The mediating role of psychological birth trauma in association between childbirth satisfaction and the desire to avoid pregnancy among Iranian postpartum women.

OBJECTIVE

Iran's declining fertility rate is a major demographic concern. The desire to avoid pregnancy (DAP) is a key predictor of future fertility. While dissatisfaction with childbirth care and psychological birth trauma are known to negatively impact future fertility decisions, their specific pathways to influencing the desire to avoid future pregnancy remain unclear. This study therefore aimed to examine the relationship between mothers' satisfaction with childbirth care and their desire to avoid subsequent pregnancy, while investigating the mediating effect of childbirth-related psychological trauma.

DESIGN

Cross-sectional study

SETTING

Urban comprehensive health centers in Qazvin, Iran.

PARTICIPANTS

350 married women, with a mean age of 31.83 years, within six months postpartum.

MEASUREMENTS: Validated scales including the Birth Satisfaction Scale-Revised (BSS-R), the City Birth Trauma Scale, and the Desire to Avoid Pregnancy (DAP) scale.

FINDINGS: The final path analysis model demonstrated an excellent fit (CFI=1.000, RMSEA=0.000), explaining 35.4% of the variance in DAP. Psychological birth trauma functioned as a complete mediator. Regarding childbirth care satisfaction, the 'women's personal attributes' subscale of the BSS-R exerted both a direct effect on DAP (β=0.20, p<0.001) and an indirect effect via psychological birth trauma (β=0.11, p<0.001). Reproductive history showed strong associations with DAP: a higher number of pregnancies (β=0.47 for ≥4 pregnancies, p<0.001) increased DAP, while a larger desired family size (β=-0.53 for ≥3 children, p<0.001) and a history of abortion (β=-0.12, p=0.013) decreased DAP KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Psychological birth trauma was demonstrated to be a complete mediator in the relationship between childbirth care satisfaction and subsequent pregnancy avoidance. Interventions designed to improve respectful, supportive maternity care and provide trauma-informed support are not only crucial for maternal well-being but may also be essential for addressing Iran's low fertility rate by mitigating a key barrier to future childbearing.