Abstract / Summary
Abstract Background COVID-19-related changes to maternity care have frequently resulted in deviations from planned birth experiences. Discrepancies between expected and actual birth experiences are a risk factor for birth trauma. This study examined the associations between pandemic-related birth plan changes and birth trauma symptoms and assessed whether birth satisfaction mediated this relationship. Methods In this cross-sectional analysis nested within the Generation C Study, a prospective pregnancy cohort in New York City (2020–2022), we included 727 participants who reported on pandemic-related birth plan changes, birth trauma symptoms and birth satisfaction in a postpartum survey. Multivariable linear regression was used to estimate associations between any change in birth plan and birth trauma scores. Causal mediation analysis with bootstrapping was used to test the mediating role of birth satisfaction. Secondary analyses were used to examine specific changes. Models were adjusted for parity, race/ethnicity, maternal history of mental illness, pregnancy or birth complications, neonatal intensive care unit admission, time from pandemic onset to birth and time from birth to survey completion. Results Approximately one-third of the participants ( n = 239, 32.9%) reported a pandemic-related birth plan change. After adjustment, any birth plan change was associated with higher birth trauma scores (β = 0.71, 95% CI 0.44; 0.98, p < 0.001). Birth satisfaction did not mediate this association ( p = 0.830). The absence of a support person (β = 0.68, p < 0.001) and separation from the newborn after delivery (β = 1.48, p = 0.001) were the specific changes most strongly associated with higher trauma scores. Conclusions Pandemic-related birth plan changes, particularly the absence of a support person and mother–infant separation, were associated with higher birth trauma scores, and this association was not explained by birth satisfaction. Because satisfaction was similar regardless of birth plan changes, assessing satisfaction alone may not identify individuals who experienced distress related to these disruptions.