PTSD secondary to traumatic natural vaginal delivery

Abstract

Introduction Many immigrant women have experienced traumatic vaginal deliveries in their countries of origin, often as a consequence of governmental policies designed to reduce cesarean section (C-section) rates. Such policies may prioritize statistical targets over patient-centered care, leading to significant physical and psychological harm. This study reviews cases of immigrant women who, after enduring traumatic vaginal deliveries, developed severe female sexual dysfunctions that prevent sexual activity and led them to request primary C-sections as the only way to deliver their subsequent babies due to persistent physical and psychological trauma. Objective The objective is to assess the impact of prior traumatic natural vaginal deliveries on sexual function and delivery preferences in subsequent pregnancies, particularly regarding requests for primary C-sections among immigrant women diagnosed with post-traumatic stress disorder (PTSD). Methods Over a six-month period, six immigrant women presented at medical centers complaining of a history of severe sexual dysfunctions and requesting primary C-sections for their subsequent pregnancies. Five of these women also requested concurrent sterilization. All had previously undergone prolonged labor exceeding 72 hours during their first delivery. Results Each request for a primary C-section was approved, underscoring a valid yet underrecognized indication for elective cesarean delivery. All six women were diagnosed with PTSD directly associated with their prior delivery experiences. Documented sexual dysfunctions included dyspareunia (six women), hypoactive sexual desire disorder (five women), sexless marriage (three women, defined as less than three sexual relations per year), and chronic vulvovestibulodynia (four women). Physical trauma included prolonged labor (>72 hours) in all women, one pubic bone fracture, and severe pelvic floor lacerations secondary to instrumental deliveries (forceps or spatula) in four women. Neonatal outcomes were also poor: all six neonates required resuscitation at birth, and five required NICU admission. Conclusions This case series introduces a previously undescribed source for multiple sexual dysfunctions and an indication for primary C-section: post-traumatic stress disorder secondary to prior traumatic natural vaginal delivery (NSVD). In the global effort to reduce C-section rates, some national health systems may inadvertently compromise individualized care by enforcing rigid childbirth policies. Recognition of PTSD as a legitimate factor in delivery planning is essential for promoting trauma-informed obstetric care and supporting maternal physical, sexual, and mental health. Disclosure No