{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:51:28Z","timestamp":1792601488895,"version":"4.5.0"},"reference-count":57,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T00:00:00Z","timestamp":1727654400000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["No. 71974061"],"award-info":[{"award-number":["No. 71974061"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,7,30]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the relationship between social support and psychological birth trauma among Chinese primiparous women and the mediating effects of childbirth readiness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted between November 2021 and March 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>10 general tertiary hospitals and 3 specialised maternity hospitals in 7 provinces in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 751 primiparous women were recruited for this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The questionnaires consisted of questions on demographic characteristics, the Birth Trauma Scale, the Chinese Mandarin version of the Medical Outcomes Study Social Support Survey and the Childbirth Readiness Scale. Hierarchical multiple regression was used to explore the associated factors and mediating role of childbirth readiness in the relationship between social support and psychological birth trauma. The mediating model was examined by the PROCESS macro for SPSS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After adjusting for demographic variables, social support was negatively associated with psychological birth trauma (r=\u22120.242, p&lt;0.01). Childbirth readiness had a positive correlation with social support (r=0.206, p&lt;0.01) and a negative correlation with psychological birth trauma (r=\u22120.351, p&lt;0.01). The hierarchical multiple regression model indicated that social support and childbirth readiness explained 3.9% and 7.7% of the variance in psychological birth trauma, respectively. Childbirth readiness partly mediated the association between social support and psychological birth trauma for primiparas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Childbirth readiness plays a mediating role between social support and psychological birth trauma among primiparas. Strategies and interventions to enhance childbirth readiness levels may be expected to improve the impact of social support on women\u2019s psychological birth trauma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-080481","type":"journal-article","created":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T22:40:15Z","timestamp":1727736015000},"page":"e080481","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Mediating role of childbirth readiness in the relationship between social support and psychological birth trauma in primiparous women: a nationwide cross-sectional study in China"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9383-6154","authenticated-orcid":false,"given":"Dandan","family":"Ju","sequence":"first","affiliation":[{"name":"Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"},{"name":"Department of Nursing, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengmei","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingbing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tieying","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,30]]},"reference":[{"key":"2025121402550172000_14.9.e080481.1","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1111\/ijn.12286","article-title":"Iranian mothers\u2019 perceptions of the impact of the environment on psychological birth trauma: A qualitative study","volume":"21 Suppl 2","author":"Taghizadeh","year":"2015","journal-title":"Int J Nurs Pract"},{"key":"2025121402550172000_14.9.e080481.2","doi-asserted-by":"crossref","first-page":"254","DOI":"10.12968\/bjom.2016.24.4.254","article-title":"What is traumatic birth? A concept analysis and literature review","volume":"24","author":"Greenfield","year":"2016","journal-title":"Br J Midwifery"},{"key":"2025121402550172000_14.9.e080481.3","doi-asserted-by":"publisher","DOI":"10.1097\/00006199-200407000-00004"},{"key":"2025121402550172000_14.9.e080481.4","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13291"},{"key":"2025121402550172000_14.9.e080481.5","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.wombi.2015.10.009","article-title":"Understanding psychological traumatic birth experiences: A literature review","volume":"29","author":"Simpson","year":"2016","journal-title":"Women Birth"},{"key":"2025121402550172000_14.9.e080481.6","article-title":"The effect of counseling on anxiety after traumatic childbirth in nulliparous women; a single blind randomized clinical trial","volume":"14","author":"Azizi","year":"2010","journal-title":"J Kermanshah Univ Med Sci"},{"key":"2025121402550172000_14.9.e080481.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536X.2011.00475.x"},{"key":"2025121402550172000_14.9.e080481.8","doi-asserted-by":"publisher","DOI":"10.3109\/0167482x.2011.569801"},{"key":"2025121402550172000_14.9.e080481.9","doi-asserted-by":"publisher","DOI":"10.1080\/02646838.2017.1397270"},{"key":"2025121402550172000_14.9.e080481.10","doi-asserted-by":"crossref","DOI":"10.1177\/2333393615575313","article-title":"Middle Range Theory of Traumatic Childbirth: The Ever-Widening Ripple Effect","volume":"2","author":"Beck","year":"2015","journal-title":"Glob Qual Nurs Res"},{"key":"2025121402550172000_14.9.e080481.11","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1007\/s00737-015-0560-x","article-title":"Women\u2019s experiences of symptoms of posttraumatic stress disorder (PTSD) after traumatic childbirth: a review and critical appraisal","volume":"18","author":"James","year":"2015","journal-title":"Arch Womens Ment Health"},{"key":"2025121402550172000_14.9.e080481.12","doi-asserted-by":"publisher","DOI":"10.1097\/01.NNR.0000313494.87282.90"},{"key":"2025121402550172000_14.9.e080481.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpag.2009.04.006"},{"key":"2025121402550172000_14.9.e080481.14","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1177\/1524838020977161","article-title":"Traumatic Childbirth Experiences of New Parents: A Meta-Synthesis","volume":"23","author":"Shorey","year":"2022","journal-title":"Trauma Violence Abuse"},{"key":"2025121402550172000_14.9.e080481.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-017-1259-y","article-title":"\u201cNothing\u2019s actually happened to me.\u201d: the experiences of fathers who found childbirth traumatic","volume":"17","author":"Etheridge","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121402550172000_14.9.e080481.16","first-page":"270","article-title":"Exploring Contributing Factors to Psychological Traumatic Childbirth from the Perspective of Midwives: A Qualitative Study","volume":"13","author":"Huang","year":"2019","journal-title":"Asian Nurs Res (Korean Soc Nurs Sci)"},{"key":"2025121402550172000_14.9.e080481.17","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1111\/jmwh.13464","article-title":"Midwifery Students\u2019 Traumatic Childbirth Experiences, Traumatic Childbirth Perceptions, and Levels of Fear of Childbirth","volume":"68","author":"Yilmaz Sezer","year":"2023","journal-title":"J Midwif Womens Health"},{"key":"2025121402550172000_14.9.e080481.18","doi-asserted-by":"crossref","unstructured":"Beck CT , Driscoll JW , Watson S . Subsequent childbirth after a previous traumatic birth. In: Traumatic childbirth. Routledge, 2013.","DOI":"10.4324\/9780203766699"},{"key":"2025121402550172000_14.9.e080481.19","first-page":"2530","article-title":"Effect of counseling based on Gamble\u2019s approach on postpartum anxiety in primiparous women","volume":"1","author":"Hajjarian","year":"2021","journal-title":"J Midwif Reprod Health"},{"key":"2025121402550172000_14.9.e080481.20","doi-asserted-by":"publisher","DOI":"10.1097\/ANS.0000000000000000203"},{"key":"2025121402550172000_14.9.e080481.21","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.midw.2015.07.011","article-title":"Inter-relationships between sexual abuse, female sexual function and childbirth","volume":"31","author":"Gottfried","year":"2015","journal-title":"Midwifery"},{"key":"2025121402550172000_14.9.e080481.22","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-536X.2003.00215.x"},{"key":"2025121402550172000_14.9.e080481.23","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.wombi.2020.09.021","article-title":"The childbirth experience: A systematic review of predictors and outcomes","volume":"34","author":"McKelvin","year":"2021","journal-title":"Wom Birth"},{"key":"2025121402550172000_14.9.e080481.24","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(91)90150-B"},{"key":"2025121402550172000_14.9.e080481.25","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.wombi.2021.04.013","article-title":"The impact of COVID-19 on pregnant womens\u2019 experiences and perceptions of antenatal maternity care, social support, and stress-reduction strategies","volume":"35","author":"Meaney","year":"2022","journal-title":"Women Birth"},{"key":"2025121402550172000_14.9.e080481.26","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.wombi.2020.12.014","article-title":"Perceived social support and prenatal wellbeing; The mediating effects of loneliness and repetitive negative thinking on anxiety and depression during the COVID-19 pandemic","volume":"35","author":"Harrison","year":"2022","journal-title":"Women Birth"},{"key":"2025121402550172000_14.9.e080481.27","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1080\/01674820600868966","article-title":"Psychosocial factors and mode of delivery","volume":"27","author":"Van de Pol","year":"2006","journal-title":"J Psychosom Obstet Gynaecol"},{"key":"2025121402550172000_14.9.e080481.28","article-title":"Continuous support for women during childbirth","volume":"7","author":"Hodnett","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121402550172000_14.9.e080481.29","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-022-04574-6","article-title":"Childbirth Readiness Scale (CRS): instrument development and psychometric properties","volume":"22","author":"Mengmei","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121402550172000_14.9.e080481.30","doi-asserted-by":"publisher","DOI":"10.1080\/00016340600566121"},{"key":"2025121402550172000_14.9.e080481.31","doi-asserted-by":"crossref","first-page":"3612","DOI":"10.1080\/14767058.2020.1834531","article-title":"Comparison of childbirth experiences and postpartum depression among primiparous women based on their attendance in childbirth preparation classes","volume":"35","author":"Hassanzadeh","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2025121402550172000_14.9.e080481.32","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-017-4345-5"},{"key":"2025121402550172000_14.9.e080481.33","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2002.01200.x"},{"key":"2025121402550172000_14.9.e080481.34","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1097\/ANS.0000000000000152","article-title":"Theory Description, Critical Reflection, and Theory Evaluation of the Transitions Theory of Meleis et al according to Chinn and Kramer (2011)","volume":"40","author":"Bohner","year":"2017","journal-title":"ANS Adv Nurs Sci"},{"key":"2025121402550172000_14.9.e080481.35","doi-asserted-by":"publisher","DOI":"10.1111\/j.1547-5069.1994.tb00929.x"},{"key":"2025121402550172000_14.9.e080481.36","doi-asserted-by":"crossref","first-page":"28","DOI":"10.5152\/balkanmedj.2012.070","article-title":"Affected States soft independent modeling by class analogy from the relation between independent variables, number of independent variables and sample size","volume":"30","author":"Kan\u0131k","year":"2013","journal-title":"Balkan Med J"},{"key":"2025121402550172000_14.9.e080481.37","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"2025121402550172000_14.9.e080481.38","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2023.1071336","article-title":"Development and psychometric testing of a scale for assessing the psychological birth trauma","volume":"14","author":"Zhang","year":"2023","journal-title":"Front Psychol"},{"key":"2025121402550172000_14.9.e080481.39","doi-asserted-by":"publisher","DOI":"10.1002\/nur.20008"},{"key":"2025121402550172000_14.9.e080481.40","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/jedm.12050","article-title":"Introduction to mediation, moderation, and conditional process analysis: a regression-based approach","volume":"51","author":"Bolin","year":"2014","journal-title":"J Educ Meas"},{"key":"2025121402550172000_14.9.e080481.41","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1080\/14767058.2020.1711727","article-title":"Association between adverse perinatal outcomes and sleep disturbances during pregnancy: a systematic review and meta-analysis","volume":"35","author":"Yang","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2025121402550172000_14.9.e080481.42","doi-asserted-by":"crossref","DOI":"10.1016\/j.midw.2022.103406","article-title":"The association of a past childbirth experience with a variety of early physical and mental symptoms in subsequent pregnancies","volume":"112","author":"Davidsen","year":"2022","journal-title":"Midwifery"},{"key":"2025121402550172000_14.9.e080481.43","unstructured":"Herman JL . Trauma and recovery: the aftermath of violence--from domestic abuse to political terror. Hachette UK, 2015."},{"key":"2025121402550172000_14.9.e080481.44","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-018-0511-x","article-title":"Creating a positive perception of childbirth experience: systematic review and meta-analysis of prenatal and intrapartum interventions","volume":"15","author":"Taheri","year":"2018","journal-title":"Reprod Health"},{"key":"2025121402550172000_14.9.e080481.45","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-015-0683-0","article-title":"The meaning of a very positive birth experience: focus groups discussions with women","volume":"15","author":"Karlstr\u00f6m","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121402550172000_14.9.e080481.46","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2010.05391.x"},{"key":"2025121402550172000_14.9.e080481.47","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-13-60","article-title":"A community perspective on the role of fathers during pregnancy: a qualitative study","volume":"13","author":"Alio","year":"2013","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121402550172000_14.9.e080481.48","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.wombi.2014.05.003","article-title":"Qualitative insights into women\u2019s personal experiences of perinatal depression and anxiety","volume":"27","author":"Highet","year":"2014","journal-title":"Women Birth"},{"key":"2025121402550172000_14.9.e080481.49","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1080\/14767058.2020.1730799","article-title":"Effects of counseling based on Gamble\u2019s approach on psychological birth trauma in primiparous women: a randomized clinical trial","volume":"35","author":"Hajarian Abhari","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2025121402550172000_14.9.e080481.50","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1111\/ppc.12867","article-title":"Using an emotion-focused approach in preventing PBT","volume":"58","author":"G\u00f6k\u00e7e \u0130sbir","year":"2022","journal-title":"Perspect Psychiatr Care"},{"key":"2025121402550172000_14.9.e080481.51","doi-asserted-by":"crossref","first-page":"103883","DOI":"10.1016\/j.ijnurstu.2021.103883","article-title":"Self-management education among women with pre-existing diabetes in pregnancy: A scoping review","volume":"117","author":"Sushko","year":"2021","journal-title":"Int J Nurs Stud"},{"key":"2025121402550172000_14.9.e080481.52","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0191723","article-title":"Associations of psychosocial factors with pregnancy healthy life styles","volume":"13","author":"Omidvar","year":"2018","journal-title":"PLoS One"},{"key":"2025121402550172000_14.9.e080481.53","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.midw.2018.12.017","article-title":"Skills-based childbirth preparation increases childbirth self-efficacy for first time mothers","volume":"70","author":"Howarth","year":"2019","journal-title":"Midwifery"},{"key":"2025121402550172000_14.9.e080481.54","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2022.809272","article-title":"Social Support and Job Satisfaction in Kindergarten Teachers: The Mediating Role of Coping Styles","volume":"13","author":"Yang","year":"2022","journal-title":"Front Psychol"},{"key":"2025121402550172000_14.9.e080481.55","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536X.1989.tb00862.x"},{"key":"2025121402550172000_14.9.e080481.56","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1111\/jmwh.12269","article-title":"A systematic review of maternal confidence for physiologic birth: characteristics of prenatal care and confidence measurement","volume":"59","author":"Avery","year":"2014","journal-title":"J Midwifery Womens Health"},{"key":"2025121402550172000_14.9.e080481.57","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-022-04377-9","article-title":"The mediating role of coping styles in the relationship between perceived social support and antenatal depression among pregnant women: a cross-sectional study","volume":"22","author":"Chen","year":"2022","journal-title":"BMC Pregnancy Childbirth"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-080481","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T10:55:13Z","timestamp":1765709713000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-080481"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":57,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9,30]]},"published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1136\/bmjopen-2023-080481"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-080481","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]}}}