Citation

Eckerdal P, Georgakis MK, Kollia N, Wikström AK, Hogberg U, Skalkidou A. Acta Obstet. Gynecol. Scand. 2018; 97(3): 301-311.

Affiliation

Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden, 2Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens.

Copyright

(Copyright © 2018, John Wiley and Sons)

DOI

10.1111/aogs.13275

PMID

29215162

Abstract

INTRODUCTION: Although a number of perinatal factors have been implied in the etiology of postpartum depression (PPD), the role of mode of delivery remains controversial. Our aim was to explore the association between mode of delivery and PPD, considering the potentially mediating or confounding role of several covariates MATERIAL AND METHODS: In a longitudinal-cohort study in Uppsala, Sweden, with 3888 unique pregnancies followed-up postpartum, the effect of mode of delivery (spontaneous vaginal delivery, vacuum extraction, elective cesarean section, emergency cesarean section) on self-reported PPD symptoms (Edinburgh Postnatal Depression Scale ≥12) at six weeks postpartum was investigated through logistic regression models and path analysis RESULTS: The overall prevalence of PPD was 13%. Compared to spontaneous vaginal delivery, women delivered by emergency cesarean section were at higher risk for PPD six weeks after delivery in crude (OR: 1.45, 95%CI: 1.04-2.01), but not in adjusted analysis. However, the path analysis revealed that emergency cesarean section and vacuum extraction were indirectly associated with increased risk of PPD, by leading to postpartum complications, self-reported physical symptoms postpartum, and therefore a negative delivery experience. In contrast, history of depression and fear of delivery increased the odds of PPD, but also led more frequently to elective cesarean section, which was however associated with a positive delivery experience.

CONCLUSIONS: Mode of delivery has no direct impact on risk of PPD; nevertheless, several modifiable or non-modifiable mediators are present in this association. Women delivering at an emergency setting by emergency cesarean section or vacuum extraction, and reporting negatively experienced delivery comprise a high-risk group for PPD. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en

Keywords

cesarean section; delivery experience; mode of delivery; postpartum depression; vacuum extraction