Reclaiming Agency Through Birth: Birth Mode, Postpartum Mental Health, and Ethical Responsibilities in High-Risk Pregnancies.

Objective This study examines whether mode of birth is associated with postpartum psychological distress among women who experienced high-risk versus low-risk pregnancies. It adds an ethical perspective to the literature by considering how medicalization of birth may differentially affect women's autonomy and well-being across pregnancy risk contexts. Method In a cohort of 138 women who gave birth at a northern Israeli hospital (January to September 2023), psychological outcomes were measured eight weeks postpartum using the DASS-21 and PTSD Checklist (PCL-5). Birth mode and pregnancy risk status were extracted from medical records. Pearson correlations were computed separately for high-risk (n = 20) and low-risk (n = 118) groups. Results Among women with high-risk pregnancies, more medicalized birth modes were significantly correlated with higher levels of stress (rp = 0.655), anxiety (rp = 0.863), depression (rp = 0.726), and PTSD symptoms (rp = 0.789). No significant associations were found in the low-risk group. Conclusions Birth mode plays a critical role in postpartum mental health for women with high-risk pregnancies. These findings underscore the ethical duty to prevent psychological harm and to respect women's relational autonomy, making trauma-informed, autonomy-supportive care a moral imperative in medically complex births.