Unplanned Cesarean delivery is associated with risk for postpartum depressive symptoms in the immediate postpartum period

Abstract

Purpose

Postpartum depression (PPD) is a common pregnancy complication. The association between cesarean delivery (CD) and PPD has shown conflicting results in prior studies, although emergent CD appears to be a clear risk factor. Establishing PPD risk is critical and may, however, be related to the unplanned nature of the CD, rather than the surgery itself. Our objective was to determine whether women who underwent unplanned CD were more likely than those with vaginal delivery to have higher depressive symptoms and thus screen positive for PPD risk in the immediate postpartum period.

Materials and methods

This cohort study was conducted at a community medical center using data for deliveries between 8/2015–1/2016. Women were screened in the hospital for depressive symptoms (PPD risk) using the Edinburgh Postnatal Depression Scale (EPDS) within 4 days post-delivery. Logistic regression, adjusting for maternal race/ethnicity and parity, was performed to evaluate the association between delivery route (vaginal vs planned vs unplanned CD) and PPD risk (EPDS ≥ 10).

Results

A total of 2094 women had complete data for analysis. Overall, 44 women (2.1%) screened positive for PPD risk. Logistic regression results showed that unplanned CD was significantly associated with PPD risk (OR = 2.28, 95% CI 1.13–4.57, p = .022), after adjusting for parity and race/ethnicity. Planned CD was not associated with PPD risk.

Conclusion

Unplanned CD may be an independent risk factor for PPD risk in the immediate postpartum period. This finding might explain why some previous studies have demonstrated different results with regards to risk of CD where the unplanned nature of the delivery was not accounted for.

Keywords:

• Cesarean delivery
• postpartum depression
• postpartum depression screening

Acknowledgements

S.S., R.G., R.M., & R.H. designed and conducted the parent study. E.A. developed the secondary research questions for analyses. J.M. analyzed the data. S.S. and E.A. wrote the first draft of this manuscript. All authors contributed to the interpretation of data, assisted in writing and approved the final manuscript. The authors have no financial gain related to the outcome of this research, and there are no potential conflicts of interest. We thank the participants in this study for contributing to this research and increasing our knowledge about the experiences of pregnant women. We acknowledge the support of the research team members, Fady M Awad MS3 and Grace Sainz RN.

Disclosure statement

The authors have no conflicts of interest to disclose.