The association between labor complications and posttraumatic stress symptoms among women with low social support

Trauma during childbirth can lead to childbirth-related posttraumatic stress disorder (CB-PTSD), affecting maternal attachment and infant behavioral health. This study examined the association between birth complications and posttraumatic stress symptoms (PTSS) at one month postpartum in a cohort of low-income women enrolled in a home visiting program.

Pregnancy conditions (e.g., preeclampsia, gestational diabetes) and labor complications (e.g., prolonged labor, fetal distress) were self-reported at the 1-month postnatal visit. Sociodemographic and psychosocial risk factors were assessed prenatally and postnatally. PTSS was measured using the Posttraumatic Stress Disorder Checklist-Civilian (PCL-C) at baseline and one month postpartum. PTSS was analyzed continuously and using a cutoff score of ≥14, indicating risk for clinically elevated symptoms and possible PTSD. Linear regression assessed associations between complications and PTSS, adjusting for covariates.

Of 212 participants, 22.6% scored ≥14 on the PCL-C at one month. Labor complications were associated with higher PTSS risk (33.3% vs. 19% without complications). A significant interaction was found between labor complications and maternal social support (p=0.03); the association was significant only among mothers with low social support (β=4.32, 95% CI: 1.93, 6.71).

Labor complications, but not pregnancy conditions, were linked to increased PTSS, particularly among mothers with limited social support. Social support and potentially traumatic events emerged as factors that may be important for future intervention research seeking to prevent or reduce PTSS in the postpartum period.