The mediating role of rumination in the relationship between traumatic childbirth perception, birth satisfaction, and postpartum depressive symptoms.

This study was conducted to examine the mediating role of ruminative thinking in the relationship between perceived traumatic birth, birth satisfaction, and postpartum depressive symptoms among mothers receiving care in the postpartum unit. This descriptive study was conducted between April and December 2024 and included 309 postpartum women. Data were collected within the first 24-48 hour postpartum using the Personal Information Form, the Visual Analog Scale for Birth Satisfaction (VAS-BS), the Traumatic Childbirth Perception Scale (TCPS), the Ruminative Response Scale (RRS), and the Edinburgh Postnatal Depression Scale (EPDS). It was found that 25.9% of the participants were at risk for postpartum depression, while 21.4% perceived their childbirth as traumatic and 11.7% as very highly traumatic. The mediation analysis showed that TCPS had a significant positive effect on RRS, whereas VAS-BS had a significant negative effect. RRS positively predicted EPDS scores. The direct effect of TCPS on EPDS was not significant; however, its positive indirect effect through RRS was significant, indicating a full mediating role of RRS. VAS-BS had both a significant negative direct effect on EPDS and a significant negative indirect effect through RRS, suggesting partial mediation. The final model explained 40.7% of the variance in EPDS scores. Postpartum care should not be limited to depression screening. Women with traumatic childbirth perceptions or low birth satisfaction should also be assessed for ruminative thinking. Nurses and other healthcare professionals play a key role in supporting women's participation in birth-related decisions and helping them process their birth experiences to promote postpartum mental health.