Are 6 more accurate than 4? The delivery mode and its influence on postpartum depression and PTSD.

Abstract

Abstract Background Empirical evidence shows that 2–6% of all women develop post-traumatic stress disorder (PTSD) and about 10–15% postpartum depression (PPD) after childbirth. This study examines PTSD and PPD in the context of delivery mode, focusing 4 different caesarean section modes, elective primary (Grade 4), medically indicated primary (Grade 3), secondary from relative indication (Grade 2) and emergency secondary caesarean section (Grade 1), compared to vaginal and assisted vaginal delivery (AVD). The impact of the six subdivided delivery mode categories on the level of postpartum depression and PTSD will be investigated using common predictors (for postpartum depression psychological treatment before childbirth, Fear of childbirth, Planning of pregnancy, social support after childbirth and for PTSD psychological treatment before childbirth, fear of childbirth, induction of labor, birth debriefing and social support after childbirth). Methods Between four weeks and two years postpartum, 1223 women were surveyed once via an anonymous online questionnaire on demographic and gynecological data, type of delivery, PTSD (PCL-5) and PPD (EPDS). Results For both psychiatric disorders, ANOVA revealed significant differences between delivery mode and PPD and PTSD. With weak effects for PPD and medium to strong effects for PTSD. Post-hoc tests showed increased levels of postpartum depression for all caesarean section types compared to both vaginal delivery types. For PTSD, secondary relative indication (Grade 2), emergency secondary caesarean section (Grade 1) and assisted vaginal delivery (AVD) were associated with elevated levels of PTSD. Regression analysis revealed the delivery mode as a significant predictor of EPDS- (medium effect size) and PCL-5-Score (medium to high effect size). Limitation: Delivery was assumed to be the traumatic event; previous traumas were not recorded. The definition of the delivery mode was reported subjectively and not medically confirmed. Conclusion The study highlights the influence of delivery modes on the mental health of postpartum mothers: different modes influence different postpartum disorders in different ways. However, the definition of the delivery mode was only stated subjectively and not medically confirmed. Further research should investigate which aspects of the different delivery modes influence maternal mental health and how the perception of the birth may depend on a specific delivery mode.