Future targeted interventions focusing on pain management, lactation support, and enhanced partner engagement may be beneficial, though prospective validation of these factors as predictors is warranted.