Childbirth readiness mediates the effect of social support on psychological birth trauma of primiparous women: a nationwide online cross-sectional study in China

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This study aimed to identify the relationship between social support, childbirth readiness, and psychological birth trauma and to further explore whether childbirth readiness can play a mediating role. Methods A nationwide online cross-sectional study was conducted among 751 primiparous women in seven provinces in China from November 2021 to March 2022. The questionnaire consisted of questions on demographic characteristics, the Psychological Birth Trauma Scale (PBTS), the Chinese Mandarin version of the Medical Outcomes Study Social Support Survey (MOS-SSS-CM), and the Childbirth Readiness Scale (CRS). Hierarchical multiple regression was used to explore the associate 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. Results After adjusting for demographic variables, social support was negatively associated with psychological birth trauma ( r =-0.242, P <0.01). Childbirth readiness had a positive correlation with social support ( r = 0.206, P <0.01) and a negative correlation with psychological birth trauma ( r =-0.351, P <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. Conclusions Childbirth readiness played 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's psychological birth trauma. Psychological birth trauma Social support Childbirth readiness Primiparous women Figures Figure 1 Introduction Psychological birth trauma (PBT) refers to the severe psychological harm caused by events that occur before and during childbirth 1,2 and is characterized by intense fear, loss of control, powerlessness, and helplessness during labor and birth. 3 The incidence rate is high, and its effects are far-reaching. The prevalence of traumatic psychological distress experience during childbirth in Iran, Netherlands, Australia, the United Kingdom, and the USA was reported to be between 9.0% and 55.5% in several studies 4–9 . The harms of psychological birth trauma are centered on the mother and expand like a "ripple" 10 that affects the mother's health, infant's health, mother-infant relationship, the partnership, the medical staff, and even subsequent pregnancy. For the women themselves, psychological birth trauma may lead to the advent of posttraumatic stress, which manifest as traumatic memories, negative cognition, and displayed avoidance behaviors. Moreover, it may also develop into Post Traumatic Stress Disorder (PTSD) 11 and even lead to adverse events such as suicide. In terms of infants' health, breastfeeding is scant for infants due to maternal alienation and aversion, which affects their nutritional status and mental health during adolescence 12,13 . A previous study highlighted that mothers with poor attachments with their infants might adopt harmful infant care and be less dedicated in childcare, thus affecting their children's physical, cognitive, and behavioral growths 14 . Regarding their partner, they may blame themselves for nothing they can do to release the pain of maternal pregnancy and childbirth 15 , and those traumatic memories can strain the marital relationship 4 . For medical staff, secondary traumatic stress (STS) may appear because they witnessed and participated in the whole distress birth process, manifesting as powerlessness and helplessness and doubting their professional faith 16,17 . Additionally, the women who had experienced negative traumatic births might avoid subsequent pregnancies, affecting their future fertility choices 14,18 . Given the importance of psychological birth trauma to women, exploring how to prevent women's psychological birth trauma is crucial to promote positive birthing experiences and reduce the negative consequences of childbirth in women 14 . However, there is scant evidence on prevention. Prior studies indicated that psychological birth trauma was affected by multiple factors, including age, income, history of sexual abuse, excruciating labor pain, previous trauma, and high expectation 19–22 . Research has found a strong correlation between social support and psychological birth trauma 23 . Social support, defined as the practical, emotional, information, tangible, affectionate support perceived by individuals from their social networks 24 , was confirmed to be a protective factor for psychological birth trauma 22 , which may reduce negative birth experiences, enhance physical and mental fitness and thereby prevent the psychological birth trauma of the women. Previous studies have demonstrated that continuous support from health care providers during pregnancy, labor, and birth reduces negative maternal psychological experiences, decreases the rate of emergency cesarean section, the interventions of instrumental vaginal delivery, and improves maternal outcomes 25 . Insufficient support further compounds women's negative birth experiences and may lead to psychological birth trauma. However, while the importance of the level of social support received by women is recognized, few studies have aimed to identify the mechanism underlying how social support affects the psychological birth trauma of women. In addition to social support, poor childbirth readiness levels may connect with the women's psychological birth trauma. Childbirth readiness refers to women's level of childbirth readiness during pregnancy, which is a comprehensive assessment of their ability before childbirth and perception of whether they are ready for childbirth 26 . Inadequate childbirth readiness can endanger maternal and infant health and affect childbirth outcomes. Research has shown that insufficient childbirth readiness can cause prolonged labor, preterm labor, postpartum hemorrhage, and even increasing maternal and infant mortality 27 . Moreover, inadequate childbirth readiness may increase the incidence of birth trauma, lead to negative childbirth experiences, postpartum depression, and even progress to PTSD 28 29 . Based on the above literature, we assumed that childbirth readiness was an essential factor to psychological birth trauma of women. Furthermore, prior studies have shown that social support can facilitate role adaptation, attain knowledge, enhance self-efficacy, build birth confidence, reduce negative emotions of the women and thus assist them in being well prepared for childbirth. Numerous studies focus on women's social support in different countries and regions. However, little is known about the social support perceived by the women and the associations between social support and psychological birth trauma among women in China. Additionally, few have considered that childbirth readiness may mediate the relationship between social support and psychological birth trauma. If childbirth readiness is a mediator between social support and psychological birth trauma, it will provide an important intervention direction for preventing psychological birth trauma. Considering that primiparous women would not be disturbed by the past negative birth experience, we determined to select the primiparous women as the research population. To sum up, this is the first study to examine the impact of social support on psychological birth trauma and the relationship between psychological birth trauma, social support, and childbirth readiness. This study aims to verify the following three hypotheses among nulliparous women: 1) social support has a negative effect on psychological birth trauma, 2) childbirth readiness has a negative effect on psychological birth trauma, 3) childbirth readiness mediates the association between social support and psychological birth trauma. Materials And Methods Ethics statement The study protocol was approved by the Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (reference number: TJ-IRB20210755). The research conforms to the provisions of the Declaration of Helsinki 30 . All participants gave informed consent before the research, and their anonymity was preserved. Study Design And Sample A cross-sectional study was conducted using a convenient sampling method to select primiparas from obstetric wards of 10 comprehensive hospitals and three specialized hospitals from 7 provinces in China (Hainan, Zhejiang, Shanxi, Hubei, Guangxi, Xinjiang, Jilin) between November 2021 and March 2022. A total of 751 women entered the study. A self-administered online questionnaire was used to collect data. Women who had given birth within 72 hours at the study hospitals during the study period were recruited. The inclusion criteria were primiparous women aged ≥ 18 with a singleton pregnancy who were willing to participate in the study. The exclusion criteria were women who had psychological diseases or severe obstetric complications. Measurement Of Psychological Birth Trauma The Psychological Birth Trauma Scale (PBTS), a 15-item self-report scale, was used to assess the psychological birth trauma levels of the women. Each item is rated on a 5-point Likert scale from 1 (not meet at all) to 5 (exact match). The total score is between 15 to 75. A higher total score indicates stronger psychological birth trauma levels. The PBTS consists of four dimensions: being neglected (four items, Cronbach's α = 0.878), out of control (four items, Cronbach's α = 0.804), physiological emotional response (four items, Cronbach's α = 0.863), and cognitive behavioral response (three items, Cronbach's α = 0.904). Cronbach's α for the present study was 0.937. Our research team developed, tested, and validated the PBTS to assess the psychological birth trauma of women, following a rigorous process of development and psychometric testing. We conducted a qualitative stage (generation of an item pool), which has been published 31 , and a quantitative stage (assessment of psychometric properties of PBTS). We conducted tests for content validity, item analysis, construct validity, split-half reliability, and internal consistency reliability 32 . Cronbach's α in this research was 0.874 and was judged acceptable. The results of confirmatory factor analysis were: χ 2 / df = 2.603, RMSEA = 0.067, CFI = 0.961, GFI = 0.929, NFI = 0.938, IFI = 0.961, TLI = 0.950 and RMR = 0.064, and supported the structure of four-factor model. Measurement Of Social Support The Chinese Mandarin Version of the Medical Outcomes Study Social Support Survey(MOS-SSS-CM) 33 was used to assess the women's perception of social support; this scale has 20-item and includes 1 item evaluating the support network and 19 items assessing the availability of certain types of social support in emotional/informational, tangible, affectionate, and positive social interaction domains. It is a 5-point Likert scale, ranging from 1(none of the time) to 5 (all of the time), with a higher score indicating greater social support. The Cronbach's α and 2-week test-retest reliability for the Chinese version of the MOS-SSS were 0.98 and 0.84, respectively 33 . Cronbach's α for the present study was 0.973. Measurement Of Childbirth Readiness Levels The childbirth readiness scale (CRS) was used to assess the childbirth readiness levels 26 . The CRS is an 18-item scale with four dimensions: self-management, information literacy, birth confidence, and birth plan. It is a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). The total score is between 18 to 90. A higher total score indicates greater childbirth readiness levels. The CRS has been validated in Chinese pregnant women with good reliability (split-half reliability = 0.88, Cronbach's α = 0.94) 26 . In the present study, the CRS's Cronbach's α = 0.957. Demographic Characteristics The demographic characteristics included eight questions on participants' age, education, marital status, residence area, employment status, monthly household income (RMB, renminbi, Chinese yuan), pregnancy sleep status, and pregnancy exercise status. Statistical Analyses IBM SPSS Statistics 26.0 (IBM., Asia Analytics Shanghai) was used to conduct the statistical analysis. Two-tailed P < 0.05 was set as the significant level. All continuous variables were tested for normality, and they all confirmed normality. Independent t-test and one-way ANOVA were used to describe group differences in demographic characteristics of continuous variables. Pearson's correlations were used to examine the correlations between psychological birth trauma, childbirth readiness, and social support. The hierarchical multiple regression analysis was performed to explore childbirth readiness as a potential mediating role in the association between social support and psychological birth trauma. Control variables were entered in model 1. In model 2, social support was added, and in model 3 childbirth readiness levels were added as a mediator. The VIF less than 5 indicated that there is no severe multicollinearity. All the VIF values were < 5 in this study. The mediation model was conducted using PROCESS 4.0 for the SPSS macro-program. The selection of control variables was based on the statistical of the univariate analysis. Social support was modeled as the independent variable, with psychological birth trauma as the dependent variable and childbirth readiness as the mediator. The total effect (path c), the direct effect (path c'), and the indirect effects (path a*b) were examined. 5000 bootstrapped samples based on bias-corrected confidence intervals were used to examine the indirect effect 34 . If the 95% bootstrap confidence interval does not include zero, the effect is regarded as significant. Results Description of demographic characteristics Demographic characteristics of primiparous women and group differences in psychological birth trauma, childbirth readiness, and social support are presented in Table 1 . The age range was from 18 to 42 years, with the average age of the participants being 28.53 ± 3.74 (mean ± SD). 77.8% of them received a bachelor's or above educational degree. The majority of the women were married (96.7%), lived in the urban area (83.0%), and were employed (82.3%). For 18.2% of the women, the monthly household income is below 3000 yuan. Most of the women slept well during pregnancy (60.3%). 12.1% of the women always kept exercising during pregnancy. Table 1 Relationship between demographic characteristics and PTB, CRL as well as social support ( n = 751) Psychological birth trauma childbirth readiness levels Social support variables N (%) mean ± SD mean ± SD mean ± SD Age (years) ≤ 25 126(16.8) 29.94 ± 13.83 76.52 ± 12.09 73.91 ± 15.98 26–30 420(55.9) 28.15 ± 11.35 76.48 ± 10.68 74.33 ± 13.90 ≥ 31 205(27.3) 26.69 ± 10.64 77.46 ± 10.17 74.53 ± 14.44 P value 0.047 0.548 0.931 Education level secondary school and below 167(22.2) 29.60 ± 12.19 76.72 ± 12.32 70.50 ± 17.53 university and above 584(77.8) 27.61 ± 11.46 76.76 ± 10.32 75.40 ± 13.24 P value 0.052 0.968 <0.001 Marital status married 726(96.7) 28.03 ± 11.53 76.79 ± 10.72 74.37 ± 13.32 others (divorced/widowed/single) 25(3.3) 28.76 ± 14.97 75.80 ± 13.02 72.76 ± 14.44 P value 0.758 0.653 0.584 Residence area urban area 623(83.0) 27.84 ± 11.55 76.80 ± 10.85 74.80 ± 13.98 rural area 128(17.0) 29.07 ± 12.13 76.52 ± 10.55 71.95 ± 16.35 P value 0.278 0.791 0.067 Employment status No 133(17.7) 29.23 ± 12.65 76.99 ± 10.69 72.67 ± 16.95 Yes 618(82.3) 27.80 ± 11.42 76.70 ± 10.82 74.67 ± 13.83 P value 0.198 0.779 0.205 Monthly household income (¥) ≤ 3000 137(18.2) 30.19 ± 13.78 75.78 ± 11.87 72.93 ± 17.38 3001–5000 246(32.8) 28.98 ± 11.17 77.67 ± 10.39 72.74 ± 14.92 5001–10000 241(32.1) 26.28 ± 10.74 76.85 ± 10.79 76.15 ± 12.81 > 10000 127(16.9) 27.33 ± 11.30 75.85 ± 10.33 75.35 ± 12.45 P value 0.006 0.286 0.033 Pregnancy sleep status well 453(60.3) 26.06 ± 10.68 78.14 ± 10.53 75.96 ± 14.32 moderate 272(36.2) 30.48 ± 12.25 75.25 ± 10.07 72.06 ± 13.94 poor 26(3.5) 37.31 ± 12.54 68.35 ± 15.95 69.12 ± 17.52 P value <0.001 <0.001 <0.001 Pregnancy exercise status always 91(12.1) 25.29 ± 12.86 79.79 ± 14.03 75.98 ± 20.32 often 263(35.0) 28.46 ± 12.24 77.20 ± 10.11 75.59 ± 12.43 occasionally 373(49.7) 28.40 ± 10.98 75.96 ± 10.14 72.91 ± 14.06 never 24(3.2) 28.67 ± 9.36 72.67 ± 11.50 75.79 ± 12.74 P value 0.119 0.004 0.070 In the univariate analysis of the factors related to the PBT scores, three factors were significantly related to psychological birth trauma ( P <0.05): age, monthly household income, and pregnancy sleep status, and these variables were entered as control variables in the hierarchical multiple linear regression analysis. More detailed information was presented in Table 1 . Correlations Among Continuous Variables Table 2 displayed the results of Pearson's correlation analysis. Social support was negatively related to psychological birth trauma ( r = -0.242, P <0.01) and positively correlated to childbirth readiness ( r = 0.206, P <0.01). Childbirth readiness was negatively associated with psychological birth trauma ( r = -0.351, P <0.01). Table 2 Means, standard deviations, and correlations of variables Variables Mean SD 1 2 1. Social support 74.31 14.44 1 2. Childbirth readiness levels 76.75 10.79 0.206** 1 3. Psychological birth trauma 28.05 11.65 -0.242** -0.351** The Results Of Hierarchical Multiple Regression As shown in Table 3 , after adjusting for age, monthly household income, and pregnancy sleep status in model 2, social support is negatively associated with PBT ( β =-0.200, P <0.01). Social support explained an additional 3.9% of the variance of the dependent variable. In model 3, childbirth readiness was negatively associated with PBT ( β =-0.289, P <0.01), which accounted for an additional 7.7% of the variance. When CRL was added, the absolute value of the regression coefficient of social support on PBT was decreased (from 0.200 to 0.146). Thus, childbirth readiness could probably function as a mediator in the association of social support with PBT in primiparas. Table 3 Hierarchical multiple regression results for psychological birth trauma ( n = 751) Variables Model1 Model2 Model 3 B β P B β P B β P (Constant) 29.512 <0.001 41.567 <0.001 62.340 <0.001 Age (ref: 18–25) 26–30 -1.621 -0.069 0.161 -1.578 -0.067 0.163 -1.574 -0.067 0.146 31–42 -2.860 -0.109 0.026 -2.824 -0.108 0.025 -2.515 -0.096 0.037 Monthly household income (ref: ≤3000) 3001–5000 -0.760 -0.031 0.529 − .833 -0.034 0.481 -0.306 -0.012 0.787 5001–10000 -3.561 -0.143 0.003 -3.054 -0.122 0.010 -2.899 -0.116 0.011 > 10000 -2.434 -0.078 0.082 -2.055 -0.066 0.135 -2.181 -0.070 0.097 Pregnancy sleep status (ref: well) moderate 4.542 0.188 <0.001 3.901 0.161 <0.001 3.173 0.131 <0.001 poor 11.186 0.176 <0.001 10.037 0.158 <0.001 7.380 0.116 0.001 Social support -0.162 -0.200 <0.001 -0.118 -0.146 <0.001 Childbirth readiness levels -0.312 -0.289 <0.001 R 2 0.079 0.117 0.195 R 2 change 0.079 0.039 0.077 F 9.049 12.334 19.884 The mediating role of CRS in the relationship between social support and PBT in primiparous women Table 4 showed the results of the mediation analysis. The association between social support and PBT (path c) was examined. The total effect of social support on PBT (c= -0.164, P <0.01) was initially evaluated. Then, the indirect effect of social support on PBT via CRL was observed (path a*b, a = 0.138, b=-0.312, a*b (95%CI) = -0.043 (-0.074, -0.020)). The confidence interval for indirect effect did not contain zero, which suggested that childbirth readiness played a mediating role between social support and PBT. When childbirth readiness was entered into the model as a mediator, the direct effect of social support on PBT(path c') was still significant (c'=-0.121, P<0.01). Therefore, childbirth readiness had a partial mediating effect on the relationship between social support and PBT for primiparas. To understand the effect size of the mediating pathway, we calculated the proportion of the total effect of the social support on PBT that was mediated by childbirth readiness using the formula (a*b)/ c. The proportion of childbirth readiness was 26.22%. The visualization of the model was shown in Fig. 1 . Table 4 The results of the mediation analysis ( n = 751) Path Coefficient/Effect P -value 95% CI (bootstrapping = 5000) c -0.164 <0.001 (-0.220, -0.109) a 0.138 <0.001 (0.086, 0.191) b -0.312 <0.001 (-0.384, -0.239) a*b -0.043 (-0.074, -0.020) c' -0.121 <0.001 (-0.175, -0.067) Discussion Results from this study support the hypothesis that social support was negatively associated with psychological birth trauma and childbirth readiness was the negative predictor of psychological birth trauma among primiparous women. Furthermore, we found that childbirth readiness mediated in promoting the effects of social support on reducing psychological birth trauma. The current research provides evidence of potential mechanisms for the association between social support and psychological birth trauma and provides an empirical basis for psychological birth trauma among primiparous women. In the current study, we found that compared with the primiparous women who were in well pregnancy sleep status, those in moderate or poor sleep status tended to have a higher risk of psychological birth trauma. Poor sleep status during pregnancy may lead to adverse pregnancy and childbirth outcomes 35 and even negative pregnancy and childbirth experiences 36 , which may increase the probability of psychological birth trauma. The current study also found that the primiparous women with young age and lower monthly household income tended to experience psychological birth trauma. This finding is corroborated by Herman's research 20 that those who were more vulnerable in society (young and poor) may be more likely to experience trauma. As we expected, there was a negative relationship between social support and psychological birth trauma, consistent with previous studies. Tahari 37 reported that medical social support such as providing continuous care during labor and birth, implementing music therapy, and reducing medical intervention can reduce the traumatic experience during labor and birth. Additionally, research indicated that the positive relationship between women and health care providers is crucial in creating a sense of control, providing women with safe and supportive birthing environments, and influencing childbirth outcomes 38 . On the contrary, prior studies showed that most women shared their experiences of medical staff betraying their trust, neglecting them, and being apathetic and dismissive[ 14 ]. Such behaviors of medical staff contributed extensively to women's childbirth trauma. Elmir et al. 39 , integrating 10 qualitative studies of birth trauma, found that the women concerned and emphasized most were communication, being respected, and emotional support. Also, good social support is a protective factor for birth trauma. Moreover, Spousal support is a crucial factor during pregnancy and the perinatal period, as it can improve maternal self-esteem, be a buffer against pregnancy tensions and stresses, and is essential for maintaining a positive emotional experience 40,41 . Adequate social support can influence women's childbirth outcomes, enhance childbirth safety and improve the childbirth experience 17 . Therefore, it is suggested that effective interventions to promote the level of social support for women be implemented. This study found a negative correlation between childbirth readiness and psychological birth trauma in primiparous women, which was consistent with previous studies 42,43 . Promoting self-management during pregnancy could help women maintain a favorable physical and psychological state for childbirth and improve childbirth experiences 44 , reducing obstetric complications 45 . Besides, skill-based childbirth preparation can increase childbirth experience for first-time mothers and improve their self-efficacy and birth confidence 46 . Many pieces of research have shown that the psychological factors of women have a direct impact on childbirth outcomes. Furthermore, a pregnant women's belief in her ability to childbirth has been associated with numerous positive childbirth experiences. Hence, helping women a better birth preparedness will be a protective factor against psychological birth trauma. More importantly, this study confirmed the significant indirect effect of social support on psychological birth trauma through childbirth readiness and further illustrated the mechanism by which primiparous women's social support affected psychological birth trauma. Simply put, social support is both directly affected and indirectly affected via childbirth readiness and psychological birth trauma. The overall level of women's childbirth readiness is described as four dimensions: self-management, information literacy, birth confidence, and birth plan 26 . Social support is regarded as women's having obtained and perceived help from social networks 47 . Individuals with a high level of social support were more likely to adopt better childbirth readiness, which further affected the psychological birth trauma. These findings suggest that psychological birth trauma could be improved by enhancing the level of social support and developing better childbirth readiness strategies. Crown and von Baeyer 48 also identified that childbirth and parenting knowledge attained from childbirth education lectures, higher birth confidence, and less anxiety would enhance the birth experience. Moreover, positive birth can represent a 'peak' experience 49 . Therefore, adequate social support and childbirth preparation training is suggested to be supplied for the women to prevent psychological birth trauma. Based on the findings of this study, we offer the following suggestions, hoping to help primiparous women prevent or reduce psychological birth trauma. Firstly, women and their families should be informed about risk factors and the adverse consequences of psychological birth trauma from preconception till the end of the perinatal period 43 . Family members should provide enough material and spiritual support for the mothers to maintain good physical and mental fitness to ensure their health 50 . Health care providers should also care more about the feelings and communications of the mothers and help them to discuss and express their doubts and problems individually 42 . Secondly, efficient interventions for enhancing childbirth readiness should be developed. Medical staff should instruct women's daily life behavior and self-protection behavior, promote self-management, and make a sensible birth plan. Encouraging the women to know more about the process of pregnancy and childbirth and improving information literacy was also very crucial. Moreover, medical staff and family members should help the women believe in themselves and build birth confidence. Some limitations of this study should be discussed. First, a cross-sectional study did not allow us to draw a causal relationship between social support, childbirth readiness, and psychological birth trauma. Longitudinal studies need to confirm the relationship between the three variables. Second, the study variables were evaluated using self-report questionnaires. Nevertheless, all the scales have good reliability and validity and have been verified in Chinese women. Third, the data on childbirth readiness was collected within 72 hours after the women gave birth; the recall bias may exist. Future studies could collect the women's childbirth readiness during their pregnancy. Finally, this study is only concerned with primiparas, and future studies may consider extending this study to multiparas. Conclusions In conclusion, for primiparous women, social support and childbirth readiness were negatively correlated with psychological birth trauma, and childbirth readiness played a mediating role between social support and psychological birth trauma. This study drew out the implication of focusing on childbirth readiness when exploring the mechanism of how social support affected psychological birth trauma. Strategies and interventions to enhance childbirth readiness levels may be expected to improve the impact of social support on women's psychological birth trauma. Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (reference number: TJ-IRB20210755). The research conforms to the provisions of the Declaration of Helsinki (as revised in Brazil 2013). All participants gave informed consent for the research, and their anonymity was preserved. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due to them containing information that could compromise research participant consent but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This project was supported by the National Natural Science Foundation of China (No. 71974061). The funding bodies were not involved in the design of the study, data collection, analyses, and interpretation of data or in writing of the manuscript. Authors’ contributions Study design: JDD, ZK, LBB, ZTY. Data collection: JDD, ZK, ZTY, LBB, YMM. Data analysis: JDD, YMM, LBB. Manuscript writing: JDD, ZK, ZTY. All authors read and approved the final manuscript. Acknowledgments This work was supported by the National Natural Science Foundation of China (No. 71974061). The author would like to thank all the nurse managers who assisted in obtaining informed consent from the participants and collecting the data of the questionnaire. Author information 1 Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430030, China. 2 School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. References Taghizadeh Z, Arbabi M, Kazemnejad A, Irajpour A, Lopez V. 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Mengmei Y, Meizhen Z, Tieying Z, et al. Childbirth Readiness Scale (CRS): instrument development and psychometric properties. BMC Pregnancy Childbirth. 2022;22(1):257. doi: 10.1186/s12884-022-04574-6 . Akca A, Corbacioglu Esmer A, Ozyurek ES, et al. The influence of the systematic birth preparation program on childbirth satisfaction. Arch Gynecol Obstet. 2017;295(5):1127–33. doi: 10.1007/s00404-017-4345-5 . Neggers Y, Goldenberg R, Cliver S, Hauth J. The relationship between psychosocial profile, health practices, and pregnancy outcomes. Acta Obstet Gynecol Scand. 2006;85(3):277–85. doi: 10.1080/00016340600566121 . Gottvall K, Waldenström U. Does a traumatic birth experience have an impact on future reproduction? BJOG: An International Journal of Obstetrics & Gynaecology. 2002;109(3):254–60. doi: 10.1111/j.1471-0528.2002.01200.x . General Assembly of the World Medical Association. 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Association between adverse perinatal outcomes and sleep disturbances during pregnancy: a systematic review and meta-analysis. J Maternal-Fetal Neonatal Med. 2022;35(1):166–74. doi: 10.1080/14767058.2020.1711727 . Davidsen AS, Birkmose AR, Kragstrup J, Siersma V, Ertmann RK. The association of a past childbirth experience with a variety of early physical and mental symptoms in subsequent pregnancies. Midwifery. 2022;112:103406. doi: 10.1016/j.midw.2022.103406 . Taheri M, Takian A, Taghizadeh Z, Jafari N, Sarafraz N. Creating a positive perception of childbirth experience: systematic review and meta-analysis of prenatal and intrapartum interventions. Reproductive Health. 2018;15(1):73. doi: 10.1186/s12978-018-0511-x . Karlström A, Nystedt A, Hildingsson I. The meaning of a very positive birth experience: focus groups discussions with women. BMC Pregnancy Childbirth. 2015;15(1):251. doi: 10.1186/s12884-015-0683-0 . Elmir R, Schmied V, Wilkes L, Jackson D. Women’s perceptions and experiences of a traumatic birth: a meta-ethnography. J Adv Nurs. 2010;66(10):2142–53. doi: 10.1111/j.1365-2648.2010.05391.x . Alio AP, Lewis CA, Scarborough K, Harris K, Fiscella K. A community perspective on the role of fathers during pregnancy: a qualitative study. BMC Pregnancy Childbirth. 2013;13(1):60. doi: 10.1186/1471-2393-13-60 . Highet N, Stevenson AL, Purtell C, Coo S. Qualitative insights into women’s personal experiences of perinatal depression and anxiety. Women Birth. 2014;27(3):179–84. doi: 10.1016/j.wombi.2014.05.003 . Hajarian Abhari Z, Karimi FZ, Taghizdeh Z, Mazloum SR, Asghari Nekah SM. Effects of counseling based on Gamble’s approach on psychological birth trauma in primiparous women: a randomized clinical trial. J Maternal-Fetal Neonatal Med. 2022;35(4):668–76. doi: 10.1080/14767058.2020.1730799 . Gökçe İsbir G, Yılmaz M, Thomson G. Using an emotion-focused approach in preventing psychological birth trauma. Perspect Psychiatr Care. 2022;58(3):1170–6. doi: 10.1111/ppc.12867 . Sushko K, Menezes HT, Strachan P, Butt M, Sherifali D. Self-management education among women with pre-existing diabetes in pregnancy: A scoping review. Int J Nurs Stud. 2021;117:103883. doi: 10.1016/j.ijnurstu.2021.103883 . Omidvar S, Faramarzi M, Hajian-Tilak K, Amiri FN. Associations of psychosocial factors with pregnancy healthy life styles. PLoS ONE. 2018;13(1):e0191723. doi: 10.1371/journal.pone.0191723 . Howarth AM, Swain NR. Skills-based childbirth preparation increases childbirth self-efficacy for first time mothers. Midwifery. 2019;70:100–5. doi: 10.1016/j.midw.2018.12.017 . Yang Y, Lu X, Ban Y, Sun J. Social Support and Job Satisfaction in Kindergarten Teachers: The Mediating Role of Coping Styles. Front Psychol. 2022;13:809272. doi: 10.3389/fpsyg.2022.809272 . Crowe K, von Baeyer C. Predictors of a Positive Childbirth Experience. Birth. 1989;16(2):59–63. doi: 10.1111/j.1523-536X.1989.tb00862.x . Avery MD, Saftner MA, Larson B, Weinfurter EV. A Systematic Review of Maternal Confidence for Physiologic Birth: Characteristics of Prenatal Care and Confidence Measurement. J Midwifery Women’s Health. 2014;59(6):586–95. doi: 10.1111/jmwh.12269 . Chen Z, Li Y, Chen J, Guo X. The mediating role of coping styles in the relationship between perceived social support and antenatal depression among pregnant women: a cross-sectional study. BMC Pregnancy Childbirth. 2022;22(1):188. doi: 10.1186/s12884-022-04377-9 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2314441","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":160281701,"identity":"35556a5b-6601-49dd-87f0-2ada0f65f638","order_by":0,"name":"Dandan JU","email":"","orcid":"","institution":"Huazhong University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dandan","middleName":"","lastName":"JU","suffix":""},{"id":160281702,"identity":"c4e43f00-22ab-4213-8d9b-345b15349795","order_by":1,"name":"Ke ZHANG","email":"","orcid":"","institution":"Huazhong University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ke","middleName":"","lastName":"ZHANG","suffix":""},{"id":160281703,"identity":"b306064d-8234-40e4-b977-45a96ac669c2","order_by":2,"name":"Mengmei YUAN","email":"","orcid":"","institution":"Huazhong University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mengmei","middleName":"","lastName":"YUAN","suffix":""},{"id":160281704,"identity":"76b33075-ec13-46c4-8842-9fef6a869db1","order_by":3,"name":"Bingbing LI","email":"","orcid":"","institution":"Huazhong University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bingbing","middleName":"","lastName":"LI","suffix":""},{"id":160281705,"identity":"c1534dbd-732c-451b-99df-09a1aedca045","order_by":4,"name":"Tieying ZENG","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBACfvaGBOMfBjbMbOwNRGqR7DnwoJihII2dj+cAkVoMbiQ++Mzw4RC/nEQCsVrOHE7cXGBwQJpN8vHGGww1NtGEHXa8Ldl4hsEdYzbptGILhmNpuQ2EtPCdOZNmwGPwLJlNOsdMgrHhMGEtDDfyv//gMThc3yZ5hkgtAjcSEoyBWpjZJHiI1AIM5ATDGQZpzGw8QL8kEOMXUFQafPhjwyzffnjjjQ81NkT4BQkYEB01SFpI1TEKRsEoGAUjAwAAiNtBpvrnTioAAAAASUVORK5CYII=","orcid":"","institution":"Huazhong University of Science and Technology","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Tieying","middleName":"","lastName":"ZENG","suffix":""}],"badges":[],"createdAt":"2022-11-26 06:59:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2314441/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2314441/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":30521861,"identity":"8dc7c6e6-698c-480d-b999-bac47d469d33","added_by":"auto","created_at":"2022-12-19 15:29:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":14694,"visible":true,"origin":"","legend":"\u003cp\u003eModel of the mediating role of childbirth readiness levels between social support and psychological birth trauma. Note: **\u003cem\u003eP\u003c/em\u003e \u0026lt;0.001.\u003c/p\u003e","description":"","filename":"F1.png","url":"https://assets-eu.researchsquare.com/files/rs-2314441/v1/edde9bb0fad2a066e34a9a49.png"},{"id":35412741,"identity":"2d14e654-f484-4f46-93db-c9d0346257dc","added_by":"auto","created_at":"2023-04-06 19:44:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":475229,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2314441/v1/8e7efa6f-012a-443f-8ebb-cb6d68a5a0a2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Childbirth readiness mediates the effect of social support on psychological birth trauma of primiparous women: a nationwide online cross-sectional study in China","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePsychological birth trauma (PBT) refers to the severe psychological harm caused by events that occur before and during childbirth\u003csup\u003e1,2\u003c/sup\u003e and is characterized by intense fear, loss of control, powerlessness, and helplessness during labor and birth.\u003csup\u003e3\u003c/sup\u003e The incidence rate is high, and its effects are far-reaching. The prevalence of traumatic psychological distress experience during childbirth in Iran, Netherlands, Australia, the United Kingdom, and the USA was reported to be between 9.0% and 55.5% in several studies\u003csup\u003e4\u0026ndash;9\u003c/sup\u003e. The harms of psychological birth trauma are centered on the mother and expand like a \"ripple\"\u003csup\u003e10\u003c/sup\u003e that affects the mother's health, infant's health, mother-infant relationship, the partnership, the medical staff, and even subsequent pregnancy. For the women themselves, psychological birth trauma may lead to the advent of posttraumatic stress, which manifest as traumatic memories, negative cognition, and displayed avoidance behaviors. Moreover, it may also develop into Post Traumatic Stress Disorder (PTSD)\u003csup\u003e11\u003c/sup\u003e and even lead to adverse events such as suicide. In terms of infants' health, breastfeeding is scant for infants due to maternal alienation and aversion, which affects their nutritional status and mental health during adolescence\u003csup\u003e12,13\u003c/sup\u003e. A previous study highlighted that mothers with poor attachments with their infants might adopt harmful infant care and be less dedicated in childcare, thus affecting their children's physical, cognitive, and behavioral growths\u003csup\u003e14\u003c/sup\u003e. Regarding their partner, they may blame themselves for nothing they can do to release the pain of maternal pregnancy and childbirth\u003csup\u003e15\u003c/sup\u003e, and those traumatic memories can strain the marital relationship\u003csup\u003e4\u003c/sup\u003e. For medical staff, secondary traumatic stress (STS) may appear because they witnessed and participated in the whole distress birth process, manifesting as powerlessness and helplessness and doubting their professional faith\u003csup\u003e16,17\u003c/sup\u003e. Additionally, the women who had experienced negative traumatic births might avoid subsequent pregnancies, affecting their future fertility choices\u003csup\u003e14,18\u003c/sup\u003e. Given the importance of psychological birth trauma to women, exploring how to prevent women's psychological birth trauma is crucial to promote positive birthing experiences and reduce the negative consequences of childbirth in women\u003csup\u003e14\u003c/sup\u003e. However, there is scant evidence on prevention.\u003c/p\u003e \u003cp\u003ePrior studies indicated that psychological birth trauma was affected by multiple factors, including age, income, history of sexual abuse, excruciating labor pain, previous trauma, and high expectation\u003csup\u003e19\u0026ndash;22\u003c/sup\u003e. Research has found a strong correlation between social support and psychological birth trauma\u003csup\u003e23\u003c/sup\u003e. Social support, defined as the practical, emotional, information, tangible, affectionate support perceived by individuals from their social networks\u003csup\u003e24\u003c/sup\u003e, was confirmed to be a protective factor for psychological birth trauma\u003csup\u003e22\u003c/sup\u003e, which may reduce negative birth experiences, enhance physical and mental fitness and thereby prevent the psychological birth trauma of the women. Previous studies have demonstrated that continuous support from health care providers during pregnancy, labor, and birth reduces negative maternal psychological experiences, decreases the rate of emergency cesarean section, the interventions of instrumental vaginal delivery, and improves maternal outcomes\u003csup\u003e25\u003c/sup\u003e. Insufficient support further compounds women's negative birth experiences and may lead to psychological birth trauma. However, while the importance of the level of social support received by women is recognized, few studies have aimed to identify the mechanism underlying how social support affects the psychological birth trauma of women.\u003c/p\u003e \u003cp\u003eIn addition to social support, poor childbirth readiness levels may connect with the women's psychological birth trauma. Childbirth readiness refers to women's level of childbirth readiness during pregnancy, which is a comprehensive assessment of their ability before childbirth and perception of whether they are ready for childbirth\u003csup\u003e26\u003c/sup\u003e. Inadequate childbirth readiness can endanger maternal and infant health and affect childbirth outcomes. Research has shown that insufficient childbirth readiness can cause prolonged labor, preterm labor, postpartum hemorrhage, and even increasing maternal and infant mortality\u003csup\u003e27\u003c/sup\u003e. Moreover, inadequate childbirth readiness may increase the incidence of birth trauma, lead to negative childbirth experiences, postpartum depression, and even progress to PTSD\u003csup\u003e28 29\u003c/sup\u003e. Based on the above literature, we assumed that childbirth readiness was an essential factor to psychological birth trauma of women. Furthermore, prior studies have shown that social support can facilitate role adaptation, attain knowledge, enhance self-efficacy, build birth confidence, reduce negative emotions of the women and thus assist them in being well prepared for childbirth. Numerous studies focus on women's social support in different countries and regions. However, little is known about the social support perceived by the women and the associations between social support and psychological birth trauma among women in China. Additionally, few have considered that childbirth readiness may mediate the relationship between social support and psychological birth trauma. If childbirth readiness is a mediator between social support and psychological birth trauma, it will provide an important intervention direction for preventing psychological birth trauma.\u003c/p\u003e \u003cp\u003eConsidering that primiparous women would not be disturbed by the past negative birth experience, we determined to select the primiparous women as the research population. To sum up, this is the first study to examine the impact of social support on psychological birth trauma and the relationship between psychological birth trauma, social support, and childbirth readiness. This study aims to verify the following three hypotheses among nulliparous women: 1) social support has a negative effect on psychological birth trauma, 2) childbirth readiness has a negative effect on psychological birth trauma, 3) childbirth readiness mediates the association between social support and psychological birth trauma.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthics statement\u003c/h2\u003e \u003cp\u003e The study protocol was approved by the Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (reference number: TJ-IRB20210755). The research conforms to the provisions of the Declaration of Helsinki\u003csup\u003e30\u003c/sup\u003e. All participants gave informed consent before the research, and their anonymity was preserved.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design And Sample\u003c/h3\u003e\n\u003cp\u003eA cross-sectional study was conducted using a convenient sampling method to select primiparas from obstetric wards of 10 comprehensive hospitals and three specialized hospitals from 7 provinces in China (Hainan, Zhejiang, Shanxi, Hubei, Guangxi, Xinjiang, Jilin) between November 2021 and March 2022. A total of 751 women entered the study. A self-administered online questionnaire was used to collect data. Women who had given birth within 72 hours at the study hospitals during the study period were recruited. The inclusion criteria were primiparous women aged\u0026thinsp;\u0026ge;\u0026thinsp;18 with a singleton pregnancy who were willing to participate in the study. The exclusion criteria were women who had psychological diseases or severe obstetric complications.\u003c/p\u003e\n\u003ch3\u003eMeasurement Of Psychological Birth Trauma\u003c/h3\u003e\n\u003cp\u003eThe Psychological Birth Trauma Scale (PBTS), a 15-item self-report scale, was used to assess the psychological birth trauma levels of the women. Each item is rated on a 5-point Likert scale from 1 (not meet at all) to 5 (exact match). The total score is between 15 to 75. A higher total score indicates stronger psychological birth trauma levels. The PBTS consists of four dimensions: being neglected (four items, Cronbach's α\u0026thinsp;=\u0026thinsp;0.878), out of control (four items, Cronbach's α\u0026thinsp;=\u0026thinsp;0.804), physiological emotional response (four items, Cronbach's α\u0026thinsp;=\u0026thinsp;0.863), and cognitive behavioral response (three items, Cronbach's α\u0026thinsp;=\u0026thinsp;0.904). Cronbach's α for the present study was 0.937.\u003c/p\u003e \u003cp\u003eOur research team developed, tested, and validated the PBTS to assess the psychological birth trauma of women, following a rigorous process of development and psychometric testing. We conducted a qualitative stage (generation of an item pool), which has been published\u003csup\u003e31\u003c/sup\u003e, and a quantitative stage (assessment of psychometric properties of PBTS). We conducted tests for content validity, item analysis, construct validity, split-half reliability, and internal consistency reliability\u003csup\u003e32\u003c/sup\u003e. Cronbach's α in this research was 0.874 and was judged acceptable. The results of confirmatory factor analysis were: \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e/\u003cem\u003edf\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.603, RMSEA\u0026thinsp;=\u0026thinsp;0.067, CFI\u0026thinsp;=\u0026thinsp;0.961, GFI\u0026thinsp;=\u0026thinsp;0.929, NFI\u0026thinsp;=\u0026thinsp;0.938, IFI\u0026thinsp;=\u0026thinsp;0.961, TLI\u0026thinsp;=\u0026thinsp;0.950 and RMR\u0026thinsp;=\u0026thinsp;0.064, and supported the structure of four-factor model.\u003c/p\u003e\n\u003ch3\u003eMeasurement Of Social Support\u003c/h3\u003e\n\u003cp\u003eThe Chinese Mandarin Version of the Medical Outcomes Study Social Support Survey(MOS-SSS-CM)\u003csup\u003e33\u003c/sup\u003e was used to assess the women's perception of social support; this scale has 20-item and includes 1 item evaluating the support network and 19 items assessing the availability of certain types of social support in emotional/informational, tangible, affectionate, and positive social interaction domains. It is a 5-point Likert scale, ranging from 1(none of the time) to 5 (all of the time), with a higher score indicating greater social support. The Cronbach's α and 2-week test-retest reliability for the Chinese version of the MOS-SSS were 0.98 and 0.84, respectively\u003csup\u003e33\u003c/sup\u003e. Cronbach's α for the present study was 0.973.\u003c/p\u003e\n\u003ch3\u003eMeasurement Of Childbirth Readiness Levels\u003c/h3\u003e\n\u003cp\u003eThe childbirth readiness scale (CRS) was used to assess the childbirth readiness levels \u003csup\u003e26\u003c/sup\u003e. The CRS is an 18-item scale with four dimensions: self-management, information literacy, birth confidence, and birth plan. It is a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). The total score is between 18 to 90. A higher total score indicates greater childbirth readiness levels. The CRS has been validated in Chinese pregnant women with good reliability (split-half reliability\u0026thinsp;=\u0026thinsp;0.88, Cronbach's α\u0026thinsp;=\u0026thinsp;0.94) \u003csup\u003e26\u003c/sup\u003e. In the present study, the CRS's Cronbach's α\u0026thinsp;=\u0026thinsp;0.957.\u003c/p\u003e\n\u003ch3\u003eDemographic Characteristics\u003c/h3\u003e\n\u003cp\u003eThe demographic characteristics included eight questions on participants' age, education, marital status, residence area, employment status, monthly household income (RMB, renminbi, Chinese yuan), pregnancy sleep status, and pregnancy exercise status.\u003c/p\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003eIBM SPSS Statistics 26.0 (IBM., Asia Analytics Shanghai) was used to conduct the statistical analysis. Two-tailed \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was set as the significant level. All continuous variables were tested for normality, and they all confirmed normality. Independent t-test and one-way ANOVA were used to describe group differences in demographic characteristics of continuous variables. Pearson's correlations were used to examine the correlations between psychological birth trauma, childbirth readiness, and social support. The hierarchical multiple regression analysis was performed to explore childbirth readiness as a potential mediating role in the association between social support and psychological birth trauma. Control variables were entered in model 1. In model 2, social support was added, and in model 3 childbirth readiness levels were added as a mediator. The VIF less than 5 indicated that there is no severe multicollinearity. All the VIF values were \u003c 5 in this study.\u003c/p\u003e \u003cp\u003eThe mediation model was conducted using PROCESS 4.0 for the SPSS macro-program. The selection of control variables was based on the statistical of the univariate analysis. Social support was modeled as the independent variable, with psychological birth trauma as the dependent variable and childbirth readiness as the mediator. The total effect (path c), the direct effect (path c'), and the indirect effects (path a*b) were examined. 5000 bootstrapped samples based on bias-corrected confidence intervals were used to examine the indirect effect\u003csup\u003e34\u003c/sup\u003e. If the 95% bootstrap confidence interval does not include zero, the effect is regarded as significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDescription of demographic characteristics\u003c/h2\u003e \u003cp\u003eDemographic characteristics of primiparous women and group differences in psychological birth trauma, childbirth readiness, and social support are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The age range was from 18 to 42 years, with the average age of the participants being 28.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74 (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD). 77.8% of them received a bachelor's or above educational degree. The majority of the women were married (96.7%), lived in the urban area (83.0%), and were employed (82.3%). For 18.2% of the women, the monthly household income is below 3000 yuan. Most of the women slept well during pregnancy (60.3%). 12.1% of the women always kept exercising during pregnancy.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between demographic characteristics and PTB, CRL as well as social support (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;751)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePsychological birth trauma\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003echildbirth readiness levels\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126(16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.94\u0026thinsp;\u0026plusmn;\u0026thinsp;13.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.52\u0026thinsp;\u0026plusmn;\u0026thinsp;12.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.91\u0026thinsp;\u0026plusmn;\u0026thinsp;15.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e420(55.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.15\u0026thinsp;\u0026plusmn;\u0026thinsp;11.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.48\u0026thinsp;\u0026plusmn;\u0026thinsp;10.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e205(27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.69\u0026thinsp;\u0026plusmn;\u0026thinsp;10.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.46\u0026thinsp;\u0026plusmn;\u0026thinsp;10.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.53\u0026thinsp;\u0026plusmn;\u0026thinsp;14.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esecondary school and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.60\u0026thinsp;\u0026plusmn;\u0026thinsp;12.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.72\u0026thinsp;\u0026plusmn;\u0026thinsp;12.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70.50\u0026thinsp;\u0026plusmn;\u0026thinsp;17.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003euniversity and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e584(77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.61\u0026thinsp;\u0026plusmn;\u0026thinsp;11.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.76\u0026thinsp;\u0026plusmn;\u0026thinsp;10.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.40\u0026thinsp;\u0026plusmn;\u0026thinsp;13.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e726(96.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.03\u0026thinsp;\u0026plusmn;\u0026thinsp;11.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.79\u0026thinsp;\u0026plusmn;\u0026thinsp;10.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.37\u0026thinsp;\u0026plusmn;\u0026thinsp;13.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eothers (divorced/widowed/single)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.76\u0026thinsp;\u0026plusmn;\u0026thinsp;14.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.80\u0026thinsp;\u0026plusmn;\u0026thinsp;13.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.76\u0026thinsp;\u0026plusmn;\u0026thinsp;14.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.653\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.584\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eurban area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e623(83.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.84\u0026thinsp;\u0026plusmn;\u0026thinsp;11.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.80\u0026thinsp;\u0026plusmn;\u0026thinsp;10.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.80\u0026thinsp;\u0026plusmn;\u0026thinsp;13.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erural area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128(17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.07\u0026thinsp;\u0026plusmn;\u0026thinsp;12.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.52\u0026thinsp;\u0026plusmn;\u0026thinsp;10.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71.95\u0026thinsp;\u0026plusmn;\u0026thinsp;16.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.791\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133(17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.23\u0026thinsp;\u0026plusmn;\u0026thinsp;12.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.99\u0026thinsp;\u0026plusmn;\u0026thinsp;10.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.67\u0026thinsp;\u0026plusmn;\u0026thinsp;16.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e618(82.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.80\u0026thinsp;\u0026plusmn;\u0026thinsp;11.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.70\u0026thinsp;\u0026plusmn;\u0026thinsp;10.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.67\u0026thinsp;\u0026plusmn;\u0026thinsp;13.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly household income (\u0026yen;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.19\u0026thinsp;\u0026plusmn;\u0026thinsp;13.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.78\u0026thinsp;\u0026plusmn;\u0026thinsp;11.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.93\u0026thinsp;\u0026plusmn;\u0026thinsp;17.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3001\u0026ndash;5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e246(32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.98\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.67\u0026thinsp;\u0026plusmn;\u0026thinsp;10.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.74\u0026thinsp;\u0026plusmn;\u0026thinsp;14.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5001\u0026ndash;10000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e241(32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.28\u0026thinsp;\u0026plusmn;\u0026thinsp;10.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.85\u0026thinsp;\u0026plusmn;\u0026thinsp;10.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.15\u0026thinsp;\u0026plusmn;\u0026thinsp;12.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127(16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.33\u0026thinsp;\u0026plusmn;\u0026thinsp;11.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.85\u0026thinsp;\u0026plusmn;\u0026thinsp;10.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.35\u0026thinsp;\u0026plusmn;\u0026thinsp;12.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy sleep status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewell\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e453(60.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.06\u0026thinsp;\u0026plusmn;\u0026thinsp;10.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.14\u0026thinsp;\u0026plusmn;\u0026thinsp;10.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.96\u0026thinsp;\u0026plusmn;\u0026thinsp;14.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e272(36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.48\u0026thinsp;\u0026plusmn;\u0026thinsp;12.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.25\u0026thinsp;\u0026plusmn;\u0026thinsp;10.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.06\u0026thinsp;\u0026plusmn;\u0026thinsp;13.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.31\u0026thinsp;\u0026plusmn;\u0026thinsp;12.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.35\u0026thinsp;\u0026plusmn;\u0026thinsp;15.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69.12\u0026thinsp;\u0026plusmn;\u0026thinsp;17.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy exercise status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ealways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.29\u0026thinsp;\u0026plusmn;\u0026thinsp;12.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.79\u0026thinsp;\u0026plusmn;\u0026thinsp;14.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.98\u0026thinsp;\u0026plusmn;\u0026thinsp;20.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eoften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e263(35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.46\u0026thinsp;\u0026plusmn;\u0026thinsp;12.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.20\u0026thinsp;\u0026plusmn;\u0026thinsp;10.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.59\u0026thinsp;\u0026plusmn;\u0026thinsp;12.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eoccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e373(49.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.40\u0026thinsp;\u0026plusmn;\u0026thinsp;10.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.96\u0026thinsp;\u0026plusmn;\u0026thinsp;10.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.91\u0026thinsp;\u0026plusmn;\u0026thinsp;14.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.67\u0026thinsp;\u0026plusmn;\u0026thinsp;11.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.79\u0026thinsp;\u0026plusmn;\u0026thinsp;12.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the univariate analysis of the factors related to the PBT scores, three factors were significantly related to psychological birth trauma (\u003cem\u003eP\u003c/em\u003e\u003c0.05): age, monthly household income, and pregnancy sleep status, and these variables were entered as control variables in the hierarchical multiple linear regression analysis. More detailed information was presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCorrelations Among Continuous Variables\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e displayed the results of Pearson's correlation analysis. Social support was negatively related to psychological birth trauma (\u003cem\u003er\u003c/em\u003e = -0.242, \u003cem\u003eP\u003c/em\u003e\u003c0.01) and positively correlated to childbirth readiness (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.206, \u003cem\u003eP\u003c/em\u003e\u003c0.01). Childbirth readiness was negatively associated with psychological birth trauma (\u003cem\u003er\u003c/em\u003e = -0.351, \u003cem\u003eP\u003c/em\u003e\u003c0.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeans, standard deviations, and correlations of variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Social support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Childbirth readiness levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.206**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Psychological birth trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.242**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.351**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eThe Results Of Hierarchical Multiple Regression\u003c/h3\u003e\n\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, after adjusting for age, monthly household income, and pregnancy sleep status in model 2, social support is negatively associated with PBT (\u003cem\u003eβ\u003c/em\u003e=-0.200, \u003cem\u003eP\u003c/em\u003e\u003c0.01). Social support explained an additional 3.9% of the variance of the dependent variable. In model 3, childbirth readiness was negatively associated with PBT (\u003cem\u003eβ\u003c/em\u003e=-0.289, \u003cem\u003eP\u003c/em\u003e\u003c0.01), which accounted for an additional 7.7% of the variance. When CRL was added, the absolute value of the regression coefficient of social support on PBT was decreased (from 0.200 to 0.146). Thus, childbirth readiness could probably function as a mediator in the association of social support with PBT in primiparas.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHierarchical multiple regression results for psychological birth trauma (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;751)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eModel1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eModel2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e41.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e62.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e (ref: 18\u0026ndash;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-1.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-2.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly household income\u003c/b\u003e (ref: \u0026le;3000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3001\u0026ndash;5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5001\u0026ndash;10000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-3.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-3.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-2.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-2.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePregnancy sleep status\u003c/b\u003e (ref: well)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e7.380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChildbirth readiness levels\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e12.334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e19.884\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eThe mediating role of CRS in the relationship between social support and PBT in primiparous women\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e showed the results of the mediation analysis. The association between social support and PBT (path c) was examined. The total effect of social support on PBT (c= -0.164, \u003cem\u003eP\u003c/em\u003e\u003c0.01) was initially evaluated. Then, the indirect effect of social support on PBT via CRL was observed (path a*b, a\u0026thinsp;=\u0026thinsp;0.138, b=-0.312, a*b (95%CI) = -0.043 (-0.074, -0.020)). The confidence interval for indirect effect did not contain zero, which suggested that childbirth readiness played a mediating role between social support and PBT. When childbirth readiness was entered into the model as a mediator, the direct effect of social support on PBT(path c') was still significant (c'=-0.121, P\u003c0.01). Therefore, childbirth readiness had a partial mediating effect on the relationship between social support and PBT for primiparas. To understand the effect size of the mediating pathway, we calculated the proportion of the total effect of the social support on PBT that was mediated by childbirth readiness using the formula (a*b)/ c. The proportion of childbirth readiness was 26.22%. The visualization of the model was shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe results of the mediation analysis (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;751)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePath\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoefficient/Effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% \u003cem\u003eCI\u003c/em\u003e (bootstrapping\u0026thinsp;=\u0026thinsp;5000)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(-0.220, -0.109)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.086, 0.191)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(-0.384, -0.239)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea*b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(-0.074, -0.020)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ec'\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003c0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(-0.175, -0.067)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eResults from this study support the hypothesis that social support was negatively associated with psychological birth trauma and childbirth readiness was the negative predictor of psychological birth trauma among primiparous women. Furthermore, we found that childbirth readiness mediated in promoting the effects of social support on reducing psychological birth trauma. The current research provides evidence of potential mechanisms for the association between social support and psychological birth trauma and provides an empirical basis for psychological birth trauma among primiparous women.\u003c/p\u003e \u003cp\u003eIn the current study, we found that compared with the primiparous women who were in well pregnancy sleep status, those in moderate or poor sleep status tended to have a higher risk of psychological birth trauma. Poor sleep status during pregnancy may lead to adverse pregnancy and childbirth outcomes\u003csup\u003e35\u003c/sup\u003e and even negative pregnancy and childbirth experiences \u003csup\u003e36\u003c/sup\u003e, which may increase the probability of psychological birth trauma. The current study also found that the primiparous women with young age and lower monthly household income tended to experience psychological birth trauma. This finding is corroborated by Herman's research\u003csup\u003e20\u003c/sup\u003e that those who were more vulnerable in society (young and poor) may be more likely to experience trauma.\u003c/p\u003e \u003cp\u003eAs we expected, there was a negative relationship between social support and psychological birth trauma, consistent with previous studies. Tahari\u003csup\u003e37\u003c/sup\u003e reported that medical social support such as providing continuous care during labor and birth, implementing music therapy, and reducing medical intervention can reduce the traumatic experience during labor and birth. Additionally, research indicated that the positive relationship between women and health care providers is crucial in creating a sense of control, providing women with safe and supportive birthing environments, and influencing childbirth outcomes \u003csup\u003e38\u003c/sup\u003e. On the contrary, prior studies showed that most women shared their experiences of medical staff betraying their trust, neglecting them, and being apathetic and dismissive[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Such behaviors of medical staff contributed extensively to women's childbirth trauma. Elmir et al. \u003csup\u003e39\u003c/sup\u003e, integrating 10 qualitative studies of birth trauma, found that the women concerned and emphasized most were communication, being respected, and emotional support. Also, good social support is a protective factor for birth trauma. Moreover, Spousal support is a crucial factor during pregnancy and the perinatal period, as it can improve maternal self-esteem, be a buffer against pregnancy tensions and stresses, and is essential for maintaining a positive emotional experience\u003csup\u003e40,41\u003c/sup\u003e. Adequate social support can influence women's childbirth outcomes, enhance childbirth safety and improve the childbirth experience\u003csup\u003e17\u003c/sup\u003e. Therefore, it is suggested that effective interventions to promote the level of social support for women be implemented.\u003c/p\u003e \u003cp\u003eThis study found a negative correlation between childbirth readiness and psychological birth trauma in primiparous women, which was consistent with previous studies\u003csup\u003e42,43\u003c/sup\u003e. Promoting self-management during pregnancy could help women maintain a favorable physical and psychological state for childbirth and improve childbirth experiences\u003csup\u003e44\u003c/sup\u003e, reducing obstetric complications\u003csup\u003e45\u003c/sup\u003e. Besides, skill-based childbirth preparation can increase childbirth experience for first-time mothers and improve their self-efficacy and birth confidence\u003csup\u003e46\u003c/sup\u003e. Many pieces of research have shown that the psychological factors of women have a direct impact on childbirth outcomes. Furthermore, a pregnant women's belief in her ability to childbirth has been associated with numerous positive childbirth experiences. Hence, helping women a better birth preparedness will be a protective factor against psychological birth trauma.\u003c/p\u003e \u003cp\u003eMore importantly, this study confirmed the significant indirect effect of social support on psychological birth trauma through childbirth readiness and further illustrated the mechanism by which primiparous women's social support affected psychological birth trauma. Simply put, social support is both directly affected and indirectly affected via childbirth readiness and psychological birth trauma. The overall level of women's childbirth readiness is described as four dimensions: self-management, information literacy, birth confidence, and birth plan\u003csup\u003e26\u003c/sup\u003e. Social support is regarded as women's having obtained and perceived help from social networks\u003csup\u003e47\u003c/sup\u003e. Individuals with a high level of social support were more likely to adopt better childbirth readiness, which further affected the psychological birth trauma. These findings suggest that psychological birth trauma could be improved by enhancing the level of social support and developing better childbirth readiness strategies. Crown and von Baeyer\u003csup\u003e48\u003c/sup\u003e also identified that childbirth and parenting knowledge attained from childbirth education lectures, higher birth confidence, and less anxiety would enhance the birth experience. Moreover, positive birth can represent a 'peak' experience\u003csup\u003e49\u003c/sup\u003e. Therefore, adequate social support and childbirth preparation training is suggested to be supplied for the women to prevent psychological birth trauma.\u003c/p\u003e \u003cp\u003eBased on the findings of this study, we offer the following suggestions, hoping to help primiparous women prevent or reduce psychological birth trauma. Firstly, women and their families should be informed about risk factors and the adverse consequences of psychological birth trauma from preconception till the end of the perinatal period\u003csup\u003e43\u003c/sup\u003e. Family members should provide enough material and spiritual support for the mothers to maintain good physical and mental fitness to ensure their health\u003csup\u003e50\u003c/sup\u003e. Health care providers should also care more about the feelings and communications of the mothers and help them to discuss and express their doubts and problems individually\u003csup\u003e42\u003c/sup\u003e. Secondly, efficient interventions for enhancing childbirth readiness should be developed. Medical staff should instruct women's daily life behavior and self-protection behavior, promote self-management, and make a sensible birth plan. Encouraging the women to know more about the process of pregnancy and childbirth and improving information literacy was also very crucial. Moreover, medical staff and family members should help the women believe in themselves and build birth confidence.\u003c/p\u003e \u003cp\u003eSome limitations of this study should be discussed. First, a cross-sectional study did not allow us to draw a causal relationship between social support, childbirth readiness, and psychological birth trauma. Longitudinal studies need to confirm the relationship between the three variables. Second, the study variables were evaluated using self-report questionnaires. Nevertheless, all the scales have good reliability and validity and have been verified in Chinese women. Third, the data on childbirth readiness was collected within 72 hours after the women gave birth; the recall bias may exist. Future studies could collect the women's childbirth readiness during their pregnancy. Finally, this study is only concerned with primiparas, and future studies may consider extending this study to multiparas.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, for primiparous women, social support and childbirth readiness were negatively correlated with psychological birth trauma, and childbirth readiness played a mediating role between social support and psychological birth trauma. This study drew out the implication of focusing on childbirth readiness when exploring the mechanism of how social support affected psychological birth trauma. Strategies and interventions to enhance childbirth readiness levels may be expected to improve the impact of social support on women's psychological birth trauma.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (reference number: TJ-IRB20210755). The research conforms to the provisions of the Declaration of Helsinki (as revised in Brazil 2013). All participants gave informed consent for the research, and their anonymity was preserved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not\u003c/p\u003e\n\u003cp\u003epublicly available due to them containing information that could compromise\u003c/p\u003e\n\u003cp\u003eresearch participant consent but are available from the corresponding author\u003c/p\u003e\n\u003cp\u003eon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was supported by the National Natural Science Foundation of\u003c/p\u003e\n\u003cp\u003eChina (No. 71974061). The funding bodies were not involved in the design of\u003c/p\u003e\n\u003cp\u003ethe study, data collection, analyses, and interpretation of data or in writing of\u003c/p\u003e\n\u003cp\u003ethe manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design: JDD, ZK, LBB, ZTY. Data collection: JDD, ZK, ZTY, LBB, YMM. Data analysis: JDD, YMM, LBB. Manuscript writing: JDD, ZK, ZTY. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Natural Science Foundation of China (No. 71974061). The author would like to thank all the nurse managers who assisted in obtaining informed consent from the participants and collecting the data of the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong\u003c/p\u003e\n\u003cp\u003eUniversity of Science and Technology, 13 Hangkong Road, Wuhan 430030,\u003c/p\u003e\n\u003cp\u003eChina. \u003csup\u003e2\u003c/sup\u003e School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTaghizadeh Z, Arbabi M, Kazemnejad A, Irajpour A, Lopez V. Iranian mothers\u0026rsquo; perceptions of the impact of the environment on psychological birth trauma: A qualitative study. 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BMC Pregnancy Childbirth. 2022;22(1):188. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12884-022-04377-9\u003c/span\u003e\u003cspan address=\"10.1186/s12884-022-04377-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Psychological birth trauma, Social support, Childbirth readiness, Primiparous women","lastPublishedDoi":"10.21203/rs.3.rs-2314441/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2314441/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\n\u003cp\u003eThe detrimental impact of psychological birth trauma is far-reaching for women. This study aimed to identify the relationship between social support, childbirth readiness, and psychological birth trauma and to further explore whether childbirth readiness can play a mediating role.\u003c/p\u003e\n\u003ch2\u003eMethods\u003c/h2\u003e\n\u003cp\u003eA nationwide online cross-sectional study was conducted among 751 primiparous women in seven provinces in China from November 2021 to March 2022. The questionnaire consisted of questions on demographic characteristics, the Psychological Birth Trauma Scale (PBTS), the Chinese Mandarin version of the Medical Outcomes Study Social Support Survey (MOS-SSS-CM), and the Childbirth Readiness Scale (CRS). Hierarchical multiple regression was used to explore the associate 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.\u003c/p\u003e\n\u003ch2\u003eResults\u003c/h2\u003e\n\u003cp\u003eAfter adjusting for demographic variables, social support was negatively associated with psychological birth trauma (\u003cem\u003er\u003c/em\u003e=-0.242, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.01). Childbirth readiness had a positive correlation with social support (\u003cem\u003er\u003c/em\u003e = 0.206, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.01) and a negative correlation with psychological birth trauma (\u003cem\u003er\u003c/em\u003e=-0.351, \u003cem\u003eP\u003c/em\u003e\u0026lt;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.\u003c/p\u003e\n\u003ch2\u003eConclusions\u003c/h2\u003e\n\u003cp\u003eChildbirth readiness played 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's psychological birth trauma.\u003c/p\u003e","manuscriptTitle":"Childbirth readiness mediates the effect of social support on psychological birth trauma of primiparous women: a nationwide online cross-sectional study in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-12-19 15:29:02","doi":"10.21203/rs.3.rs-2314441/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ecfe7d41-e784-4b12-ad31-4d5114cde8cb","owner":[],"postedDate":"December 19th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-04-06T19:44:19+00:00","versionOfRecord":[],"versionCreatedAt":"2022-12-19 15:29:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2314441","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2314441","identity":"rs-2314441","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}