Reproductive
Severity-Graded Obstetric Trauma and Postpartum Mental Health Diagnoses in a Hospital-Based Birth Cohort Shashi Sarnaik* Shashi Sarnaik Sarnaik Sarnaik Johns Hopkins Bloomberg School of Public Health
Background: Obstetric trauma (e.g., severe physical harm during labor and delivery) may increase risk of postpartum mental health conditions, yet prior research has largely relied on self-reported data on childbirth experiences and/or mental health screening instruments. Less is known about the mental health sequelae of clinically documented obstetric trauma within hospital cohorts. This study examined whether severity-graded obstetric trauma may help identify populations at elevated risk for postpartum mental health diagnosis.
Methods: Data were from 2,442 mothers in the Boston Birth Cohort, a preterm birth cohort based at the Boston Medical Center. Obstetric trauma was defined using delivery-related diagnoses of severe maternal morbidity, postpartum hemorrhage, obstetric anal sphincter injuries obtained from participants’ medical records. Diagnoses were categorized as severe if life-threatening and non-severe if non-life threatening. Postpartum mental health cases were also extracted from medical records, and included new diagnoses of stress or adjustment disorders, depression, anxiety, or other mental health disorders obtained within one year postpartum. Associations were evaluated via logistic regression models adjusted for sociodemographic and pregnancy-related clinical covariates.
Results: 17% of participants experienced obstetric trauma (12% severe; 5% non-severe), and 20.9% received a postpartum mental health diagnosis. In adjusted analyses, severe obstetric trauma was associated with higher odds of postpartum mental health diagnosis (aOR = 1.25, 95% CI: 0.92–1.70) while associations with non-severe trauma were not apparent (aOR = 1.04, 95% CI: 0.66–1.69).
Conclusions: Severity-graded obstetric trauma showed patterns consistent with higher postpartum mental health risk, particularly for severe events. Findings suggest that obstetric trauma severity may be a clinically observable signal for postpartum mental health surveillance within healthcare systems.