Unplanned Operative Delivery is Associated with Decreased Perception of Control over Labor

Unplanned operative delivery is associated with postpartum depression (PPD), but the mechanism is unknown. We aimed to assess the sense of control over labor for those who had unplanned delivery (unplanned cesarean or operative vaginal delivery: uCD/OVD) versus spontaneous vaginal delivery (SVD).

Secondary analysis of a cross-sectional survey study of term patients admitted for delivery at a tertiary center. After delivery, patients completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor and birth. Demographics, obstetric and neonatal outcomes and LAS scores were compared between patients who underwent uCD/OVD versus SVD. Multivariable logistic regression to assess the relationship between uCD/OVD and LAS score controlling for confounders that differed in the bivariate analysis.

Of the 149 patients, 50 (33.6%) underwent uCD/OVD. There were no differences in maternal age, race/ethnicity, insurance status or education level between those who had uCD/OVD versus SVD. Patients who had uCD/OVD had higher median body mass index (BMI) than those who had SVD (33.2 vs 30.1 kg/m², p = 0.03). There were no differences in rate of medical or psychiatric morbidity between groups. Additionally, there were no differences in reason for admission, however those who had uCD/OVD had significantly longer times to delivery than those who underwent SVD (22 vs 14 hrs, p < 0.01). Gestational age at delivery was also significantly higher for those who underwent uCD/OVD compared to SVD (40.2 vs 39.6 wks, p = 0.02). For the primary outcome, LAS scores were lower for those who underwent uCD/OVD compared to SVD (146 vs. 164, p < 0.01). This remained significant even after controlling for length of labor, BMI and gestational age at delivery (p < 0.01).

Even after accounting for length of labor, uCD/OVD is associated with a reduction in perceived control over labor, which may mediate the known increased risk of PPD. Further qualitative research is needed to examine how to better support patients' wellbeing after uCD/OVD.