PTSD‐Like Symptoms Among Postpartum Black Women: The Lasting Impact of High‐Risk Pregnancies, Birth Trauma, and Mistreatment During Perinatal Care

Black, Hispanic, and multiracial women in the U.S. experience higher rates of discrimination and mistreatment in perinatal care compared to White women, which can lead to fear, anxiety, and reduced engagement with obstetric healthcare providers. Black women are also more likely to experience high-risk pregnancies and health complications such as gestational diabetes and hypertensive disorders. As a result, Black women face a heightened risk of birth trauma and subsequent posttraumatic stress disorder (PTSD) in the postpartum period. Despite these inequities, little is known about Black birthing individuals' experiences of healthcare interactions. This study explores Black women's accounts of negative experiences of perinatal care in the context of high-risk pregnancy. Fourteen individuals from across the U.S. participated in semi-structured interviews conducted within 6 months postpartum between September 2022 and December 2024. Interview responses were analyzed using directed content analysis, with coding of their emotional distress guided by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) definition of PTSD. Their accounts aligned with the four DSM-5-TR symptom clusters: intrusive symptoms, avoidance, negative alterations in cognition or mood, and alterations in arousal and reactivity. PTSD-like symptoms resulted from pregnancy complications, traumatic birth experiences, mistreatment by clinicians or a combination of these factors. The findings suggest that birth trauma and mistreatment in perinatal care have significant emotional and behavioral impacts on Black women. The study results underscore the urgent need for trauma-informed, antiracist approaches in perinatal care to address these disparities and improve outcomes for Black birthing individuals.