Cesarean delivery is associated with suppressed activities of the stress axes

Figures & data

Figure 1. Experimental design. Women undergoing vaginal delivery (n = 35) or cesarean delivery (n = 56) accepted to participate to the current study. In the birth clinic, all parturitions took place between 08:30–11:00 h. Women provided saliva samples for cortisol measurement and had a 5-min electrocardiogram recording for HRV (heart rate variability) assessment before and after delivery (6 h after the first sampling).

Table 1. Demographic and obstetrical variables of the participants (n = 91).

Variables	Vaginal delivery (n = 35)	Cesarean delivery (n = 56)	p Value
Age (years)	27.7 ± 5.9	29.4 ± 4.6	0.137
BMI (kg/m^2)	26.7 ± 2.6	27.2 ± 3.4	0.442
Gestational age (week)	39.2 ± 1.5	39.3 ± 1.1	0.506
Birth numbers	2.1 ± 1.1	2.4 ± 0.7	0.136

The data represents mean ± standard deviation. BMI: body mass index.

Figure 2. Cortisol levels (mean ± SD) were higher in the women having vaginal delivery than that of the women having cesarean delivery (*p = 0.022). However, there were no differences between the cortisol levels measured before and after delivery (p > 0.05).

Table 2. Salivary cortisol and HRV parameters in vaginal and cesarean delivery before and after birth (mean ± SD).

	Groups				Statistics
	Vaginal delivery		Cesarean delivery		Delivery type				Time			Interaction
Variables	Before	After	Before	After	df	F	η^2	p	F	η^2	p	F	η^2	p
Kortizol	87.6 ± 79.3	86.5 ± 127	53.6 ± 47.9	49.1 ± 55.5	1	5.364	0.04	0.022	0.001	0	0.980	0.005	0	0.946
HR (bpm)	91.7 ± 16.4	79.1 ± 9.2	93.6 ± 12	81.8 ± 12	1	1.169	0.008	0.281	34.361	0.191	<0.001	0.042	0	0.838
RRNN (ms)	674 ± 122	768 ± 89	651 ± 87	748 ± 106	1	1.651	0.011	0.201	32.613	0.183	<0.001	0.008	0	0.929
SDNN (ms)	47.5 ± 22.3	53.3 ± 21	38.7 ± 14.7	44.3 ± 19	1	8.158	0.053	0.005	3.242	0.022	0.074	0	0	0.983
RMSSD (ms)	35.9 ± 25.8	50.6 ± 26.8	24.5 ± 22.7	40.1 ± 27.5	1	6.734	0.044	0.010	12.856	0.081	<0.001	0.012	0	0.911
pNN50 (%)	13.7 ± 18.4	22.4 ± 18.5	6.59 ± 14.4	16.8 ± 19	1	4.952	0.033	0.028	10.670	0.068	<0.001	0.062	0	0.804
TP (ms^2)	2524 ± 2670	2870 ± 2620	1507 ± 1127	2048 ± 1628	1	7.635	0.05	0.006	1.774	0.012	0.185	0.087	0.001	0.769
VLF (ms^2)	1332 ± 1560	988 ± 791	937 ± 891	736 ± 563	1	3.878	0.026	0.051	2.743	0.018	0.100	0.189	0.001	0.665
LF (ms^2)	617 ± 649	791 ± 642	349 ± 247	638 ± 615	1	5.469	0.036	0.021	6.602	0.043	0.011	0.414	0.003	0.521
HF (ms^2)	575 ± 747	1090 ± 1800	220 ± 338	674 ± 737	1	5.572	0.037	0.020	8.807	0.057	0.004	0.037	0	0.847
LF n.u	64.1 ± 21.5	53.2 ± 18.8	71.4 ± 17.7	55.8 ± 19.4	1	2.426	0.016	0.122	17.162	0.105	<0.001	0.539	0.004	0.464
HF n.u	35.9 ± 21.5	46.8 ± 18.8	28.6 ± 17.7	44.2 ± 19.4	1	2.426	0.016	0.122	17.162	0.105	<0.001	0.539	0.004	0.464
LF/HF	4.02 ± 5.03	1.56 ± 1.2	4.8 ± 5.6	2.02 ± 2.01	1	0.821	0.006	0.366	15.013	0.093	<0.001	0.056	0	0.813
% VLF	58.9 ± 21.3	40.2 ± 16.8	60.9 ± 20	41 ± 18	1	0.19	0.001	0.663	36.704	0.201	<0.001	0.036	0	0.849
% LF	23.7 ± 11.8	30.6 ± 11.8	26.6 ± 14.2	31.4 ± 13	1	0.729	0.005	0.395	7.505	0.049	0.007	0.221	0.002	0.639
% HF	17.3 ± 16.2	29.1 ± 17.3	12.5 ± 12.3	27.5 ± 17	1	1.549	0.01	0.215	27.026	0.156	<0.001	0.389	0.003	0.534

df: Degree of freedom; η²: partial eta-squared.

P values in bold denote statistically significant effects.