Association Between Delivery Mode and Postpartum Psychiatric Conditions

Area of Science:

• Obstetrics and Gynecology
• Maternal Mental Health
• Public Health

Background:

• Postpartum psychiatric conditions represent a significant public health concern.
• Understanding risk factors associated with mode of delivery is crucial for maternal care.
• Cesarean delivery rates have been increasing globally.

Purpose of the Study:

• To investigate the association between different modes of delivery and the incidence of new postpartum psychiatric conditions.
• To compare the risk of postpartum psychiatric conditions across spontaneous vaginal, operative vaginal, and various cesarean delivery types.

Main Methods:

• Observational cohort study using a large US national obstetric database (2008-2022).
• Included singleton live births, excluding those with prior psychiatric diagnoses or preterm birth (<37 weeks).
• Analyzed five delivery modes: spontaneous vaginal, successful operative vaginal delivery (OVD), planned cesarean, unplanned cesarean without OVD, and unplanned cesarean after failed OVD.

Main Results:

• Compared to spontaneous vaginal births, cesarean deliveries (planned, unplanned without OVD, unplanned after failed OVD) showed significantly higher risks of postpartum psychiatric conditions.
• Specifically, planned cesareans (aRR 1.19) and unplanned cesareans (aRR 1.16-1.26) were associated with increased risk.
• No significant difference in risk was observed between spontaneous vaginal births and successful operative vaginal deliveries (aRR 1.00).

Conclusions:

• Cesarean delivery, both planned and unplanned, is associated with an increased risk of new postpartum psychiatric conditions.
• Successful operative vaginal delivery does not appear to increase this risk compared to spontaneous vaginal birth.
• Findings highlight the need for enhanced postpartum psychiatric surveillance following cesarean deliveries.