Psychological adjustment to Caesarean delivery: a review of the evidence

Abstract

Despite public interest, there is a paucity of adequate research into the psychosocial consequences of Caesarean delivery. A large number of merely anecdotal or clinical descriptive papers exist which suggest that depression, guilt, loss of self-esteem, and hostility towards hospital staff are common consequences. The existing studies are considered with particular emphasis on their methodological adequacy. Their results suggest that women may be less satisfied following Caesarean childbirth and that this dissatisfaction may contribute to disturbances of affect, such as depression or anxiety, and to a loss of self-esteem. There may also be a deleterious effect on early mother—infant interaction, but claims that these effects are long-term have not been confirmed. Even if these effects are a consequence of the mode of delivery, it is still not known who is most likely to be adversely emotionally affected, though there are suggestions that women lacking a supportive partner may be more at risk. Evidence suggests that psychological distress following Caesarean delivery may be moderated by: specific psychological and educational preparation, the presence of a partner or other supportive person in the operating theatre, the use of regional rather than general anesthesia, and not routinely separating mother from neonate at birth. Given the nature of the studies published to date, there is a need for adequately designed, prospective research that uses objective measures and larger samples if this issue is to be elucidated.