gms | German Medical Science

Background: Many women experience the birth of their child as negative or even traumatic and some women may develop childbirth-related posttraumatic stress disorder (CB-PTSD) as a result. The Birth Satisfaction Scale-Revised (BSS-R) is a short instrument, which measures women’s satisfaction with their birth experience. It was originally developed in English, but has since then been translated into many different languages, German not being one of them. The City Birth Trauma Scale (City BiTS) was developed to measure women’s symptoms of CB-PTSD according to DSM-5 criteria and the original English version has also been translated into various languages.

Aim/research question: The aim of the two current studies was to translate the BSS-R and the City BiTS into German and test their psychometric properties in large community samples.

Methods: To validate the BSS-R, a community sample of n=3,909 mothers from Dresden, Germany was interviewed via telephone three to four months postpartum and asked about their birth experience and other birth-related information. The tridimensional measurement model of the original BSS-R was tested using confirmatory factor analysis (CFA) and internal consistency. Furthermore, known-groups discriminant validity, divergent validity, convergent validity, and predictive validity were assessed. To validate the City BiTS, a community sample of n=1,072 German mothers completed an online survey within 12 months of giving birth. Exploratory factor analysis (EFA) on a random split-half sample and CFA in the holdout sample were performed. Additionally, convergent and divergent validity as well as known-groups differences were tested.

Results: The tri-dimensional measurement model of the BSS-R indicated excellent fit to the data. However, internal consistency for the total scale and the three subscales was questionable to acceptable. Validity analyses showed good known-groups discriminant validity, good divergent validity, and negative correlations between the BSS-R and CB-PTSD symptoms (i.e., good convergent validity). Moreover, lower scores on all three BSS-R subscales predicted more CB-PTSD and depression symptoms (i.e., good predictive validity). EFA for the City BiTS confirmed the previously reported two-factorial structure and CFA confirmed that this structure had the best model fit. Internal consistency was good to excellent and convergent as well as divergent validity could be shown.

Relevancy: The BSS-R is a short, 10-item questionnaire, which can easily be used in research as well as clinical practice to assess women’s satisfaction with their birth experience. The City BiTS is the first German instrument, which allows to assess symptoms of CB-PTSD according to DSM-5 criteria. Both instruments provide the opportunity for improvement of clinical routine and for comparison of international prevalence rates and symptom presentations.

Recommendations/conclusions: As recommended by the International Consortium for Health Outcomes Measurement, the BSS-R should be used to assess women’s birth satisfaction and to be able to improve women’s birth experience as well as the care provided. The City BiTS should be used to assess women’s CB-PTSD symptoms to be able to verify them according to DSM-5 criteria and subsequently identify starting points for relieving women’s distress. The German BSS-R and City BiTS constitute reliable instruments, which can be compared to already existing, international versions.

Ethics and conflicts of interest: Both studies mentioned above were approved by the respective responsible ethics committees. The study on which the BSS-R validation is based was funded by the Deutsche Forschungsgemeinschaft. The study on which the City BiTS validation is based did not receive any financial support from third parties. There are no conflicts of interest.