Validation of the City Birth Trauma Scale in a sample of Norwegian mothers

Silje Marie Haga; Luisa Bergunde; Lara Seefeld; Susan Ayers; Malin Eberhard-Gran; Susan Garthus-Niegel

doi:10.1111/aogs.70149

Validation of the City Birth Trauma Scale in a sample of Norwegian mothers

Acta Obstet Gynecol Scand. 2026 Mar;105(3):508-518. doi: 10.1111/aogs.70149. Epub 2026 Jan 26.

Authors

Silje Marie Haga¹, Luisa Bergunde^{2

3}, Lara Seefeld^{2

4}, Susan Ayers⁵, Malin Eberhard-Gran^{6

7}, Susan Garthus-Niegel^{2

8

9}

Affiliations

¹ Regional Centre for Child and Adolescent Mental Health, Eastern and Southern, Oslo, Norway.
² Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine and University, Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
³ Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine and University, Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
⁴ Department of Psychology & Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, Canada.
⁵ School of Health & Medical Sciences, City St. George's, University of London, London, UK.
⁶ Norwegian Research Centre for Women's Health, Oslo University Hospital and University of Oslo, Oslo, Norway.
⁷ Institute for Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway.
⁸ Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, MSH, Hamburg, Germany.
⁹ Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway.

Abstract

Introduction: Approximately 3%-4% of women experience childbirth-related posttraumatic stress disorder (CB-PTSD). The City Birth Trauma Scale (City BiTS) is a questionnaire developed to assess CB-PTSD, following the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders. The aim of the present study was to evaluate the psychometric properties of the Norwegian version of this questionnaire (City BiTS-Nor).

Material and methods: A community sample of 1079 mothers completed a cross-sectional online survey. The survey included questions on sociodemographic and obstetric characteristics, the City BiTS-Nor, the Impact of Event Scale-Revised, the Edinburgh Postnatal Depression Scale, the 10-item anxiety subscale of the Hopkins Symptom Checklist, and the Bergen Insomnia Scale.

Results: Confirmatory factor analysis supported a bifactor model comprising Birth-related Symptoms and General Symptoms in CB-PTSD, along with a General CB-PTSD factor that explained 58.4% of the variance. The study found high internal consistency (≥0.90), and good convergent and divergent validity were shown. Discriminant validity was evaluated by examining factors such as mode of birth, maternal complications, infant complications, parity, history of traumatic childbirth, and previous traumatic experiences. Higher General and Birth-related scores were observed in women who experienced emergency cesarean sections or instrumental vaginal births. This trend was observed in primiparous women, cases involving pregnancy and birth complications, and individuals with prior traumatic experiences.

Conclusions: The City BiTS-Nor presents appropriate psychometric properties for assessing CB-PTSD symptoms according to DSM-5 criteria. The findings suggest that using the total score, along with the individual subscale scores, is justified and enhances the comprehensive assessment of CB-PTSD symptoms. These findings support the clinical utility of the City BiTS-Nor as a screening tool for CB-PTSD, with potential to differentiate childbirth-related trauma from general psychopathology and to guide targeted interventions in perinatal care.

Keywords: City Birth Trauma Scale; birth trauma; childbirth‐related posttraumatic stress disorder.