Association between mode of delivery and early mother-infant bonding

The primary objective of this study is to evaluate the effect of mode of delivery (vaginal delivery [VD], cesarean delivery [CD]) on mother-infant bonding (MIB) in the early postpartum period. The secondary objectives are to compare MIB between planned (PCD) and unplanned (UCD) cases in the CD cohort and to identify factors affecting MIB.

This descriptive cross-sectional study was conducted at Ankara Etlik City Hospital between July and October 2025. A total of 210 postpartum women were included, comprising 105 VD and 105 CD. The Postpartum Bonding Questionnaire (PBQ) and the Edinburgh Postnatal Depression Scale (EPDS) were administered to all participants before discharge in the early postpartum period. Demographic and clinical characteristics, as well as PBQ scores, were compared between groups. Comparisons were also made between PCD and UCD. Factors associated with PBQ scores were evaluated using a general linear regression model (GLM) in the overall cohort and separately within the CD subgroup to identify independent predictors.

Mean PBQ scores were significantly higher in the CD group compared with the VD group (10.09 ± 0.34 vs. 7.14 ± 0.34; P < 0.001). Within the CD group, PBQ scores were also higher in UCD than in PCD (P < 0.001). PBQ and EPDS scores showed a moderate positive correlation (r = 0.466, P < 0.001). In the GLM for the entire cohort, CD and EPDS score were independent predictors of PBQ scores (B = -2.94, 95% confidence interval [CI]: -3.91 to -1.98, P < 0.001; B = 0.50, 95% CI: 0.35-0.65, P < 0.001, respectively). In the analysis limited to the CD group, both EPDS score and type of CD remained significant predictors of PBQ scores (P < 0.001 and P < 0.001).

Compared to vaginal birth, participants who had a cesarean section were associated with greater difficulties in early MIB, especially when it was unplanned. Additionally, postpartum depression symptoms independently contributed to higher PBQ scores. These findings emphasize the necessity of prenatal counseling and psychological support to mitigate the negative impact of CD on the bonding process.