Mode of birth and maternal health up to three years postpartum: A dutch retrospective population-based cohort study

Maternal postpartum health problems can persist well beyond the conventional six-week postpartum care period. No nationwide studies have combined large-scale electronic health records (EHRs) from perinatal and general practice (GP) care linking long-term health problems to birth mode. We aimed to examine how birth mode (spontaneous vaginal, instrumental vaginal, and caesarean section) influences the frequency and hazard of maternal physical and psychological health problems in GP care from six weeks to three years postpartum. In this observational population-based cohort study we linked Dutch perinatal EHRs (2014-2020) to GP EHRs (2015-2023), including women who gave birth to a term singleton. Health problems were retrieved from GP EHR's using International Classification of Primary Care codes and GP notes, the latter analysed with natural language processing. Women were stratified by parity. Cox proportional hazard models estimated crude and adjusted associations between birth mode and postpartum health problems, using spontaneous vaginal birth as the reference. In total, 10 628 primiparous and 11 719 multiparous women were included. Adjusted for confounders, caesarean section and instrumental vaginal birth were linked to significantly increased hazards of dyspareunia. Caesarean section was additionally associated with an elevated anaemia hazard but reduced hazards of urinary incontinence and ureterovaginal prolapse compared to spontaneous vaginal birth. We showed that maternal health problems may persist up to three years postpartum and vary by birth mode. These findings may raise awareness among mothers and care providers of key long-term maternal health problems, underscoring the need for a new paradigm of prolonged postpartum care.