Agora: Red Deer Polytechnic Undergraduate Journal
Volume 15:1 2024 Agora Conference Proceedings

An Exploration of Subjective Traumatic Births and the Influence
of Childhood Trauma and Low Maternal Confidence1
Shree Aiyer
Motherhood can be a pivotal part of some women’s life, and it is usually a stage she looks
forward to from a young age. A predominant phase in this progress is the perinatal period, which
is defined as a short period of time before labour to a few weeks after having given birth (VogelsBroeke et al., 2021). Evidently, the event of childbirth is very definitive in this milestone, but a
woman’s perinatal period is far more than just childbirth and the events of care involved before,
during, and post-birth. Although the concept of mother-centered care related to the birth and the
postpartum period has become more widespread in the past couple decades, transitioning to
motherhood is influenced by various dynamic physical, psychological, and social characteristics
that actively shape the mother’s experience throughout the peripartum period (Larkin et al., 2009;
Prinds et al., 2014; Seefat-van Teeffelen et al., 2011; Vogels-Broeke et al., 2021).
The perinatal period and the transition to motherhood also features many neurobiological,
psychological, and social changes, as well as stressors that may be influential in the mother and
child’s wellbeing (Cárdenas et al., 2020). Environmental and psychosocial stressors that the mother
experiences can be damaging to the overall pregnancy and labour, as well as the health of the
mother and fetus. The dangers of psychological, social, and physical impacts can be detrimental
to both mother and child; thus, there is basis to suggest that maternal stress during the prenatal
period can be consequential for current and future generations (Coussons-Read, 2013). Women
who are affected by psychological, emotional, and/or physical stressors specifically during labour
can be traumatized by childbirth. This is generally referred to as birth trauma (Watson et al., 2021).
Some known stressors are the fear of childbirth, medical interventions, interactions with healthcare
professionals, as well as the experience of childhood trauma (Atzl et al., 2019; Bhatia & Jhannjee,
2012; Elmir et al., 2010; Reed et al., 2017).
During pregnancy, an individual may recall experiences of childhood trauma; this can
potentially trigger certain psychological symptomology in those susceptible to developing

This research was funded by SSHRC. This is an executive summary. For the complete thesis, please see the
digital publication in the RDP Library Repository
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psychopathology (Atzl et al., 2019). The emotional, physical, psychological, and cognitive
stressors involved in pregnancy can be heightened by the experience of childhood trauma, since
these memories arise as women reminisce about their entire childhood experience as they prepare
themselves for motherhood (Atzl et al., 2019; Narayan et al., 2017). There were strong links found
between the occurrence of childhood trauma and perinatal psychological disorders such as posttraumatic stress disorder (PTSD) and depression (Choi & Sikkema, 2016). Atzl and colleagues
(2017) researched the influence of childhood adversity and age on pregnancy related mental health
issues. It was found that when childhood maltreatment was experienced at an early age (0 to 5
years), it was significantly predictive of a perinatal-related PTSD diagnosis. There was no
relationship found between middle or adolescent age childhood trauma and birth trauma-related
PTSD or depression. This finding is significant, because it highlights the critical nature of the early
childhood period in shaping future outcomes in the stress response system and mental health,
specifically during the peripartum period.
Mothers who have a traumatic birth experience are more likely to develop psychosocial
difficulties during the postnatal period. Their mental health may be in a deteriorating state, making
them more susceptible to face issues with anxiety, PTSD, and obsessive-compulsive disorder
(OCD) (Ionio & DiBlasio, 2014; Molloy et al., 2021). Further negative impacts of birth trauma
include extreme emotional responses, difficulty in communication, formation of maladaptive
attachment styles, self-doubt, and low maternal confidence (Elmir et al., 2010; Molloy et al., 2021;
Schwartz et al., 2015). The experience shapes how a mother views her capabilities in parenting
and whether she views herself as a “good mother” (Molloy et al., 2021). Some mothers have noted
that they feel that self-perception and self-knowledge of their own bodies and experiences are put
into question or even dismissed during the labour experience by healthcare professionals (Molloy
et al., 2021); these negative interactions can plant seeds of doubt in the mother’s mind about her
parenting abilities, which can consequently influence the mother’s experience with parenting and
the attachment she forms with the child. Furthermore, self-efficacy in general is developed
predominantly in childhood and plays a role in overall psychological well-being (Orth & Robins,
2014). Thus, the experience of a traumatic childhood can lead to a decrease in self-esteem,
confidence, and self-efficacy (Walter et al., 2010), which can negatively impact their resilience as
well (Beutel et al., 2017).

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Unfortunately, the subjective nature of birth trauma creates an obstacle in identification,
diagnosis, and treatment (Beck, 2004). There is a significant lack of acknowledgement and
comprehension about birth trauma in society, which leads to the inability to fully recognize
women’s situations, provide consistent support, aid in recovery, and reform care and practice
associated with the peripartum period (Watson et al., 2021).
When looking at the previous research in this field, as far as is known, there are has not yet
been a study that considers both childhood trauma and maternal confidence in relation to the
experience of birth trauma, particularly in the Canadian context. Thus, we aim to uncover how
these three factors influence and interact with one another. Through this research, we will be able
to provide insight into some of the broad patterns that underlie birth trauma and gain a better
understanding of their predictive factors and negative impacts. In essence, the goal is to strengthen
and add to the literature in the field to improve the perinatal period and enhance wellbeing for the
mother and the child.

Method
Hypotheses
Derived from the literature in the field, the study is testing three hypotheses. First,
childhood trauma is predictive of subjective birth trauma. Second, lower parenting self-efficacy or
maternal confidence has a significant relationship with birth trauma. Lastly, childhood trauma has
a significant relationship with lower maternal confidence/ parenting self-efficacy.
As described previously, the literature in the field supports the connections between one
variable and the other. However, there has not yet been, as far as is known, a study regarding the
intersection off all three variables. The primary goal of the study is to look at general tends between
birth trauma, childhood trauma, and maternal confidence through an exploratory lens.
Design
The current study utilized descriptive statistics, correlational analyses, and a linear
regression to comprehend the self-report data from the survey participants. The aim of this research
is to understand predictive and risk factors relating to birth trauma while considering childhood

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trauma and maternal self-efficacy, as well as socioeconomic, geographic, and demographic
characteristics.
Participants
The sample (N = 84) of participants consisted of 83 females and one demi-woman with a
mean age of 31.19 years (SD = 5.873, range = 22 – 45). The participants consisted of the following
ethnicities: 3.6% Asian, 32.1% Black, 57.1% European/Caucasian, 2.4% Hispanic, 1,2%
Indigenous, and 3.6% mixed). All of the participants were Alberta residents at the time of
participation, with 63.1% having given birth in a large urban population centre with a population
of 100,000 and over. The majority of the participants (60.7%) had described experiences with their
first child, 42.9% of which reported about their first pregnancy. When considering the type of birth,
41.7% had an emergency c-section, 14.3% had an elective c-section, 17.9% had assisted vaginal
births, 25.0% had normal vaginal births, and 1.2% did not answer. Participants’ household income
varied minimally with 8.3% making under $20,000 and 22.6% making $100,001 or over.
Approximately half of the participants (45.1%) reported that their child had spent time in NICU,
of which the average was 14.56 days.
Materials
Participants were given self-report scales and questionnaires and asked open-ended
questions to assess and understand their retrospective accounts of birth trauma, childhood trauma,
maternal confidence, and social support (refer to Appendix A for complete survey).
City Birth Trauma Scale.
The City Birth Trauma Scale was used to understand the subjective traumatic birth
experience of their most recent birth (Ayers et al., 2018). It assesses childbirth related PTSD
according to criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5) for traumatic events during or immediately after the childbirth. The self-report
scale consisted of 29 questions with four subscales: symptoms of re-experiencing, negative
cognitions and mood, and hyperarousal. A higher score indicates more PTSD symptoms being
present, which will represent a subjectively traumatic birth. This scale and its subscales have
shown good internal consistency, with α = 0.92 for the total scale.

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Trauma and Distress Scale.
Childhood trauma was assessed using the Trauma and Distress Scale (TADS; Patterson et
al., 2002). It is a 43 question self-report scale which is used to measure childhood adversities in
five different domains: emotional neglect, emotional abuse, physical neglect, physical abuse, and
sexual abuse. There are 4 to 5 questions per domain, and all questions take age categories into
account (0–6, 7–12, and 13–18 years). The TADS is a 5-point Likert Scale: 0 = never, 1 = rarely,
2 = sometimes, 3 = often, and 4 = almost always. The total score, which represents the complete
burden of childhood adversities, is calculated as the combination of the scores from all five
domains.
Perceived Maternal Parenting Self-Efficacy Scale.
Maternal self-efficacy was assessed using the Perceived Maternal Parenting Self-Efficacy
scale (PMP-S-E; Barnes & Adamson-Macedo, 2007). The questionnaire examines a mother’s
beliefs about their ability to be successful as a maternal figure and in their parenting role. This
scale has 20 items as a 4-point Likert scale (1 – Strongly disagree, 2 Disagree, 3 – Agree, 4 –
Strongly agree) with four subscales: care taking procedures, evoking behaviour(s), reading
behaviour(s) or signalling, and situational beliefs. The scale has strong internal consistency
reliability and external reliability (α = 0.91, α = 0.96), as well as good validity.
Maternal Confidence Questionnaire.
Lastly, maternal confidence was measured with the Maternal Confidence Questionnaire
(MCQ; Parker & Zahr, 1985). This 14 item 5-point Likert scale (1 – Never, 2 – Seldom, 3 – Some,
4 – Often, 5 – A great deal) quantifies maternal confidence in parenting skills and the ability to
recognize their infant’s needs. The questionnaire has also been shown to have good flexibility,
reliability, and validity.
Procedure
The sample for the study was chosen through self-selection, where Alberta residents over
18 years of age subjectively identified themselves as having experienced a traumatic birth in the
past five years. The self-report survey was sent to various community resources where participants
had access, such as women’s clinics. The incentive for participation was a $15 online gift card.
The research was approved by the Red Deer Polytechnic Research Ethics Board (REB) (Red Deer
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Polytechnic, 2024). Participants were provided a consent form at the outset of the survey, which
provided information on the survey. Due to the sensitive topic, participants were provided with a
list of community resources within the consent form. Participants then completed demographic
questions, which asked about socioeconomic and geographic factors, then completed the scales.
Responses from the participants were anonymous and collected through Simple Survey. For data
analysis, IBM SPSS, a statistics software, was used.

Results
Descriptives
Of the 84 participating women, 72.7% reported experiencing complications during
pregnancy, 35.7% were diagnosed with at least one psychological disorder related to the birth, and
26.2% were diagnosed with at least one psychological disorder unrelated to the birth. It was found
that 30% of the participants were found to have high levels of birth trauma related PTSD and 44%
had moderate symptomology.
Regression Analyses
In order to test the first hypothesis of the study, a Pearson’s correlation was conducted
between the Birth trauma-related PTSD subscale in the City Birth Trauma scale and the total
childhood trauma subscale in the TADS. A significant positive correlation was found, r = .342, p
< .001. Further analyses showed that birth trauma related PTSD was significantly correlated with
childhood emotional abuse (r = .397, p < .001), childhood physical abuse (r = .323, p < .003), and
childhood sexual abuse (r = .299, p < .006). A linear regression was conducted with total childhood
trauma as the predictor and the analysis yielded a significant regression, b = .162, t(83) = 3.30, p
= .001, meaning that childhood trauma was predictive of birth trauma. It also accounted for
significant variance in birth trauma related PTSD, R2 = .117, F(1, 82) = 10.89, p = .001.
For the second hypothesis, two Pearson’s correlations were computed comparing birth
trauma related PTSD with maternal confidence and parenting self-efficacy. Neither correlation was
significant since birth trauma related PTSD and maternal confidence yielded r = .012, p = .917 and
birth trauma related PTSD and parenting self-efficacy yielded r = .142, p = .198, which shows that
there were no correlational relationships between the variables. It is important to note that the
correlation between maternal confidence questionnaire and parenting self-efficacy was r = .762, p
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< .001. Thus, linear regression analyses with these variables were computed as a total of MCQ and
PMP-S-E scores. A significant regression was not found when considering total confidence/selfefficacy from birth trauma related PTSD, b = .164, t(83) = .791, p = .431; therefore, birth trauma
is not predictive of maternal confidence or self-efficacy. Birth trauma related PTSD did not account
for any variance in total maternal confidence and self-efficacy R2 = .008, F(1, 82) = 0.63, p = .431.
When testing the third hypothesis, two Pearson’s correlations were computed. Both yielded
significantly negative correlations between maternal self-confidence and total childhood trauma (r
= -.509, p < .001) and between parenting self-efficacy and total childhood trauma (r = -.297, p <
.006). Furthermore, a linear regression with total childhood trauma as the predictor of total
confidence/self-efficacy was computed, which found b = -0.374, t(83) = -4.20, p < .001; Thus,
total childhood trauma is significantly predictive of maternal confidence and self-efficacy.
Total childhood trauma also accounts for significant variance in total maternal confidence
and self-efficacy, R2 = .177, F(1, 82) = 17.64, p < .001. Notably, total childhood trauma accounts
for more variance when predicting maternal confidence/self-efficacy than birth trauma related
PTSD.
Discussion
The purpose of this study was to improve the general understanding of birth trauma.
Specifically, the aim was to comprehend the relationships that underlie birth trauma, childhood
trauma, and post-natal maternal confidence. Among the study participants, it was found that 30%
experienced severe birth trauma related PTSD and 44% experienced a moderate level, which
matches consistent reports that 30% of women globally have a traumatic birth experience (Soet et
al., 2003). In fact, this is more than the 9.3% prevalence rate that Smarandache et al. (2016) had
found among Canadian women; hence, the data further supports the need for increased awareness
surrounding this phenomenon.
The first hypothesis was established showing that if a woman had experienced traumatic
experiences in her childhood, then she had an increased likelihood of experiencing a traumatic
birth as well, which is supported by vast research in the field. Experiences of trauma, regardless
of the domain, have been shown to decrease resilience and heighten sensitivity to triggering
situations (Atzl et al., 2019; Beutel et al., 2017). Furthermore, women are likely to recall traumatic
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memories from their childhood during the labour period, making them more susceptible to
experience trauma. These factors come into play during labour, which is a very demanding
situation, causing women to feel more distressed and, eventually, leading to PTSD symptomology
(Choi & Sikkema, 2016). The results of the study do, however, slightly contradict the research
presented by Porthan and colleagues (2023), which states that emotional abuse and emotional
neglect have the strongest relationship with birth trauma as opposed to our findings that rather
showed that emotional, physical, and sexual abuse are correlational. Clearly, emotional abuse is a
critical component and may be more influential than any other domain of childhood trauma, since
it, in most cases, underlies the other domains of trauma (Dye, 2022; Hart et al., 1996). However,
there is minimal focus on the five domains of childhood trauma separately in relation to birth
trauma; perhaps, further research can shed light on the details regarding this phenomenon.
The current study did not find any significant relationship between birth trauma related
PTSD and maternal confidence or parenting self-efficacy; it was neither correlational nor
predictive. This contradicts past research which has found that when mothers experience a
traumatic birth experience, particularly when linked to negative interactions with healthcare
professionals, they have shown increased self-doubt and doubted their knowledge about parenting,
resulting in lower maternal confidence (Molloy et al., 2021). Raudasoja et al. (2022) also
demonstrated that it was possible to predict maternal self-efficacy from birth trauma; however, it
can yield mixed results. Specifically, the predictive relationship only holds true in extreme case
such as a very positive or very negative birth experience. Furthermore, the researchers concluded
that there were other factors that influenced maternal confidence, not just birth trauma. Taking that
into light with the current study, it is important to consider that there were relatively low reports
of low maternal confidence or parenting self-efficacy. Furthermore, there may have been an
influence of social desirability bias. Since the scales focused on parenting skills and confidence/
self-efficacy, there may have been a difficulty in admitting shortcomings in fear of being
considered a “bad mother”, resulting in such high numbers.
The third hypothesis was supported: experiencing childhood trauma decreased the
confidence or self-efficacy that mothers felt after giving birth. As mentioned, the experience of
childhood trauma can have detrimental effects on one’s resilience, confidence, and self-efficacy
(Walter et al., 2010; Beutel et al., 2017). These feelings are escalated during the stressful
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postpartum period, possibly leading to low maternal confidence, particularly for first time mothers
(Garon-Bissonnette et al., 2022). Low maternal confidence can influence parenting outcomes and
result in complications when bonding with the child and in forming a secure attachment (Goto et
al., 2010; Huang et al., 2022; Kojra et al., 2012). Traumatic childhood experiences of the mother
were able to predict higher levels of maladaptive socioemotional behaviour in the child
(McDonnell & Valentino, 2016); this may possibly result in intergenerational trauma since the
level of trauma in mothers was linked to similar levels of trauma in the child. It is important to
consider this relationship very carefully in terms of parenting because it has the potential to
perpetuate continuously.

Next Steps
Building on these findings, this research will have subsequent phases.
Phase 2
The next step of this project will be conducting focus groups with participants from the
survey. We are expecting around 30 participants to provide experiences of their labour and shed
light on connections to childhood trauma and maternal confidence. A qualitative approach will
provide more insight into individual experiences of birth trauma, as well as demonstrate a full
picture into what women feel in regards to the perinatal period.
Phase 3
The data found from the current study (Phase 1) and phase 2 will help to design
preventative care and eventually implement a perinatal psychoeducation program to be launched
in Central Alberta. The findings help to highlight optimal methods in providing support to
expectant mothers to decrease the likelihood and negative impacts of birth trauma.

Considerations
Due to the focus of the study, there are some factors to be aware of. This study focused on
the birth experiences of cis women in order to control for certain extraneous variables such as
sense of belonging, sense of identity, and social support that may influence the validity of the
findings. However, the survey did contain gender-neutral and inclusive language, allowing
replication of this study while studying different gender demographics. Furthermore, since the
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findings were from Central Alberta, there is limited generalizability among populations. Due to
vast differences in healthcare, economy, and lifestyle, experiences of women around the world and
even Canada may differ substantially.

Conclusion
This study provides insight into the broad patterns surrounding birth trauma when
considering the mother’s childhood trauma and her confidence in motherhood. It is evident that
the predictive nature of traumatic childhood experiences plays a critical role in peripartum
experiences, influencing both birth trauma and maternal confidence, meaning that it would be an
ideal target for preventative care in order to enhance the wellbeing of the mother and child.

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