Labor Companion Support, Women‐Centered Care, and Childbirth Preparation in Relation to Psychological Birth Trauma: A Cross‐Sectional SEM Analysis

Abstract

ABSTRACT Background and Aims Psychological birth trauma (PBT) is a significant maternal health concern characterized by fear, helplessness, and loss of control during childbirth. While continuous labor companion support, women‐centered care, and childbirth readiness are individually associated with improved maternal outcomes, their cross‐sectional statistical association with reported levels of PBT remain underexplored. This study aimed to examine the associations between these variables among postnatal women in Ethiopia. Methods A facility‐based cross‐sectional study was conducted among 440 postnatal women in Addis Ababa. Participants were selected using systematic random sampling. Data were collected using validated tools: the Birth Trauma Scale, Childbirth Readiness Scale, Person‐Centered Maternity Care scale, and Birth Companion Support Questionnaire. All instruments were translated into Amharic using forward–backward translation. While internal consistency was high (Cronbach's alpha > 0.80), formal psychometric validation in Amharic has not been previously published, which introduces potential unmeasured variance in construct validity and measurement equivalence, and is acknowledged as a key analytical limitation. Structural Equation Modeling (SEM) with Weighted Least Squares Mean and Variance (WLSMV) estimation was applied. Indirect association analysis was performed using SEM and 5000 bias‐corrected bootstrap samples. Model fit was assessed using χ 2 /df, CFI, TLI, RMSEA, and SRMR. All analyses, including SEM pathways, were conducted using two‐tailed tests. Results Among 431 postnatal women (98.0% response rate; mean age = 29.0, SD = 4.86), continuous labor companion support was directly and inversely associated with psychological birth trauma levels ( β = −0.31, 95% CI [−0.50, −0.14], p < 0.001). Statistically significant indirect association connected companion support to lower birth trauma via childbirth readiness ( β = −0.03, 95% CI [−0.098, −0.011], q = 0.013) and person‐centered maternity care ( β = −0.108, 95% CI [−0.111, −0.022], q = 0.002). The final SEM model showed excellent fit indices ( χ 2 /df = 3.446, CFI = 0.950, RMSEA = 0.071, SRMR = 0.056) with path coefficients reported as standardized estimates ( β ). Conclusion Continuous labor companion support was significantly associated with lower reported psychological birth trauma, with statistical indirect relationships co‐occurring with higher levels of childbirth readiness and person‐centered care. These findings should be interpreted solely as correlational associations; causal inference requires longitudinal or intervention designs.