Composite indicators of neonatal morbidity specific to Métis populations in Canada are lacking. To estimate the incidence of neonatal morbidity and neonatal death among Métis neonates in Alberta, and to identify maternal and neonatal factors associated with neonatal morbidity. Population-based retrospective cohort study including all singleton live births to Métis mothers in Alberta between April 2006 and March 2016. Hospital discharge data were used to evaluate the Neonatal Adverse Outcome Indicator (NAOI), which comprises a set of newborn medical complications and neonatal death. We estimated overall and annual NAOI incidence proportions and overall neonatal mortality. Multilevel regression models were used to estimate adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) for maternal and neonatal characteristics associated with NAOI. Among 7853 neonates, the overall NAOI incidence proportion was 10.1% (95% CI 9.5, 10.8), ranging annually from 7.7% (95% CI 6.1, 9.7) to 11.9% (95% CI 8.1, 17.2). The most common conditions were respiratory conditions originating in the perinatal period (4.8%, 95% CI 4.3, 5.3) and birth trauma (3.4%, 95% CI 3.0, 3.8). The overall neonatal mortality rate was 2.9 per 1000 live births (95% CI 1.9, 4.4). Increased risk of NAOI was associated with pre-pregnancy disease (aRR 1.27, 95% CI 1.03, 1.51), pregnancy-related disease (aRR 1.92, 95% CI 1.65, 2.18), assisted vaginal delivery (aRR 2.52, 95% CI 2.09, 2.94), caesarean delivery (aRR 1.23, 95% CI 1.04, 1.41), male sex (aRR 1.27, 95% CI 1.09, 1.42), preterm birth (aRR 4.36, 95% CI 3.71, 5.00) and any congenital malformation (aRR 2.71, 95% CI 1.87, 3.56). The incidence of neonatal morbidity among Métis neonates in Alberta highlights the importance of continued surveillance using standardised indicators. Incorporating NAOI into perinatal and obstetric care may inform culturally responsive improvements in care.

INTRODUCTIONTraumatic birth experiences are increasingly recognized as a significant issue in maternity care. While many studies focus on the perspectives of birthing persons, little is known about how healthcare providers perceive the causes of traumatic births and possible strategies to prevent them. This study explores obstetric care providers’ perceptions of factors contributing to traumatic birth experiences and their suggestions for improving trauma sensitive obstetric care.METHODSA convergent parallel mixed methods design was used. An online survey among obstetric care providers in Germany was conducted between October 2024 and February 2025 (n=102). Quantitative data were analyzed descriptively and using logistic regression models. In addition, four expert interviews were conducted and analyzed using qualitative content analysis. Findings from both strands were integrated during interpretation.RESULTSMost respondents defined traumatic birth experiences primarily through loss of control (85.3%) and negative emotions (75.5%). Lack of communication and information was identified as the most important contributing factor (97.1%), followed by lack of emotional support (89.2%). Emotional support was rated as the most important preventive measure (mean=4.86; SD=0.51). The main barriers to trauma sensitive care were lack of time (mean=4.52; SD=0.81) and staff shortages (mean=4.35; SD=0.83). Interview findings highlighted structural challenges, the importance of reflective practice among caregivers, and the need for systematic training in trauma sensitive communication.CONCLUSIONSThe findings highlight the need to strengthen trauma sensitive approaches in obstetric care through improved communication, emotional support, and shared decision making. In addition to structural improvements such as adequate staffing, regular training and reflective practice among providers may help reduce traumatic birth experiences.

Perinatal depression affects up to 30% of women in Kenya, yet many contributing factors remain poorly understood. We explored mental health problems, social needs, and associated risk factors among women ante- and postnatally in Kajiado County, southern Kenya, from the perspectives of women and health-care workers (HCWs). We conducted a qualitative study based on dual-perspective focus group interviews with mothers (ante- and postnatal) and HCWs in five health-care facilities (two urban and three rural) across Kajiado County (5-11 March 2025). Interviews were recorded, transcribed verbatim, translated into English when needed, and analysed using qualitative content analysis with an explorative and inductive approach. The text was divided into meaning units and manually coded in Atlas.ti ( https://atlasti.com ). Themes, subthemes and categories were articulated following a stepwise, iterative and reflexive process of abstraction and interpretation. Across five sites, 51 mothers and 39 HCWs participated. Three themes were developed relating to stress, distress and affecting mental wellbeing, (a) Women's autonomy and self-determination - mothers lacked control over resources or decision-making, while shouldering most household responsibilities, and HCWs highlighted the vulnerability of girls subjected to early marriage and female genital mutilation, often unprepared for motherhood, (b) Responsive maternal and mental health care - distance, costs, and low expectations limited access, while women feared traumatic births, miscarriage, and caesarean sections, and (c) Community knowledge and acceptance of mental health problems - mental health problems were often seen as irrationality or spiritual possession, delaying care. Stigma was particularly associated with caesarean sections, mental health problems, and HIV. Our findings describe how maternal mental health is closely intertwined with gender norms and prevailing perceptions of mental illness including stigma. Expanding maternal mental health services may be important but it is unlikely to be sufficient in isolation. Sustainable change may depend on the promotion of women's rights, increased mental health literacy at the community level, and the engagement of men. In addition, fear of traumatic birth and stigma associated with CS may need to be addressed not only at the individual level but also within the broader community context.

Postpartum Post-Traumatic Stress Disorder (PTSD) is a significant mental health concern for postpartum women. In Malawi, there were no data showing the prevalence of Postpartum Post-Traumatic Stress Disorder and no validated Chichewa tool for assessing Postpartum PTSD. City Birth Trauma Scale (CityBiTS) is a tool that is used to assess Postpartum PTSD. CityBiTS is the best choice because it was developed specifically to measure trauma related to childbirth, tailors to the unique psychological, physical and emotional experiences of postpartum women. The tool also adheres to DSM-5 Criteria and has been validated across cultures which has shown high reliability and credibility to be used in clinical practice and research. The study aimed at assessing the diagnostic accuracy of the Chichewa Version City Birth Trauma Scale at Postnatal clinics in Lilongwe District, Malawi. The study's objectives were; to determine the prevalence of postpartum PTSD and establish the psychometric properties of Chichewa Version of the City Birth Trauma Scale in Malawi. It was a cross-sectional study conducted at two hospital facilities and these were Bwaila Hospital and Area 25 Health Centre postnatal clinics in Lilongwe District, Malawi. English City Birth Trauma Scale was translated into Chichewa version and adapted. A total of 384 postnatal mothers were selected by systematic random sampling technique. Data was analysed by SPSS version 23 and Sensitivity Analysis was done to examine the psychometric properties. The prevalence of Postpartum PTSD was 22.6% [95% CI 18.8% - 27.1%] on Structured Clinical Interview for Diagnostic Statistical for Mental Disorders Version 5 and 10.9% [95% CI 7.9% - 14.5% on City Birth Trauma Scale. The following psychometrics were established: Cronbach's alpha 0.780, ROC 0.872, sensitivity 81.6% [95% CI 71.8%-89.1%], specificity 78.9% [95% CI 73.8%-83.4%], Positive Predictive Value 53.0% [95% CI 47%-58.9%], Negative Predictive Value 93.6%, [95% CI 90.4%-95.8%] optimum cut-off score > 23, Youden Index 0.605, Exploratory Factor Analysis for variance 65.6%.Factor 1 which are birth-related symptoms and factor 2 which are general symptoms emerged and all items loaded except items 10 and 17 and Convergent Validity at 0.65. The prevalence rate of Postpartum PTSD and Psychometric properties were consistent with other studies affirming its utility. The study determined the information on prevalence of Postpartum PTSD. It further demonstrated that Chichewa Version City Birth Trauma Scale is a reliable, accurate and valid tool for screening Postpartum PTSD with good psychometric properties for clinical practice and research.

Tokophobia refers to a clinically significant fear of childbirth that affects women across the reproductive lifespan. Given its prevalence and association with adverse mental health, obstetric, and reproductive decision-making outcomes, valid and reliable measures are essential to identify women at risk of tokophobia. Tokophobia Severity Scale (TSS) psychometric properties were analyzed in nulliparous non-pregnant, pregnant, and women in the postpartum using data from cross-sectional and longitudinal studies conducted in four countries: Australia, Lithuania, Poland, and Portugal. Sample (n = 1,585) comprised nulliparous non-pregnant (Poland, n = 559), pregnant (Lithuania, n = 197, Portugal, n = 353), and women at two months postpartum (Australia, n = 292; Lithuania, n = 184). Participants completed the TSS, and self-reported questionnaires on sociodemographic, obstetric, fetal/neonatal, mental health-related characteristics, depressive and anxiety symptoms, birth trauma perception, and another measure of fear of childbirth (FOC). Results supported a three-factor model: fear, coping, and intrusive thoughts. Invariance was found across childbearing-age periods and countries. Cronbach's alpha and McDonald's omega coefficients for the TSS total score were 0.89-0.90. Known-group validity was established with differences in sociodemographic, obstetric, fetal/neonatal, and mental health-related characteristics. Concurrent validity was found with depressive and anxiety symptoms, and birth trauma perception. Convergent validity was found with another FOC measure. TSS scores in pregnancy predicted elective cesarean section, birth trauma perception, and postpartum depressive and anxiety symptoms. TSS discriminates women with or without clinically significant tokophobia symptoms in childbearing-age periods and countries. TSS is a psychometrically strong measure that can be used to screen clinically significant tokophobia symptoms.

Traumatic perceptions of childbirth and beliefs about the birth process may influence the emotional bond formed between a mother and her unborn baby. This study aimed to examine the relationships between traumatic birth perception, birth beliefs, and prenatal attachment in pregnant women. This descriptive and correlational study was conducted between December 2024 and June 2025 in the antenatal outpatient clinic of a hospital located in the Central Anatolia region of Türkiye. A total of 390 pregnant individuals who attended the clinic during the study period were included. Data were collected using a Personal Information Form, the Traumatic Childbirth Perception Scale (TCPS), the Birth Beliefs Scale (BBS), and the Maternal Antenatal Attachment Scale (MAAS). The participants had a mean age of 24.23±3.70 years, and most were in the third trimester of pregnancy (72.6%). Overall, participants reported moderate levels of traumatic childbirth perception and relatively high prenatal attachment. Correlation analyses indicated a statistically significant but small negative association between traumatic childbirth perception and prenatal attachment (r=-0.155, p<0.01). Prenatal attachment was also positively associated with beliefs that conceptualize childbirth as a natural process; however, this relationship was likewise small in magnitude (rₛ=0.103, p<0.05). Multiple regression analysis further showed that traumatic childbirth perception was a significant but small negative predictor of prenatal attachment (β=-0.157, p<0.01). Traumatic childbirth perception was inversely associated with prenatal attachment, whereas beliefs that conceptualize childbirth as a natural process were positively associated with prenatal attachment. The findings suggest that addressing traumatic childbirth perceptions and supporting positive childbirth beliefs may be relevant considerations in antenatal care practices aimed at promoting prenatal attachment.

Symptom presentation of childbirth-related post-traumatic stress in 31 countries: the INTERSECT study.

The mediating role of rumination in the relationship between traumatic childbirth perception, birth satisfaction, and postpartum depressive symptoms.

IntroductionThe first year after childbirth is a critical yet insufficiently monitored period for parental health. Postpartum mental and physical morbidity can affect both mothers and co-parents, but national longitudinal data remain scarce. The Stress Of Co-parents Related to A Traumatic Experience of birth across Switzerland (SOCRATES) cohort study aims to describe maternal and co-parental health and well-being trajectories during the first year after childbirth.Methods and analysisSOCRATES is a prospective, population-based cohort study conducted in all linguistic regions of Switzerland. Eligible participants include women aged 14 and above who gave birth to a live or stillborn infant (≥22+0 weeks’ gestation and ≥500 g) and their cohabiting co-parents, provided they speak German, French, Italian or English. Recruitment was conducted in 81 of the 112 Swiss maternity units, birth centres and organisations of midwives over 6 weeks in spring 2025. Clinical data on pregnancy, childbirth and the early postpartum period are extracted from medical records. Postpartum hospitalisation data are obtained through linkage with national medico-administrative databases. Participants complete online questionnaires shortly after birth and at 2, 6 and 12 months post partum, including sociodemographic characteristics and patient-reported outcomes. The primary outcome is the prevalence of childbirth-related post-traumatic stress disorder at 2 months, assessed using the City Birth Trauma Scale. Secondary outcomes include depression, physical recovery, sexual health, quality of life, healthcare use, perceived care quality and overall well-being. A weighting procedure will be used to ensure representativeness and to account for attrition.Ethics and disseminationEthical approval was granted by all seven Swiss ethics committees (number 2024-02262). All participants provided informed consent. Findings will be disseminated through national and international conferences, peer-reviewed publications, policy briefs, social media and stakeholder engagement activities.Trial registration numberNCT06886841.

"We shouldn't have to beg to be heard" - A qualitative framework analysis of the public submissions to the NSW Birth Trauma Inquiry.

Maternal-infant early bonding, a robust precursor for later healthy infant development, may be jeopardized by maternal early exposures to adverse experiences (ACEs). Both psychological and biological aspects of maternal functioning have been identified as potential putative mechanisms for the deleterious effects of ACEs on maternal-infant bonding, but research has rarely included both in mediation testing, limiting our understanding of the relative contributions of each. We prospectively evaluated the direct and indirect effects of maternal report of ACEs on mother-infant bonding using pregnancy maternal mental health (depression, anxiety, and posttraumatic stress symptoms) and cortisol levels, a marker of HPA-axis functioning. Participants were 446 women recruited from the community; poverty and intimate partner violence (IPV) were overrepresented in our sample. Women completed self-report surveys during their pregnancy and at 1 month postpartum. Baseline cortisol levels were assessed in the laboratory during late pregnancy. A structural equation model to test sequential mediation was estimated and included relevant covariates (race, IPV, traumatic birth). There was a significant indirect effect of ACEs on maternal-infant postpartum bonding via late-pregnancy mental health, but not through maternal late-pregnancy baseline cortisol levels. Our findings underscore the potential for screening and therapeutic intervention addressing depression, anxiety, and PTSD symptoms during pregnancy among women with ACEs history, with benefits that may span two generations and set the stage for a healthy mother-child relationship.

"It gave me a voice": Pre-pilot qualitative evaluation of a co-designed maternity planning guide.

AimThis study aims to examine the relationships between perception of traumatic childbirth, prenatal attachment, stress, anxiety, and depression in pregnant women.MethodThis cross‐sectional study involved 304 pregnant women who visited the obstetrics and gynecology outpatient clinic of a hospital in Türkiye between June 2024 and June 2025. Data were collected using a Demographic Information Form, the Depression, Anxiety, Stress Scale (DASS‐21), the Traumatic Childbirth Perception Scale (TCPS), and the Prenatal Attachment Inventory (PAI). Descriptive statistical methods, Pearson correlation, and multiple linear regression analysis were used in the analysis of the data.ResultsThe study determined that 22% of pregnant women experienced stress, 45.1% experienced depression, and 62.8% experienced anxiety. The mean PAI score of pregnant women was found to be 40.53 ± 7.97, and the mean TCPS score was 71.64 ± 28.02 (moderate). The study found that stress, depression, and anxiety scores in pregnant women were significantly correlated positively with the TCPS score and significantly correlated negatively with the PAI score. Depression (p = 0.003) and prenatal attachment (p = 0.018) were determined to be the predictors of traumatic birth perception.ConclusionThis study determined that as women’s depression, stress, anxiety, and levels increased, their perception of traumatic childbirth increased, and their prenatal attachment levels decreased. Depression and prenatal attachment were identified as predictors of traumatic childbirth perception. Providing mental health support to pregnant women by nurses can contribute to the protection and improvement of maternal and infant health.

ABSTRACT Background Childbirth fear and traumatic birth perceptions negatively affect maternal well-being and labour outcomes. The aim of this study was to evaluate the effectiveness of a transformative learning-based antenatal education programme on childbirth fear, traumatic birth perception, and childbirth preparedness in primigravida women. Methods In this parallel-group randomised controlled trial, 54 primigravida women were randomly assigned to an experimental group (n = 27), receiving a three-session transformative learning-based programme over three weeks, or a control group (n = 27) receiving standard antenatal education. Outcomes were assessed using the W-DEQ A, Traumatic Birth Perception Scale, and the Labour Preparation subscale of the PSES. Data were analysed using MANOVA and mixed-design ANOVAs. Results Significant group ×time interactions were observed for all outcomes. Childbirth fear decreased significantly in the experimental group (63.5 ± 8.1 to 46.3 ± 9.5) compared with the control group (60.3 ± 7.8 to 59.7 ± 8.6; p < .001, ηp2 = .300). Traumatic birth perception also decreased significantly in the experimental group (80.1 ± 6.9 to 70.3 ± 8.1) compared to the control group (82.3 ± 7.3 to 76.1 ± 7.9; p = .001, ηp2 = .193). Furthermore, childbirth preparedness improved significantly in the experimental group (24.0 ± 3.2 to 17.0 ± 2.8) versus the control group (21.0 ± 3.5 to 19.0 ± 3.3; p < .001, ηp2 = .264). Conclusion The transformative learning-based antenatal education programme significantly reduced childbirth fear and traumatic birth perception while enhancing childbirth preparedness among primigravida women compared with standard antenatal education.

Birth Trauma and Thoracic Outlet Syndrome: Preliminary Evidence.

Background:The physical and emotional experiences women undergo during childbirth influence not only the formation of their maternal role but also their willingness to have additional children. Birth trauma can lead to a depressed mental state in the postpartum period, which further complicates breastfeeding and the development of the mother–infant bond.Purpose:In this study, the experiential process of women with the experience of birth trauma during labor and delivery is explored.Methods:Strauss and Corbin’s grounded theory and purposive sampling were employed. Fifteen postpartum women were recruited, and face-to-face interviews were conducted from August 1 to November 30, 2024. A semistructured interview guide was used, and data analysis was performed using the constant comparative method from grounded theory.Results:Grounded theory was used to explore the experiential process of women who underwent birth trauma. The core category “overwhelming challenge of losing one’s sense of wholeness” that emerged from the narratives of the participants encompassed five subcategories, including unimaginable pain, loss of dignity, ignored emotions, unease from invasion of bodily privacy, and endless waiting. The outcome category was “I do not want to experience another childbirth.”Conclusions/Implications for Practice:The results of the exploration in this study of the process underlying the trauma experience of women during labor and delivery highlight the urgent need to improve the quality of care provided during labor. Obstetric clinicians and health care administrators may apply the theoretical model developed in this study to design appropriate continuing education programs and intervention strategies that, for example, implement shared decision-making, provide individualized care, and offer diverse methods for pain relief. It is hoped these findings will contribute to enhancing clinical practices, improving the quality of labor and delivery, and fostering more positive childbirth experiences for women.

Unstable fetal lie, characterized by frequent changes in fetal presentation during late pregnancy, poses challenges in pregnancy management and delivery planning. We aimed to examine the obstetrical and neonatal outcomes associated with term pregnancies complicated by an unstable fetal lie. This retrospective cohort study included data recorded during 2012-2022 of women with term singleton pregnancies with an unstable fetal lie who attempted vaginal delivery after stabilizing to vertex. We compared their obstetrical and neonatal outcomes in a 1:2 ratio to those of women without a history of unstable fetal lie who had a singleton fetus in vertex presentation at delivery. Of 67,360 deliveries, 174 (0.25%) were with an unstable fetal lie. For women who attempted vaginal delivery (n = 116, 66.7%) compared to women with spontaneous vertex presentation who delivered vaginally (n = 232), the intrapartum cesarean delivery (CD) rate was higher (31.0% vs. 10.3%, p < 0.001). Also higher were the CD rates attributed to fetal distress (12.9% vs. 6.0%, p = 0.038) and labor dystocia (11.2% vs. 4.7%, p = 0.041), and the nuchal cord incidence rate (17.2% vs. 5.6%, p < 0.001). Multivariate logistic regression identified unstable fetal lie as an independent risk factor for emergent CD (OR 4.1, 95% CI 2.1-8.2, p < 0.001). Birth trauma, cord prolapse, and perinatal death were not reported. Vaginal delivery attempts in women with an unstable fetal lie did not show similar progression of labor and obstetrical outcomes as spontaneous vertex presentation. This emphasizes the need for tailored management.

Birth trauma is a common experience, with 50% of birthing individuals perceiving their birth as traumatic. Using interpretive phenomenological analysis with an intersectional feminist trauma lens, this study aimed to understand how people experience healing from birth trauma. Eleven participants, who self-identified as having experienced and healed from a psychologically traumatic birth, were recruited. Data were collected through in-person interviews, follow-up phone interviews, and optional focus groups. The study identified five key themes related to the experience of healing from birth trauma: (1) seeking and strengthening support, (2) creating community and sharing stories, (3) empowerment as reframing the narrative and returning to self, (4) giving birth again, and (5) healing over time. The participants sought support from partners, friends, family, and healthcare providers, with some seeking professional therapy and medication. Creating communities and sharing stories, both in-person and online, helped reduce isolation and validate their experiences. For most participants, giving birth again was a major component of healing, providing opportunities for self-advocacy, regaining control, and experiencing patient-centered care. Empowerment is a key healing experience involving reframing narratives and self-acceptance. Healing was experienced as a nonlinear process over time, with moments of realization and reflection. Findings suggest that while psychological intervention is sometimes accessed, sharing stories, creating a community, and strengthening support systems over time are key components in moving forward from birth trauma. Interventions should integrate peer-led support and focus on reducing isolation and promoting community for those with birth trauma.

IntroductionRecent research shows that 40.6% of women in the United Kingdom experience childbirth as at least moderately traumatic, and 5.9% develop childbirth‐related posttraumatic stress disorder (CB‐PTSD). However, risk factors for birth trauma ratings and CB‐posttraumatic stress symptoms (CB‐PTSS) in this sample remain unexplored. Therefore, the aim was to understand risk factors for birth trauma and CB‐PTSS in a UK sample.Material and MethodsA cross‐sectional survey of traumatic birth and CB‐PTSD with women (N = 339) from three hospitals in England, two in Wales, and three in Scotland. Participants completed the survey at 6–12 weeks postpartum. It included questions about (i) demographics and mental health; (ii) pregnancy; (iii) labor and birth; and (iv) the infant. Outcome variables were birth trauma rating and CB‐PTSS.ResultsHigher birth trauma ratings were predicted by women not having other children, maternal complications during birth, lower birth satisfaction, and a mother not having skin‐to‐skin contact with her baby after birth. Higher CB‐PTSS were predicted by younger maternal age, women not having other children, current mental health difficulties, previous trauma, giving birth in Scotland, emergency cesarean section, and lower birth satisfaction.ConclusionsOverall, this paper found that traumatic birth and CB‐PTSS symptoms are associated with a range of demographic, mental health, birth‐related, and infant‐related variables. Results from this study can be used to improve maternity care.

Epidemiological data on injuries and fractures in children under two years of age is limited, thus, we aimed to explore the incidence, patterns and mechanisms. Retrospective, population-based cross-sectional study including children under two, seen at the A&E department due to a trauma, or having a radiograph due to birth trauma. All radiographs were re-reviewed. Four hundred thirty children (49.8% female), mean age 14.7 months (SD 6.8), were included, of whom four had a high-energy trauma and 42 were birth-related. Of 388 children (50.3% female) (mean age 16.3 months, SD 5.1 months) with non-birth related injury, 163 (42.0%) had a fracture (annual incidence 4.3 per 1,000 children; 2.4 per 1,000 infants vs. 6.1 per 1,000 children aged 12 to 24 months of age. 47/163 (28.8%) fractures involved the forearm and 41 (25.2%) involved the leg. Fracture mechanisms 39.9% fall from more than own height/furniture; 17.2% fall from own height, 6.7% crush injury and 6.1% dropped by parent. In 12.9% of the traumas, no mechanism was provided. The number of fractures increased significantly by age group (p=0.027), and the distribution differed, with skull fractures predominating in 0-6-months-old (33.0%), clavicle fractures (33.0%) in 6-12-months-old and forearm fractures in the two older age groups (35.0% and 34.4%, respectively) (p < 0.001). No classic metaphyseal lesions were found in the entire cohort. Four children, all of whom had radiological "red flags", had inflicted injury. Forty-two children had birth-related injury, of whom 50.0% had a fracture (1.1 per 1,000 live births). Fractures in infants are rare, in particular classic metaphyseal fractures. The occurrence of radiological "red flags" should raise suspicion of non-accidental injury and instigate further assessment.