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Cited by 19Maternal Mental Health During Pregnancy and PostpartumMaternal and Perinatal Health InterventionsMaternal and fetal healthcare

Are 6 more accurate than 4? The influence of different modes of delivery on postpartum depression and PTSD

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Beck-Hiestermann, Franziska Marie Lea, Hartung, Lisa Kathrin, Richert, Nadine, Miethe, Sandra, Wiegand-Grefe, Silke·2024·BMC Pregnancy and Childbirth
DOI 10.1186/s12884-024-06267-8PMC PMC10851577

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Abstract

Background: Empirical evidence shows that 4.6–6.3% of all women develop a post-traumatic stress disorder (PTSD) and approximately 10–15% postpartum depression (PPD) following childbirth. This study explores the relationship between delivery mode and the occurrence of PTSD and PPD, specifically examining four distinct caesarean section (CS) modes: primary on maternal request (Grade 4), medically indicated primary (Grade 3), secondary CS from relative indication (Grade 2) and emergency secondary CS (Grade 1), compared to vaginal and assisted vaginal delivery (AVD). The research aims to understand how these six subcategories of delivery modes impact PPD and PTSD levels. Common predictors, including the need for psychological treatment before childbirth, fear of childbirth, planning of pregnancy, induction of labor, birth debriefing, and lack of social support after childbirth, will be analyzed to determine their association with postpartum mental health outcomes. Methods: The study was planned and carried out by a research team of the psychology department at the Medical School Hamburg, Germany. Within an online-study (cross-sectional design) N = 1223 German speaking women with a baby who did not die before, during or after birth were surveyed once between four weeks and twelve months postpartum via an anonymous online questionnaire on demographic and gynecological data, delivery mode, PTSD (PCL-5) and PPD (EPDS). Results: For both psychiatric disorders, ANOVA revealed significant differences between delivery mode and PPD and PTSD. With weak effects for PPD and medium to strong effects for PTSD. Post-hoc tests showed increased levels of PPD for two CS types (Grade 1, Grade 3) compared to vaginal delivery. For PTSD, secondary CS from relative indication (Grade 2), emergency secondary CS (Grade 1) and assisted vaginal delivery (AVD) were associated with elevated levels of PTSD. Regression analysis revealed delivery mode as a significant predictor of EPDS- (medium effect size) and PCL-5-Score (medium to high effect size). Limitation: Delivery was considered as the potential traumatic event, and any previous traumas were not documented. Additionally, the categorization of delivery modes relied on subjective reports rather than medical confirmation. Conclusion: The study highlights the influence of delivery mode on the mental health of postpartum mothers: different modes influence postpartum disorders in various ways. However, the definition of delivery mode was only stated subjectively and not medically confirmed. Further research should investigate which aspects of the different delivery modes affect maternal mental health and explore how the perception of childbirth may be influenced by specific delivery experiences.

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Cited by

Sorted by citations

Authors
Beck-Hiestermann, F. M. L., Hartung, L. K., Richert, N., Miethe, S., & Wiegand-Grefe, S.
Affiliations
  • MSH Medical School Hamburg – University of Applied Sciences and Medical University (DE)
  • Medizinische Hochschule Hannover (DE)
  • Universität Hamburg (DE)
Corresponding author
Beck-Hiestermann, Franziska Marie Lea
ORCID
Miethe, Sandra
Venue
BMC Pregnancy and Childbirth
Publisher
Springer Science and Business Media LLC
Published
2024-02-08
Volume
24
Issue
1
Pages
118-118
ISSN
1471-2393 (ISSN-L)
DOI
10.1186/s12884-024-06267-8
PMC
PMC10851577
OpenAlex
W4391651490
Cited by
19
References
4
Citations by year
2026: 5 · 2025: 8 · 2024: 6
FWCI
6.91
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Pregnancy and Childbirth (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PUBLISSO (German National Library of Medicine) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
MSH Medical School Hamburg - University of Applied Sciences and Medical University
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 fetal healthcare
Keywords
post-traumatic stress disorder, mode of delivery, cesarean section, instrumental delivery, emergency cesarean section, birth trauma, postpartum mental health
MeSH terms
Cesarean Section, Cross-Sectional Studies, Female, Humans, Pregnancy, Stress Disorders, Post-Traumatic, Depression, Postpartum, Parturition, Delivery, Obstetric, Postpartum Period

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