Abstract
BACKGROUND: One third of all childbirths are experienced as traumatic, which is a risk for developing birth-related PTSD (BR-PTSD). Understanding factors that increase the level of BR-PTSD symptoms (BR-PTSS) is crucial for the development of adequate preventive strategies. Most previous research has utilised general PTSD measurements, which negatively impacts its validity. This study therefore aimed to assess associated factors for BR-PTSS using a birth-specific instrument. METHODS: In this cross-sectional study, BR-PTSS was measured using City Birth Trauma Scale. Information on prenatal and birth-related associated factors and comorbid symptoms of postpartum depression was collected via a self-report questionnaire including Childbirth Experience Questionnaire 2. Independent significant associated factors were analysed using single and multiple linear regression. The results were controlled for comorbidity with postpartum depression. RESULTS: Independent significant associated factors were previous traumatic experience, primiparity, complications in pregnancy or childbirth, and a negative subjective experience of childbirth. When controlling for comorbidity with postpartum depression, significant associated factors were primiparity, complications in pregnancy or childbirth and a negative subjective experience of childbirth. CONCLUSIONS: This study identifies a negative subjective experience of birth as the most important associated factor for BR-PTSS and highlights the importance of modifiable factors. Our findings indicate that implementation of care acknowledging past trauma and primiparity, and evaluating the birth experience can help identify individuals with higher BR-PTSS. Future research should explore the effect on BR-PTSS when evaluating strategies focused on preventing and mitigating the experience of complications in pregnancy and birth, providing safe and supportive care, and promoting agency and self-efficacy during labour. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-025-08517-9.