Childbirth can be psychologically traumatic for a substantial share of women, yet Lithuania had no validated measure for birth-related PTSD and stress symptoms. This study tests whether one established scale can work in Lithuanian language and culture.

Pregnancy and childbirth bring about significant physiological, psychological, social, and spiritual changes for women. It is a period marked by tremendous transformation, transition, and adjustment to a new phase of life. While childbirth is a positive experience for some women, studies indicate that twenty to forty-eight percent of women find giving birth psychologically traumatic.

Meta-analyses have revealed that three to four percent of women who have given birth develop posttraumatic stress disorder, and clinically significant symptoms of PTSD are present in up to sixteen point eight percent of women. A positive childbirth experience promotes women’s health, both during and beyond the perinatal period.

Little research on birth-related trauma has been conducted in Lithuania, and there are no validated measures of birth-related trauma available there. The study’s goal was to translate, adapt, psychometrically test, and validate the City Birth Trauma Scale, or City BiTS, in the Lithuanian language and culture.

A secondary aim was to report the prevalence of birth-related stress symptoms among the study population. The City Birth Trauma Scale was developed by Ayers, Wright, and Thornton in twenty eighteen. It is designed based on the diagnostic criteria for PTSD outlined in the DSM-five and is used to assess the presence of PTSD following childbirth.

The initial two questions determine whether the event meets the criteria for a traumatic stressor by asking about serious harm or death of the woman or baby, with yes-or-no responses. The translation of the City BiTS followed established principles for instrument translation and adaptation.

Two native Lithuanian translators independently translated the scale from English to Lithuanian: one was a professional translator and the other was a nursing researcher. A nurse educator compared both Lithuanian versions, and discrepancies were resolved through discussion to reach consensus.

Experts in midwifery, maternity care, psychology, psychiatry, and Lithuanian language proficiency were consulted to address linguistic and cultural differences. To validate City BiTS-LT, face validity, content validity, construct validity, and reliability were assessed.

Construct validity was evaluated through exploratory factor analysis and confirmatory factor analysis. Exploratory factor analysis used Principal Axis Factoring, Bartlett’s Test of Sphericity, the Kaiser-Meyer-Olkin Test, eigenvalues greater than one, and Promax rotation.

Confirmatory factor analysis treated ordinal variables as categorical and employed the WLSMV estimator, while fit indices included Chi-squared, SRMR, RMSEA, CFI, and TLI. Discriminant validity used Mann-Whitney U and Kruskal-Wallis tests, and reliability used Cronbach’s alpha and McDonald’s omega.

After the field study, the instrument’s validity and reliability were assessed, and three confirmatory factor analysis models were tested. The models were a four-factor solution based on DSM-five dimensions, a two-factor model with birth-related and general symptoms, and a bifactor model with a global factor and two specific factors.

Good fit criteria included RMSEA below zero point zero six, CFI and TLI above zero point ninety-five, and SRMR below zero point zero eight. Table one reports factor loadings for the City Birth Trauma Scale under a two-factor model and a bifactor model.

In the two-factor model, items load on birth-related symptoms, or BRS, and general symptoms, or GS; the bifactor model additionally reports a general factor, GF. The table makes item-level patterns visible: for example, Q6 loads at zero point nine two seven on BRS, while Q13 loads at zero point seven five zero on the general factor.

For the entire scale, Cronbach’s alpha was zero point nine hundred six and McDonald’s omega was zero point nine hundred, indicating strong internal consistency values for the scale. Inter-item correlations ranged from zero point one hundred sixty-eight to zero point seven hundred seventy-nine.

Cronbach’s alpha would improve only if question ten, ‘Not able to remember details of the birth,’ were removed. Discriminant validity was assessed through known-group differences, and the results revealed several significant differences among subgroups.

Women who experienced pre-term births had significantly higher birth-related symptoms and higher total City BiTS-LT scores than women who had term births. Primiparous women reported higher birth-related symptoms and higher total City BiTS-LT scores than multiparous women.

Women who underwent an emergency caesarean section had significantly higher birth-related symptoms than women with spontaneous vaginal deliveries or planned caesarean sections. Table two tests discriminant validity by comparing City BiTS-LT scores across clinically relevant known groups.

The table reports significant differences for pre-term versus term delivery in birth-related symptoms and total score, for parity in birth-related symptoms and total score, and across delivery types for birth-related symptoms and total score. The clearest separation appears for traumatic versus non-traumatic birth, with significant results for both subscales and the total score; newborn health is also associated with general symptoms and total score.

Table three shows how many women met each DSM-five PTSD criterion, based on yes responses to the questionnaire items. Criterion A was met by 28.6 percent through either perceived serious injury or fear of death, while re-experiencing symptoms were reported by 68.53 percent and avoidance symptoms by 24.83 percent.

Applying all criteria, the table identifies DSM-five PTSD in 8.37 percent of participants, or 7.97 percent after removing women with possible exclusion criteria. A substantial portion of participants were recruited through online and social media platforms, making it challenging to determine the response rate of the potential sample.

Self-selection and limited personal data further hindered assessment of the sample’s representativeness. Online-recruited samples may exhibit a higher risk profile, potentially inflating estimates of PTSD prevalence. Although the study followed proper psychometric procedures, it did not include a test-retest measurement, limiting conclusions about City BiTS-LT stability over time.

The Lithuanian City Birth Trauma Scale showed good validity and reliability, with a bifactor model fitting best. It offers a usable way to identify birth-related trauma symptoms, although sampling and the lack of test-retest data limit what can be concluded.