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Cited by 336Maternal Mental Health During Pregnancy and PostpartumMaternal and Perinatal Health InterventionsPosttraumatic Stress Disorder Research

Development of a Measure of Postpartum PTSD: The City Birth Trauma Scale

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Ayers, Susan, Wright, Daniel B., Thornton, Alexandra·2018·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2018.00409PMC PMC6153962
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Abstract

Posttraumatic stress disorder (PTSD) affects 4% of women after birth yet there are very few questionnaire measures of postpartum PTSD that have been validated in this population. In addition, none of the available questionnaires assess postpartum PTSD in accordance with criteria specified in the latest edition of the Diagnostic and Statistical Manual (DSM-5, 2013). The City Birth Trauma Scale is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria of: stressor criteria (A), symptoms of re-experiencing (B), avoidance (C), negative cognitions and mood (D), and hyperarousal (E), as well as duration of symptoms (F), significant distress or impairment (E), and exclusion criteria of other causes (H). Two additional items from DSM-IV were also included on the basis of evidence suggesting they might be important in this population. The first was criterion A2 that women responded to events during birth with intense fear, helplessness or horror. The second was symptoms of emotional numbing. Items were first reviewed by researchers (n = 9) and postpartum women (n = 8) and revised accordingly. The questionnaire was then completed by 950 women recruited online. Results showed the City Birth Trauma Scale had excellent reliability (Cronbach’s α = .92) and is easy to understand (Flesch reading score 64.17). Exploratory factor analysis found two factors which together accounted for 56% of the variance: (i) Birth-related symptoms (40.8% variance) and (ii) General symptoms (15.5% variance). PTSD symptoms were highly associated with distress, impaired functioning, and women reporting they wanted treatment (r = .50 - .61). Removing DSM-IV A2 criteria only increased births classified as traumatic by 2%. Adding the item on emotional numbing did not change the psychometric properties of the scale. These items were therefore removed. The City Birth Trauma Scale has good psychometric properties and the two symptom clusters identified are consistent with previous research on symptoms of postpartum PTSD. This scale therefore provides a promising measure of PTSD following childbirth that can be used in research and clinical practice. Future research should examine the scale’s predictive validity using clinical interviews.

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  • The City Birth Trauma Scale (CBTS) is a validated measure developed by Ayers et al., grounded in DSM-5 PTSD diagnostic criteria, and includes 29 items primarily used to identify women at risk of developing PTSD following childbirth.

    “Another widely used tool is the City Birth Trauma Scale (CBTS), a validated measure developed by Ayers et al. [52], which is also grounded in DSM-5 PTSD diagnostic criteria. The CBTS includes 29 items and is primarily used to identify women at risk of developing PTSD following childbirth.”

    From The traumatic childbirth experience of mothers after emergency cesarean section(EmCS) in China: a descriptive qualitative study (2025) · cites this paper as [52]

    The Abstract describes the City Birth Trauma Scale as a 29-item measure of birth-related PTSD based on DSM-5 criteria. But the Discussion (Limitations) says the study does not offer full validation and calls for further research on predictive validity. The paper presents the scale as measuring PTSD symptoms after childbirth, not primarily identifying women at risk of developing PTSD. (LLM, conf=0.91)

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Research works printed but not linked: 19

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Authors
Ayers, S., Wright, D. B., & Thornton, A.
Affiliations
University of London (GB)
Corresponding author
Ayers, Susan
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2018-09-18
Volume
9
Pages
409-409
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2018.00409
PMC
PMC6153962
OpenAlex
W2889844364
Cited by
336
References
4
Citations by year
2026: 65 · 2025: 76 · 2024: 55 · 2023: 48 · 2022: 24 · 2021: 36 · 2020: 23 · 2019: 8 · 2018: 1
FWCI
15.67
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • City Research Online (City University London) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
City, University of London
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
postpartum PTSD, birth trauma, City Birth Trauma Scale, questionnaire development, DSM-5 PTSD criteria, psychometric validation, emotional numbing, post-traumatic stress disorder, symptom clusters

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