Maternal Mental Health and Labor Dysfunction: Prenatal Posttraumatic Stress Disorder, Labor Dystocia, and Unplanned Cesarean in a Cohort of Black Pregnant People

Labor dysfunction, defined as labor dystocia or unplanned cesarean, is a significant contributor to maternal morbidity for Black pregnant people in the United States. Exposure to trauma and posttraumatic stress disorder (PTSD) has been shown to increase risk for poor perinatal outcomes; however, the physiological mechanisms responsible are largely unexplored. The purpose of this study was to evaluate relationships between PTSD symptom severity, provisional PTSD diagnosis, and labor dysfunction in a cohort of Black pregnant people. This is a secondary data analysis of two prospective cohort studies involving Black pregnant people recruited from one academic medical center and one midwife-led care birth center in the same geographic area. Participants had term labor, a singleton fetus in cephalic presentation, and reached active phase labor (N = 238). Prenatal PTSD symptoms were measured by the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Labor dystocia and mode of birth were abstracted from medical records. Associations were examined between PTSD symptom severity, provisional PTSD diagnosis by PCL-5 score cutoff, and labor dysfunction outcomes after stratification by mode of labor onset and prenatal care site. No associations were found between PTSD symptom severity or provisional PTSD diagnosis and labor dysfunction in the total sample. However, in the group of participants with induced labor at the academic medical center, higher total PTSD symptom severity and provisional PTSD diagnosis increased the odds of labor dystocia, even after adjusting for sociodemographic and labor factors. Further research is needed to understand the potential relationships between PTSD symptom severity and labor dysfunction to inform interventions toward birth equity.