Cited by 157Maternal Mental Health During Pregnancy and PostpartumMaternal and Perinatal Health InterventionsMaternal and Neonatal Healthcare

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Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study: Mode of Delivery and Postpartum Depression

Sword, W, Kurtz Landy, C, Thabane, L, Watt, S, Krueger, P, Farine, D, Foster, G·2011·BJOG: An International Journal of Obstetrics & Gynaecology

DOI 10.1111/j.1471-0528.2011.02950.x

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Abstract

OBJECTIVE: To examine the relationship between delivery mode and postpartum depression at 6 weeks following hospital discharge. DESIGN: A prospective cohort study. SETTING: Eleven hospitals in Ontario, Canada. SAMPLE: A total of 2560 women ≥16 years of age who delivered singleton, live infants at term. METHODS: Women completed a questionnaire in hospital and 74% (n = 1897) participated in a structured telephone interview 6 weeks after discharge. Additional data were extracted from labour and delivery records. Generalised estimating equations (GEEs) were used to investigate factors associated with postpartum depression. MAIN OUTCOME MEASURE: Women were screened for depression at 6 weeks following hospital discharge using the Edinburgh Postnatal Depression Scale (EPDS). A score of ≥12 on the EPDS was used as a measure of the primary outcome, depression. RESULTS: Mode of delivery was not independently associated with postpartum depression, and did not factor into the main-effects model. The multivariable analysis identified 11 predictor variables for depression: young maternal age (OR 5.27; 95% CI 2.73-10.15); maternal hospital readmission (OR 3.02; 95% CI 1.46-6.24); non-initiation of breastfeeding (OR 2.02; 95% CI 0.99-4.11); good, fair, or poor self-reported postpartum health (OR 1.82; 95% CI 1.19-2.80); urinary incontinence (OR 1.79; 95% CI 1.06-3.03); multiparity (OR 1.59; 95% CI 1.22-2.08); low mental health functioning (OR 1.20; 95% CI 1.15-1.25); low subjective social status (OR 1.16; 95% CI 1.02-1.33); high number of unmet learning needs in hospital (OR 1.12; 95% CI 1.03-1.22); low social support (OR 1.06; 95% CI 1.03-1.09); and low physical health functioning (OR 1.03; 95% CI 1.003-1.055). An exploratory interaction model revealed that caesarean section was associated with higher odds of becoming depressed in Canadian-born women, but that in women born outside of Canada it was associated with a lower risk of becoming depressed. CONCLUSIONS: Delivery mode had no significant impact on the development of postpartum depression in the main-effects model. However, it may interact with place of birth and other unmeasured factors to create a risk for depression.

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Background
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Result
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Background
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Result
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Post-partum depression: a cross-sectional study of women enrolled in a conditional cash transfer program in 30 Brazilian cities
Santos, I. S., Munhoz, T. N., Blumenberg, C., Barcelos, R. S., Bortolotto, C. C., Matijasevich, A., Júnior, H. G. D. S., dos Santos, L. M., Correia, L. L., de Souza, M. R., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.12.042 · Cited by 23
Sexual function and postpartum depression 6 months after attempted operative vaginal delivery according to fetal head station: A prospective population-based cohort study
Ducarme, G., Hamel, J., Brun, S., Madar, H., Merlot, B., & Sentilhes, L. (2017) · PLoS ONE · doi:10.1371/journal.pone.0178915 · Cited by 23
Urinary incontinence increases risk of postpartum depression: systematic review and meta-analysis
Gallego‐Gómez, C., Rodríguez‐Gutiérrez, E., Torres-Costoso, A. I., Martínez‐Vizcaíno, V., Bustelo, S. M., Quezada-Bascuñán, C. A., & Ferri‐Morales, A. (2024) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2024.02.307 · Cited by 22
Biomarker screening for antenatal depression in women who underwent caesarean section: a matched observational study with plasma Lipidomics
Wu, Z., Zhao, P., Long, Z., Li, J., Yang, G., Zhang, Q., Duan, G., & Li, H. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2241-1 · Cited by 20
Does immediate skin‐to‐skin contact at caesarean sections promote uterine contraction and recovery of the maternal blood haemoglobin levels? A randomized clinical trial
Pérez‐Jiménez, J. M., Oliveros, M. L., Gonzalez‐Perez, D., Rivera‐Sequeiros, A., & Rodríguez‐Blanco, C. (2022) · Nursing Open · doi:10.1002/nop2.1331 · Cited by 19
“There is evidence of a relationship between undergoing a caesarean section and depressive symptomatology (Xie et al., 2011); however, Sword et al. (2011) provide conflicting results on this topic.”
Result
Outcome measures in studies on the use of oxytocin for the treatment of delay in labour: a systematic review.
Begley, C., Gross, M., Dencker, A., Benstoem, C., Berg, M., & Devane, D. (2014) · Midwifery · doi:10.1016/j.midw.2014.06.005 · Cited by 18
“No direct association has been shown between oxytocin use and postnatal depression, but postnatal depression is linked with postnatal readmission of the mother (Sword et al., 2011).”
A Detailed Biological Approach on Hormonal Imbalance Causing Depression in Critical Periods (Postpartum, Postmenopausal and Perimenopausal Depression) in Adult Women
Saraswat, N., Wal, P., Pal, R. S., Wal, A., Pal, Y., & Roohi, T. F. (2021) · The Open Biology Journal · doi:10.2174/1874196702109010017 · Cited by 17
Factors Associated with the Development of Postnatal Depression After Cesarean Delivery: A Prospective Study
Chan, C.-J., Tan, C. W., Chan, J. J. I., Sultana, R., Chua, T.-E., Chen, H. Y., Sia, A. T. H., & Sng, B. L. (2020) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s241984 · Cited by 16
Does Urinary Incontinence and Mode of Delivery Affect Postpartum Depression? A Nationwide Population-Based Cohort Study in Korea
Nam, J. Y., Park, E., & Cho, E. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18020437 · Cited by 16
“A prospective cohort study showed that women with UI were at a high risk of PPD six weeks after childbirth [5] and another revealed that women with UI were at a 2.”
Background
Sezaryen doğumun postpartum depresyona ve maternal bağlanmaya etkisi
Kokanalı, D., Ayhan, S., Devran, A., Kokanalı, M. K., & Taşçı, Y. (2018) · Journal of Contemporary Medicine · doi:10.16899/gopctd.366181 · Cited by 16
Enhancing research publications and advancing scientific writing in health research collaborations: sharing lessons learnt from the trenches
Li, G., Jin, Y., Mbuagbaw, L. C. E., Dolovich, L. R., Adachi, J. D., Levine, M., Cook, D., Samaan, Z., & Thabane, L. (2018) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s152681 · Cited by 19
Severe Maternal Morbidity and Postpartum Depressive Symptomatology: A Prospective Double Cohort Comparison Study
Norhayati, M. N., Hussain, N. H. N., Aniza, A. A., & Razak, A. A. (2016) · Research in Nursing & Health · doi:10.1002/nur.21741 · Cited by 16
Associations of pelvic floor dysfunction and postnatal mental health: a systematic review
VanWiel, L., Unke, M., Samuelson, R. J., & Whitaker, K. M. (2024) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2024.2314720 · Cited by 15
“…2016, 2020; Hullfish et al., 2007; Jurášková et al., 2020; Nam et al., 2021; Padoa et al., 2020; Safadi et al., 2016; Surkan et al., 2017; Swenson et al., 2018; Sword et al., 2011; van de Pol et al., 2007; Vinturache et al., 2017; Webb et al., 2008; Woolhouse et al., 2014; Zhang et al., 2023).”
Mode of birth and early postnatal psychological morbidity
Hanlon, A. J. M., & Beckmann, M. M. (2015) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/ajo.12387 · Cited by 15
PREDICTORS OF EMOTIONAL AND BEHAVIORAL PROBLEMS IN 1‐YEAR‐OLD CHILDREN: A LONGITUDINAL PERSPECTIVE
Širvinskienė, G., Žemaitienė, N., Jusienė, R., & Markūnienė, E. (2016) · Infant Mental Health Journal · doi:10.1002/imhj.21575 · Cited by 15
Identification of Postpartum Depression in an Online Community
Teaford, D., Goyal, D., & McNiesh, S. G. (2015) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1111/1552-6909.12740 · Cited by 15
“Well-established risk factors associated with a high risk of developing PPD, including depression during the pregnancy, socioeconomic status, social support, history of intimate partner violence, and sleep disturbance, were not assessed, which further limited our findings (Beydoun, Beydoun, Kaufman, Lod, & Zonderman,…”
Result
Association between high levels of comorbid anxiety and depressive symptoms and decreased likelihood of birth without intervention: A longitudinal prospective cohort study
Hulsbosch, L. P., Boekhorst, M., Lodder, P., Potharst, E., Nyklíček, I., Bergink, V., Oei, S., Verhoeven, C., & Pop, V. (2022) · BJOG: an International Journal of Obstetrics and Gynaecology · doi:10.1111/1471-0528.17273 · Cited by 13
Mode of Delivery Is Associated with Postpartum Depression: Do Women with and without Depression History Exhibit a Difference?
Liu, T., Peng, H., Chen, C., & Chen, C.-S. (2022) · Healthcare · doi:10.3390/healthcare10071308 · Cited by 17
Long-term postpartum effect of severe maternal morbidity on sexual function
Norhayati, M. N., & Azman, M. Y. (2017) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217417738933 · Cited by 15
Association between habitual weekday sleep duration and depressive symptoms among Chinese adolescents:The role of mode of birth delivery
Guo, L., Wang, T., Wang, W., Fan, B., Xie, B., Zhang, H., Liao, Y., & Lu, C. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.095 · Cited by 12
“I felt like I was left on my own”: A mixed‐methods analysis of maternal experiences of cesarean birth and mental distress in the United States
Sega, A., Cozart, A. C., Cruz, A. O., & Reyes‐Foster, B. M. (2021) · Birth · doi:10.1111/birt.12541 · Cited by 13
Between Personality Traits and Postpartum Depression: The Mediated Role of Maternal Self-Efficacy
Han, L., Zhang, J., Yang, J., Yang, X., & Bai, H. (2022) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s346327 · Cited by 17
Maternal Depression and Mother-to-Infant Bonding: The Association of Delivery Mode, General Health and Stress Markers
Song, M., Ishii, H., Toda, M., Tomimatsu, T., Katsuyama, H., Nakai, Y., & Shimoya, K. (2017) · Open Journal of Obstetrics and Gynecology · doi:10.4236/ojog.2017.72017 · Cited by 13
Comparison of level of depression among mothers with lower segment cesarean section and vaginal delivery: A cross-sectional study
Bhatt, J., & Mahishale, A. V. (2017) · Journal of the Scientific Society · doi:10.4103/0974-5009.202547 · Cited by 22
Hubungan Faktor Demografi Dan Dukungan Sosial Dengan Depresi Pascasalin
Nurfatimah, N., & Entoh, C. (2018) · Jurnal Profesi Medika Jurnal Kedokteran dan Kesehatan · doi:10.33533/jpm.v11i2.229 · Cited by 12
Prevalence and determinants of postnatal depression in a tertiary care teaching institute in Kerala, India
Heera Shenoy, T., Remash, K., & Sheela Shenoy, T. (2019) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20193811 · Cited by 11
Prevalence of maternal psychological disorders after immediate postpartum haemorrhage: a repeated cross-sectional study - the PSYCHE* study protoco
Pranal, M., Debost‐Legrand, A., de Chazeron, I., Llorca, P., & Vendittelli, F. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-027390 · Cited by 10
Social and Demographic Factors Associated with Postnatal Depression Symptoms among HIV-Positive Women in Primary Healthcare Facilities, South Africa
Mokwena, K. E., & Mbatha, N. L. (2021) · Healthcare · doi:10.3390/healthcare9010065 · Cited by 9
Symptoms of Discomfort and Problems Associated with Mode of Delivery During the Puerperium: An Observational Study
Martínez‐Galiano, J. M., Delgado‐Rodríguez, M., Rodríguez‐Almagro, J., & Hernández‐Martínez, A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16224564 · Cited by 9
Investigating the association between maternal childbirth intention, labor epidural analgesia, and postpartum depression: A prospective cohort study
Zhuang, J., Chen, Q., Liu, C., Zuo, R., Zhang, Y., Dang, J., & Wang, Z. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.12.108 · Cited by 8
Association between the serum insulin‐like growth factor‐1 concentration in the first trimester of pregnancy and postpartum depression
Adachi, S., Tokuda, N., Kobayashi, Y., Tanaka, H., Sawai, H., Shibahara, H., Takeshima, Y., Shima, M., & the Japan Environment and Children's Study Group (2021) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13200 · Cited by 8
Evaluation of Repeated Web-Based Screening for Predicting Postpartum Depression: Prospective Cohort Study
Haßdenteufel, K., Lingenfelder, K., Schwarze, C. E., Feißt, M., Brusniak, K., Matthies, L. M., Goetz, M., Wallwiener, M., & Wallwiener, S. (2021) · JMIR Mental Health · doi:10.2196/26665 · Cited by 8
“Other studies, in contrast, have reported multiparity being a risk factor for PDD as caring for more than 1 child can lead to additional stress and may overwhelm mothers in their everyday life [78,90].”
Background
The prevalence of peripartum depression and its relationship to mode of delivery and other factors among mothers in Ixopo, Kwazulu-Natal, South Africa
Duma, N. E., & Madiba, T. E. (2020) · South African Journal of Psychology · doi:10.1177/0081246320931355 · Cited by 7
“Some studies postulate that age of 25 years or less is an important risk factor for PPD (Inandi et al., 2002; Sword et al., 2011; Zaidi et al., 2017), while others have found no age-related risk (Breese McCoy et al., 2008; Goker et al., 2012).”
BackgroundResult
COMPARISON OF POSTNATAL DEPRESSION IN WOMEN FOLLOWING NORMAL VAGINAL DELIVERY AND CAESAREAN SECTION: A PILOT STUDY
Malik, F. R., Malik, B. B., & Irfan, M. (2015) · Journal of Postgraduate Medical Institute · Cited by 7
The Association between Cesarean Section Delivery and Child Behavior: Is It Mediated by Maternal Post-Traumatic Stress Disorder and Maternal Postpartum Depression?
Grisbrook, M.-A., Dewey, D., Cuthbert, C. A., McDonald, S., Ntanda, H. N., & Letourneau, N. L. (2024) · Behavioral Sciences · doi:10.3390/bs14010061 · Cited by 10
“The lack of control experienced during emergency obstetrical interventions, such as an emergency C-section, may be associated with the development of depression [31,32] and birth trauma [33] among new mothers.”
Background
Frequency of postpartum depression among primi mothers undergoing delivery in JIPMER using Edinburgh postnatal depression scale
Selvam, G., Balasubramanian, J., & Chanu, S. M. (2020) · The New Indian Journal of OBGYN · doi:10.21276/obgyn.2020.6.2.9 · Cited by 6
Is cesarean section a clinical marker for psychiatric and sleep disorder in young mothers? A cross-sectional study from rural South India
Ryali, V. S. R., Kumar, M. S., Ryali, V. S. S. R., & Sreelatha, P. (2022) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_51_22 · Cited by 6
“A CS happened significantly more often than VD (14.4% vs 5.8%, P = 0.024) following an unplanned pregnancy [Table 2].”
Influential
Predictors of Postpartum Depression in an Iranian Population, 2006
Sooki, Z., Zahra, T., Sharifi, S. M., Sharifi, K., Musavi, S., & Zahmatkesh, B. H. (2012) · Nursing and Midwifery Studies · doi:10.5812/nms.7915 · Cited by 6
“have also reported that the prevalence of PPD is higher in women who underwent a cesarean delivery (CD) (23, 24), but some researchers did not confirm such a relationship (10, 25, 26).”
Obstetric anesthesia clinic childbirth course combined with labor epidural analgesia is associated with a decreased risk of postpartum depression : a prospective cohort study
Tong, S., Rao, C., Min, S., Li, H., Quan, D., Daping, C., & Zhu, Y. (2022) · BMC Anesthesiology · doi:10.1186/s12871-022-01931-y · Cited by 6
Emergency cesarean section is a risk factor for depressive symptoms when breastfeeding is limited
Takács, L., Šmolík, F., Lacinová, L., Daňsová, P., Feng, T., Mudrák, J., Zábrodská, K., & Monk, C. E. (2021) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110691 · Cited by 5
“Indeed, previous research consistently shows that one of the strongest predictors of PPD is a history of depression (both pre-pregnancy and pregnancy) [1], but a number of psychosocial risk factors have been identified as well, including low social support [25], life stress events [22], unsatisfactory relationship wit…”
Background
Cesarean Section Can Be Related With Postpartum Depression: A Cross-sectional Study
Dousti, R., Hakimi, S., Pourfathi, H., Nourizadeh, R., & Sattarzadeh, N. (2022) · International Journal of Women s Health and Reproduction Sciences · doi:10.15296/ijwhr.2022.37 · Cited by 5
Tipo de parto y sensibilidad materna: Efectos en el desarrollo socioemocional de niños y niñas al año de edad
Ramos, R., Yávar, V., Río, A. D., Schettino, J., Bresciani, V., Gómez, D. M., Álvarez, C., & Farkas, C. (2020) · Acta Colombiana de Psicología · doi:10.14718/10.14718/acp.2020.23.2.10 · Cited by 5
Impact of socio-cultural factors on postpartum depression in South Indian women
Poomalar, G. K., & Bupathy, A. (2014) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.5455/2320-1770.ijrcog20140610 · Cited by 5

Authors: Sword, W., Kurtz Landy, C., Thabane, L., Watt, S., Krueger, P., Farine, D., & Foster, G.
Affiliations: McMaster University (CA)
St. Joseph’s Healthcare Hamilton (CA)
University of Toronto (CA)
Mount Sinai Hospital (CA)
Corresponding author: Sword, W
ORCID: Sword, W
Thabane, L
Watt, S
Krueger, P
Farine, D
Foster, G
Venue: BJOG: An International Journal of Obstetrics & Gynaecology
Publisher: Wiley
Published: 2011-04-13
Volume: 118
Issue: 8
Pages: 966-977
ISSN: 0306-5456 (ISSN-L)
1470-0328
DOI: 10.1111/j.1471-0528.2011.02950.x
OpenAlex: W1483308241
Cited by: 157
References: 69
Citations by year: 2025: 3 · 2024: 11 · 2023: 6 · 2022: 16 · 2021: 12 · 2020: 15 · 2019: 14 · 2018: 13 · 2017: 12 · 2016: 13 · 2015: 15 · 2014: 8 · 2013: 11 · 2012: 6
FWCI: 8.48
Type: journal article
Language: en
Open access: closed
Licence: doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 1602 d)
Locations: BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
PubMed (publishedVersion)
Funders: Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
Keywords: postpartum depression, mode of delivery, vaginal delivery, cesarean section, risk factors, maternal age, hospital readmission, breastfeeding initiation, urinary incontinence, multiparity, social support, postpartum health, mental health, subjective social status, Edinburgh Postnatal Depression Scale, term singleton delivery, Ontario hospitals, post-discharge follow-up
MeSH terms: Adult, Cesarean Section, Female, Humans, Infant, Newborn, Ontario, Pregnancy, Prospective Studies, Surveys and Questionnaires, Cohort Studies, Risk Assessment, Depression, Postpartum, Delivery, Obstetric

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Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study: Mode of Delivery and Postpartum Depression

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