Research and impact | By Shamim Quadir

Impact: How do we best measure the effect of PTSD on women following traumatic childbirth?

It is thought that up to one-third of women report childbirth as a traumatic experience and recent City research shows that post-traumatic stress disorder (PTSD) following childbirth occurs in three to four per cent of women.


This figure increases to 15 to 18 per cent in high-risk groups, such as those who have a history of sexual abuse, have had an emergency caesarean section, premature birth or severe pregnancy complications.


Academics at City have developed Birth Trauma Scale, the only available questionnaire to diagnose PTSD in women after childbirth.

The scale is based on the criteria for PTSD outlined by the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5); a globally used standard for psychiatric diagnoses. In November 2019, a study evaluated and recommended City’s Birth Trauma Scale for use with the postnatal population. Conducted by academics from City in partnership with the Catholic University of Croatia, the study surveyed 603 first-time mothers in Croatia who had given birth within the previous 12 months and who used the City Birth Trauma scale. The scale included answering ‘yes’ or ‘no’ to questions such as, ‘Did you believe you or your baby would be seriously injured?’ as well as rating (‘0’ – not at all, ‘1’ – once, ‘2’ – two to four times and ‘3’ – five or more times) to statements such as ‘Getting upset when reminded of the birth’ and ‘Trying to avoid things that remind me of the birth’. The responses helped to identify the frequency of  symptoms over the previous week.

To validate the scale, the mothers were also surveyed with widely used and validated questionnaires relating to the processing of traumatic events, depression and anxiety. The study confirmed that grouping of measures on the scale with birth-related symptoms (e.g., from questions related to distressing memories and avoiding thinking about the birth) and general symptoms of PTSD (e.g., negative mood, irritability and tension) could be used to explain accurately the responses of the new mothers who participated in the study.

The grouping of measures showed that high-risk groups, including first-time mothers and women who had either an instrumental vaginal delivery or emergency caesarean section, reported more PTSD symptoms. Susan Ayers, Professor of Child and Maternal Health at City, and principle investigator of the study, said:

“Since we published the City Birth Trauma Scale in 2018, I have been struck by how many people have contacted us and asked to use the scale, which shows just how needed it was. The scale has already been translated into 10 languages and research studies in the UK, Israel and Croatia, found the scale has similar properties in different populations so it is a reliable measure of PTSD after birth”.