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.