Mistreatment and Discrimination during Childbirth, Associations with Symptoms of Childbirth-Related Posttraumatic Stress Disorder and the Mediating Role of the Subjective Birth Experience: A Quantitative Analysis Within the Prospective Cohort Study RESPECT_PARENTS

Abstract

Background

Mistreatment and discrimination during childbirth are a global public health concern. Such experiences can adversely affect the subjective birth experience and increase the likelihood of compromised postpartum mental health, including symptoms of childbirth-related posttraumatic stress disorder (CB-PTSD) not only in mothers/birthing parents, but also in partners. This study examines instances of mistreatment and discrimination during childbirth, their association with CB-PTSD symptoms, and the potential mediating role of the subjective birth experience in both parents.

Methods

Data were retrieved from the prospective RESPECT_PARENTS cohort, a German community sample. For the current study, data from n = 1075 mothers/birthing parents and n = 454 partners, collected at two assessment points, i.e., during pregnancy and eight weeks after birth, were included. Regression and mediation models were used to analyze the associations separately for mothers/birthing parents and partners.

Results

Mistreatment during childbirth was reported by 25.8% of mothers/birthing parents and 6.8% of partners, whereas perceived discrimination was reported by 3.9% of mothers/birthing parents and 3.5% of partners. These experiences predicted more severe CB-PTSD symptoms among mothers/birthing parents. For both parents, experiencing more mistreatment and more discrimination was associated with a more negative subjective birth experience, which in turn was associated with more severe CB-PTSD symptoms, demonstrating a significant mediation effect.

Conclusion

The current study indicates that mistreatment and discrimination during childbirth exist in Germany among both mothers/birthing parents and partners, potentially contributing to a more negative subjective birth experience and more severe CB-PTSD symptoms. The findings emphasize the need to address mistreatment and discrimination during childbirth for both parents, in general and as potential risk factors for adverse outcomes.

Zusammenfassung

Hintergrund

Gewalt und Diskriminierung unter der Geburt stellen ein weltweites Problem der öffentlichen Gesundheit dar. Derartige Erfahrungen können das subjektive Geburtserleben beeinträchtigen und die Wahrscheinlichkeit von psychischen Problemen nach der Geburt, einschließlich Symptomen einer geburtsbezogenen Posttraumatischen Belastungsstörung (PTBS), sowohl für Mütter/Gebärende als auch Partner*innen erhöhen. Diese Studie untersucht das Auftreten von Gewalt und Diskriminierung unter der Geburt, den Zusammenhang mit geburtsbezogenen PTBS-Symptomen sowie die potenziell vermittelnde Rolle des subjektiven Geburtserlebens für beide Elternteile.

Methoden

Die Daten stammen aus der prospektiven Kohorte RESPECT_PARENTS, einer in Deutschland rekrutierten bevölkerungsbasierten Stichprobe. Für die aktuelle Studie wurden Daten von n = 1075 Müttern/Gebärenden und n = 454 Partner*innen ausgewertet, die zu 2 Messzeitpunkten (während der Schwangerschaft und 8 Wochen nach der Geburt) erhoben wurden. Es wurden Regressions- und Mediationsmodelle verwendet, um die Zusammenhänge für Mütter/Gebärende und Partner*innen in separaten Analysen zu betrachten.

Ergebnisse

Gewalterfahrungen unter der Geburt wurden von 25,8% der Mütter/Gebärenden und 6,8% der Partner*innen berichtet, während Diskriminierung von 3,9% der Mütter/Gebärenden und 3,5% der Partner*innen berichtet wurde. Diese Erfahrungen sagten schwerwiegendere geburtsbezogene PTBS-Symptome bei Müttern/Gebärenden vorher. Für beide Elternteile war das Erleben von mehr Gewalt und Diskriminierung mit einem negativeren subjektiven Geburtserleben verbunden, welches wiederum mit schwerwiegenderen geburtsbezogenen PTBS-Symptomen assoziiert war und einen signifikanten Mediationseffekt zeigte.

Schlussfolgerungen

Die vorliegende Studie zeigt, dass Gewalt und Diskriminierung unter der Geburt in Deutschland sowohl bei Müttern/Gebärenden als auch bei Partner*innen auftreten und zu einem negativerem Geburtserleben und schwerwiegenderen geburtsbezogenen PTBS-Symptomen beitragen können. Die Ergebnisse unterstreichen die Notwendigkeit, Gewalt und Diskriminierung beider Elternteile unter der Geburt sowohl allgemein als auch als potenzielle Risikofaktoren für negative Folgen zu adressieren.

Keywords

RESPECT study - obstetric violence/mistreatment - discrimination - subjective birth experience - CB-PTSD symptoms

Schlüsselwörter

RESPECT-Studie - Gewalt in der Geburtshilfe - Diskriminierung - subjektives Geburtserleben - geburtsbezogene PTBS-Symptome

Publication History

Received: 16 June 2025

Accepted after revision: 20 September 2025

Article published online:
11 November 2025

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