By Walker Karraa, MFA, MA
Previous studies conducted by Britain’s National Institute
for Health and Clinical Excellence (2011), and Lobel and Deluca (2007)
suggested that some women benefit from a planned cesarean delivery compared to women who do not plan for interventions –
particularly in lower rates of depression and anxiety.
A recent study, Mode of birth and women’s
psychological and physical wellbeing in the postnatal period (Rowlands
& Redshaw, 2012) sheds light on the growing literature. Using 5,332 randomly
selected individuals from the national birth registry, the study authors used
multinomial logistic regression models to explore associations between mode of
delivery and self-reported physical and psychological well-being. Of the 5,332
women who responded, 61% (3,275) women had unassisted vaginal births, 13% (675)
had unplanned cesarean, 12% (630) had planned caesarean, 7% (359) had forceps-assisted,
and 6% (302) had ventouse-assisted births.
Women who experienced forceps-assisted vaginal births and
unplanned caesarean reported the poorest physical and psychological health and
well-being. While emotional and physical well-being for most women improved
over time, women who had forceps-assisted vaginal birth were more likely to
report post-traumatic symptoms several months after birth. The authors offered:
“Although caesareans section births are often described as
resulting in poorer postnatal psychological outcomes for women, it seems that
the outcomes for women depend on whether the caesarean section was planned or
not.” (Rowlands & Redshaw, 2012, p. 10)
A review of three measures (depression, anxiety, and
breastfeeding difficulties) provides a snapshot of the data provided in the
larger study:
- Of the 3,275 unassisted vaginal births, 7% (225)
of women reported depression, 3% (93) reported PTSD, and 4% (128) reported
breastfeeding difficulties.
- Of the 302 ventouse-assisted births, 6% (17)
reported depression, 2% (5) reported PTSD, and 4% (11) reported breastfeeding
difficulties.
- Of the 630 women who delivered via planned
caesarean, 6% (39) reported depression, 3% (17) reported symptoms of PTSD, and
4% (25) reported difficulties with breastfeeding.
- Of the 675 unplanned caesarean births, 6% (43)
reported depression, 3% (21) reported symptoms of PTSD, and 5% (32) had
difficulties breastfeeding.
- Of the 359 forceps-assisted births, 9% (31) reported
depression, 7% (25) reported symptoms of PTSD, and 7% (25) reported
breastfeeding difficulties.
Finally, of those women who had forceps-assisted deliveries,
58% reported that they reached out to health professional regarding their
feelings regarding their birth, indicating a need to discuss psychological
aspects of their postpartum health. 43% of those who didn’t speak to their
health care providers about their birth experience reported that they would
have liked to have spoken with someone. The authors suggested:
“While health professionals may be
more aware of the physical morbidity for women after childbirth, the ongoing
psychological issues may be less clear or alternatively, perceived as more
difficult to treat beyond their area of expertise. Referral pathways need to be
in place to address this point” (Rowlands & Redshaw, 2012, p. 9).
It is my hope that this brief review serves as an invitation
to examine the study in greater detail, and to discuss the implications of
planned cesarean births in considering postpartum health and wellbeing.
References:
Lobel, M., DeLuca, R.S. (2007). Psychosocial sequelae of
cesarean delivery: Review and analysis of their causes and implications. Soc Sci Med, 64(11), 2272-2284.
National Institute for Health and Clinical Experience, 2011.
NICE: Caesarean section. NICE clinical
guideline 132. London, UK: NICE.
Rowlands, I.J., & Redshaw, M. (2012). Mode of birth and
women’s psychological and physical wellbeing in the postnatal period. BMC Pregnancy and Childbirth, 12,138. http://www.biomedcentral.com/1471-2393/12/138
Walker Karraa is a doctoral candidate at Sofia University, where she
is conducting a study on the transformational dimensions of postpartum
depression. Walker was the founding President of PATTCh, an organization
founded by Penny Simkin dedicated to the prevention and treatment of traumatic
childbirth. Walker is a perinatal mental health contributor for Lamaze
International's Science
and Sensibility, Giving Birth With Confidence, and
the American College of Nurse-Midwives (ACNM) Midwives Connection. She
is currently working on co-authoring a book regarding PTSD following childbirth
with Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA. Walker
is serving as the
Suite Coordinator for the American Psychological Association (APA) Trauma
Division 56. She lives in Sherman Oaks, CA with her two children and husband.
