Midwifery. 2026 Sep 2;163:104977. doi: 10.1016/j.midw.2026.104977. Online ahead of print.
ABSTRACT
BACKGROUND: Psychological birth trauma (PBT) has been proposed as a broader construct encompassing childbirth-related psychological distress, including but not limited to symptoms consistent with post-traumatic stress disorder. Attachment theory suggests that adult attachment dimensions are associated with differences in threat appraisal, affect regulation, and help-seeking; however, their relationship with childbirth-related trauma symptoms and birth satisfaction remains unclear.
METHODS: A cross-sectional online survey was completed by 940 postpartum women in Australia (≤24 months postpartum) who had experienced an early-term or full-term (≥37 weeks), vaginal, singleton birth and whose infant did not require neonatal intensive care or special care. Participants completed a demographic questionnaire, the Adult Attachment Questionnaire, City Birth Trauma Scale, and Australian Birth Satisfaction Scale-Revised. Data were analysed in SPSS, with measures scored according to published procedures. Adult attachment anxiety and avoidance were examined as continuous dimensions as the primary analytic approach and via median-split quadrants to derive attachment classifications for secondary analyses. Childbirth-related trauma symptoms were analysed dimensionally, and probable PTSD was identified using a published algorithm. Birth satisfaction was analysed as a continuous outcome.
RESULTS: In the primary dimensional analyses, higher attachment anxiety and attachment avoidance were each associated with greater childbirth-related trauma symptom severity and lower birth satisfaction. In secondary exploratory quadrant-based analyses, women with secure attachment classifications reported the lowest trauma symptoms and most favourable birth appraisals, whereas those with attachments classified as disorganised/unresolved reported the highest symptom burden and the least favourable appraisals of stress, self-related attributes, and quality of care. Overall, 14.8% of participants met the published threshold for probable childbirth-related PTSD, with the lowest proportion observed in the secure group and the highest in the disorganised/unresolved group, based on the exploratory quadrant-derived classifications.
DISCUSSION: Higher attachment anxiety and avoidance were associated with elevated childbirth-related trauma symptoms and poorer childbirth appraisals within the current sample. Secondary exploratory attachment classification analyses further demonstrated broadly consistent patterns. These findings highlight the potential value of further investigating attachment-informed and trauma-informed approaches within relational maternity care, continuity models of midwifery care, and postnatal psychological support.
PMID:42700730 | DOI:10.1016/j.midw.2026.104977
