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

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.