Induction of labor is a common practice in obstetrics, representing more than a quarter of deliveries in France. Long perceived as a controlled medical procedure and often considered a “success” when it results in a vaginal birth, it could nevertheless have underestimated psychological repercussions. A new analysis from the TRAAP1 trial highlights a significant risk of post-traumatic stress in affected mothers.
Higher prevalence after triggering
The research team, led by Alizée Froeliger (Bordeaux University Hospital), looked at a specific sub-cohort of the TRAAP1 trial, which initially evaluated the effectiveness of tranexamic acid in the prevention of postpartum hemorrhage.
Of the 3,891 participants in the trial, 794 women who delivered vaginally after induction of labor were included in this secondary analysis. Among them, 560 (70.5%) responded to psychological questionnaires two months after delivery.
The results show an adjusted prevalence of 10.6% of post-traumatic stress disorder symptoms, measured using two validated self-questionnaires (IES-R and TES). This figure is twice as high as that previously observed in the general trial population, where around one in twenty women presented such a profile.
Clearly identified risk factors
The study also highlights several factors associated with an increased risk of PTSD. Among them are:
- A country of birth outside Europe (particularly in North Africa or sub-Saharan Africa);
- Psychiatric history;
- A fetal indication of induction;
- The need for cervical ripening;
- Severe postpartum hemorrhage (≥ 1,000 mL);
- Having a bad memory of childbirth from the second day postpartum.
These elements underline that the subjective experience of childbirth, even in the absence of major complications perceived by caregivers, plays a central role in the development of post-traumatic symptoms.
Towards better screening and early treatment
For researchers, these results should alert health professionals. “Vaginal delivery after induction is often considered a success from a medical point of view, but it can leave significant psychological scars”recalls Alizée Froeliger.
Identifying subgroups of women at risk paves the way for more targeted screening and early postpartum interventions. Objective: to prevent the lasting onset of post-traumatic stress disorder and improve maternal mental health, which is still too often relegated to the background after birth.