Mode of birth and early postnatal psychological morbidity

Postnatal depression affects the well-being of women and families. While several studies have shown an association between mode of birth and symptoms of postnatal depression, others have found no relationship.

To determine whether women who have instrumental or caesarean births report higher levels of poor coping, sleep or appetite disturbance, or relationship difficulties, than women who have vaginal births, at the time of Universal Postnatal Contact (7-10 days post-discharge).

Retrospective cohort study of term, singleton births from 1st January 2013 to 31st December 2013 at a tertiary obstetric facility. Outcomes were compared for 1816 women having vaginal births versus 1205 women having instrumental or caesarean births.

When adjusted for confounders, no association could be demonstrated between mode of birth and reporting of any postnatal symptom of psychological morbidity. However, the model did demonstrate an association between reporting of symptoms and nulliparity (aOR 1.69 (1.08-2.63); P = 0.02), as well as having an unplanned pregnancy with a supportive partner (aOR 0.54 (0.29-0.97); P = 0.04).

Mode of birth does not appear to be associated with the reporting of symptoms of psychological morbidity in the early postnatal period. However, these symptoms may be associated with nulliparity and in the context of an unplanned pregnancy, a lack of partner support. These findings highlight the ongoing need for antenatal screening with respect to pregnancy intention and the presence of a social support system, to facilitate the implementation of interventions for women at risk of postnatal depression.