Childbirth-related posttraumatic stress disorder and postpartum depression following cesarean delivery

Maternal mental health disorders are fairly common during the perinatal period, predominantly mood- and trauma-related disorders, first episodes or relapses. Untreated, these mental health conditions can have a significant impact on the health of the mother, her child, and family functioning. These disorders remain underdiagnosed during the postpartum period. Obstetric care providers must understand the stakes involved and recognize the need to assess mothers' emotional well-being in the postpartum period-an essential opportunity for early detection and intervention for maternal mental health impairments. Identifying women at risk is a major challenge. Cesarean delivery has been associated with a higher prevalence of psychiatric disorders. Given the continuously rising cesarean delivery rates, improved understanding of its maternal health outcomes seems essential. Childbirth-related posttraumatic stress disorder and postpartum depression are among the mental disorders finally receiving deserved attention in recent years. These 2 conditions frequently overlap, share common risk factors, and may have linked pathophysiological mechanisms. Childbirth-related posttraumatic stress disorder can result directly from experiencing a traumatic birth. A few studies report posttraumatic stress disorder incidence rates ranging from 4% to 20% in the first year after a cesarean delivery. Certain obstetric interventions, components of cesarean management, and adverse events may influence the risk of posttraumatic stress disorder, including induction of labor, postpartum hemorrhage, absence of immediate skin-to-skin contact with the newborn, and postoperative pain. Postpartum depression is characterized by the presence of clinically significant depressive symptoms, or a major depressive episode within the first 12 months after delivery. As a major cause of postpartum maternal morbidity and mortality, its early diagnosis and effective management are critical. With its reported prevalence after cesarean deliveries ranging from 20% to 40% in the first year postpartum, this mode of delivery is a situation at high risk for postpartum depression. Apart from psychosocial risk factors, some cesarean-related risk factors are also associated with an increased risk of postpartum depression symptoms; among them are emergency cesareans before labor or during labor after induction, lack of social support, severe postoperative pain, and possibly postpartum anemia. Two general types of screening strategies for posttraumatic stress disorder and postpartum depression are possible: universal for every woman after childbirth, or including only women at risk due to either cumulative risk factors (such as preexisting mental disorders or trauma history) or their perception of the birth as traumatic. Self-administered questionnaires could be a first step toward identifying at-risk patients with symptoms of posttraumatic stress disorder or postpartum depression, who can then be referred for a more complete psychological assessment by a specialist. This strategy seems appropriate for identifying, soon after delivery, the women at high risk who could benefit from early preventive intervention and follow-up.