This questionnaire-based, cross-sectional study was conducted on women who had a vaginal delivery admitted to a grade III-A general hospital using convenience sampling between February and April of 2024. The team’s previous research examined the influencing factors of postpartum trauma within 3 days post-delivery. This current study extends that investigation to explore the influencing factors of postpartum trauma at 42 days post-delivery, comparing these factors with those observed within the initial 3 days to better understand the changes in postpartum trauma over time. The inclusion criteria were: (1) vaginal delivery; (2) single birth; (3) Gestational age ≥ 36 weeks; and (4) Neonatal Apgar score ≥ 7 points. The exclusion criteria were: (1) Postpartum hemorrhage occurs after delivery; (2) Perineal degree III and IV cleft; (3) Instrument-assisted delivery; (4) women with imperfect information; and (5) Who did not complete the scale assessment twice. The sample size was determined using the 10 EPV principle (16), considering multiple factors. A total of 30 independent variables were involved in this study. When EPV = 10, the required research objects were 300, and the incidence rate of PBT reported in literature was about 60%. The total required sample size was 300÷50% ≈ 180. Considering that there is a 20% shedding rate, in order to avoid errors as much as possible, the sample size is required to be 216 cases, and the final number of included samples is 306 cases. This study received approval from the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University, China, and complied with ethical standards under ethics number K2024-082-01.

Data analysis was performed using SPSS 23.0 statistical software (IBM, United States). Normally distributed continuous variables are presented as mean ± standard deviation (SD) and were compared using independent sample t-tests and analysis of variance (ANOVA) for between-group comparisons. Categorical variables were presented as counts and percentages. Pearson correlation analysis explores the correlation between PBT and PP-PTSD. Perform multiple linear regression analysis on items with a p-value <0.05 in the uni-variate analysis, The significance level was set at α = 0.05.

Psychological birth trauma and childbirth-related posttraumatic stress disorder represent a substantial burden of disease with 6.6 million mothers and 1.7 million fathers or co-parents affected by childbirth-related posttraumatic stress disorder worldwide each year (19). The main risk factors and causes of PBT are as follows, During pregnancy, risk factors most strongly associated were depression, fear of childbirth, poor health or complications of pregnancy, history of trauma, or previous psychological therapy for pregnancy or birth-related problems. During birth, risk factors most strongly associated were negative subjective birth experiences, operative birth (assisted vaginal delivery or cesarean delivery), and dissociation (including depersonalization, derealization, and emotional numbness) (20). Considering the harm of PBT, this study further investigated the risk factors of PBT in Chinese population.

This study examined the incidence of postpartum trauma at 3 and 42 days postpartum using the BTPS-WVD scale. The findings indicated that the severity of PBT increased over time following childbirth, suggesting the need for extended care to monitor maternal mental health during this critical period. Hospitals should implement comprehensive follow-up programs, families should maintain continuous support for maternal well-being, and society should increase its involvement in providing resources and assistance. Additionally, integrating psychologists into home-based support systems can help mothers navigate this challenging period characterized by elevated PBT levels. The median PBT scores in this study were 41 and 44 at 3 and 42 days postpartum respectively, and the number of people with PBT above the median at 3 and 42 days postpartum were 55 and 61%, respectively. Due to the lack of objective diagnostic criteria at present, the incidence of PBT varies substantially among studies (21), ranging from 9 to 44%. The differences in outcomes could be attributed to the following subjective and objective factors, medical intervention, maternal and newborn safety/separation, environment, delivery expectation, loss of control, doctor-patient communication and support (22). Murphy et al. (23) interviewed 4 women with PBT experience after their first delivery through narrative research method, and the results showed that early family planning with medical staff was a protective factor to avoid reoccurrence of trauma. Greenfield et al. (24) investigated 9 pregnant women who had undergone PBT and had a second pregnancy using longitudinal grounding theory and discovered that they had a strong desire to avoid suffering PBT again. They agreed that having access to credible information from specialists and collaborating with professionals to create and confirm pregnancy and family planning in the early stages of pregnancy were helpful approaches to avoid additional trauma.

The average score of PP-PTSD at 3 and 42 days postpartum was no statistical significance, with positive rates of 5 and 2%, respectively. In the UK and Australia, the prevalence of PP-PTSD in large-sample studies ranges from 1 to 6% (25, 26), Wang Meifang (27) conducted PP-PTSD surveys at 1–3, 4–6, and 7–12 months postpartum. The results showed that the positive rates of PP-PTSD were 10.8%, 12.6%, and 15.1%, respectively. The differences in positive PP-PTSD rates over the three periods were not statistically significant, implying that postpartum women’s PP-PTSD status remained rather consistent over the course of a year. However, the findings of this study suggest the incidence of post-traumatic stress disorder steadily falls after delivery, indicating that the severity of post-traumatic stress disorder decreases over time. Possible reasons include the body’s recuperation following childbirth, which enables it to adequately care for both itself and the newborn. As a result, it is critical to aid postpartum women in recuperating physically and mentally throughout the postpartum period in order to reduce the detrimental influence of the traumatic event during childbirth on their psychological health. This study found that the four components of the BTPS-WVD Scale, namely medical support, labor pain, family support, and delivery outcome, are all positively connected with post-traumatic stress disorder (PTSD). The ERTAN (8) study also indicated that birth trauma is a risk factor for postpartum traumatic stress disorder, which is in line with the findings of this study. As a result, all four dimensions of birth trauma deserve account, and interventions before and after labor can be based on these four components.

The research on PBT can be traced back to as early as 1996, according to a study (5). Furthermore, there has been a consistent increase in the number of papers published in this field over the past 3 years, indicating an enduring scholarly interest in maternal psychology. The impact of PBT extends beyond the physical and mental health of the women, encompassing her family, marital relationship, and even society itself. Therefore, it is imperative to address this global public health issue (22). The identification of the factors that contribute to PBT during delivery can enable the early identification of high-risk groups, the formulation of intervention strategies, the improvement of maternal mental health management, and the advancement of the health of both mothers and infants. The interventions referred to in the previous literature are as follows: Enlarging prenatal education to enhance maternal knowledge and improve psychological resilience, thereby lowering the incidence of PBT during delivery (30). Strengthening maternal family support and medical assistance, providing spouses with intimate physical contact and continuous support (40), can contribute to mitigating the degree of PBT. Previous meta-analyses demonstrate that proactive and early psychological intervention implemented by healthcare providers within 72 h postpartum proves effective in alleviating PBT symptoms in women during the 4–6 weeks postpartum period (41). Iranian scholar Hajarian Abhari et al. (42) offered Gamble psychological counseling at 35, 36, 37 weeks, and 4–12 h postpartum. Each session centered on: establishing a therapeutic relationship with women in vaginal delivery, introducing prenatal and postpartum problems, supporting the expression of emotions, facilitating the establishment of a connection between behavior, emotions, and delivery, and encouraging the sharing of the delivery. The results demonstrated that Gamble psychological counseling could effectively reduce the incidence of PBT after delivery. Taheri et al. (43) undertook semi-structured interviews with pregnant women, spouses, and healthcare professionals to summarize the prevention strategies for PBT, which comprise, intensifying prenatal training, providing a conducive delivery environment, appropriate care measures, such as pain alleviation and avoidance of excessive manipulation, and creating a favorable working atmosphere for midwives to elevate the quality of midwifery care. At present, the intervention measures remain in the development stage. Larossa et al. (44) explored the neurobiology and attachment implications of early tactile experience and discussed the importance of early postpartum experience in mitigating birth-related trauma. According to the results of the previous study, the research team conducted a continuous study on the intervention of labor trauma in women with vaginal delivery, and the specific intervention method was to improve the PBT level through the postpartum Internet-based care integrated with extended support services. In future studies, we propose extending the follow-up periods for assessing PBT status to 3 months, 6 months, and 1 year postpartum. This will provide a more comprehensive understanding of the changes in postpartum PBT among women who have undergone vaginal delivery. This will provide theoretical underpinnings for the prevention of postpartum PBT.

In conclusion, women who experienced PBT during vaginal delivery reported significantly higher levels of perceived trauma at 42 days postpartum compared to 3 days postpartum. Mother separate from the newborn, separation time between mother and newborn, place of puerperium, psychological discomfort caused by delivering with others, the effects of wound pain, time of wound pain, who decides on abnormal delivery were its risk factors. Healthcare workers, families, and society are obligated to implement targeted and individualized nursing strategies for high-risk groups so as to diminish the perceived extent of PBT among women who had a vaginal delivery and ensure the mental well-being of women during the perinatal period. However, the study exhibited several limitations that warrant consideration. The sample was derived from a single center, and the use of convenience sampling may introduce biases, including but not limited to geographical and age distribution biases. The study did not conduct a comparative analysis between populations with high and low PBT levels. The number of factors considered in the analysis was limited, which could be expanded in future research to address these limitations more comprehensively. Lastly, The BTPS-WVD scale has only been validated in the Chinese population, suggesting the need for further research on global applicability.