Development of a Birth Trauma Prevention Model in two Teaching Hospitals in Port Harcourt, Nigeria

Abstract

Birth trauma remains a significant yet under-recognised contributor to adverse maternal and neonatal outcomes in tertiary maternity care settings. Despite increasing evidence on the determinants of traumatic birth experiences, there is limited integration of structural, clinical, and psychosocial determinants into a unified, context-specific prevention framework suitable for Nigerian tertiary hospitals. This study aimed to develop and validate a comprehensive Birth Trauma Prevention Model applicable to teaching hospitals in Port Harcourt, Rivers State. This multiphasic model development study involved a systematic review, retrospective review of facility birth records, Delphi rounds, and integrative model design with expert validation. The retrospective phase included all recorded births in 2024 from two tertiary institutions: 1,017 births in the University of Port Harcourt Teaching Hospital (UPTH) and 1,024 births in Rivers State University Teaching Hospital (RSUTH). The Delphi phase recruited 30 experts (15 obstetricians and 15 midwives) with advanced graduate degrees using purposive sampling from eligible clinicians in both hospitals. Three professors subsequently participated in model validation. Data were collected using structured data extraction forms, a Delphi consensus questionnaire, and a model appraisal checklist assessing relevance, clarity, and applicability. Quantitative data were analysed using descriptive statistics and agreement indices, while construct validation was determined using the Construct Validity Index (CVI), with ≥0.80 considered acceptable. The retrospective review showed total birth trauma prevalence of 23.99% in UPTH and 22.56% in RSUTH, with episiotomy rates of 21.05% and 20.41%, respectively. Perinatal asphyxia occurred in 1.77% and 1.27% of births, while perineal tears were recorded in 1.18% and 0.88% of vaginal births. Delphi consensus achieved agreement above 80% across core structural, process, and outcome domains integrated into the final model. The overall Construct Validity Index was 0.89, with unanimous agreement on relevance and applicability (1.00 each), and clarity rated at 0.67. The study concludes that the newly developed Birth Trauma Prevention Model demonstrates strong construct validity, contextual relevance, and practical feasibility for tertiary maternity care settings. It is recommended that the model be piloted and integrated into institutional quality improvement frameworks to guide systematic birth trauma prevention strategies.