Associations among Caesarean Section Birth, Post-Traumatic Stress, and Postpartum Depression Symptoms

Marie-Andrée Grisbrook, Deborah Dewey, Colleen Cuthbert, Sheila McDonald, Henry Ntanda, Gerald F. Giesbrecht and Nicole Letourneau
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Marie-Andrée Grisbrook: Faculty of Nursing, University of Calgary, Calgary, AB T2N 4V8, Canada
Deborah Dewey: Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada
Colleen Cuthbert: Faculty of Nursing, University of Calgary, Calgary, AB T2N 4V8, Canada
Sheila McDonald: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
Henry Ntanda: Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada
Gerald F. Giesbrecht: Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada
Nicole Letourneau: Faculty of Nursing, University of Calgary, Calgary, AB T2N 4V8, Canada

IJERPH, 2022, vol. 19, issue 8, 1-13

Abstract: Caesarean section (C-section) deliveries account for nearly 30% of births annually with emergency C-sections accounting for 7–9% of all births. Studies have linked C-sections to postpartum depression (PPD). PPD is linked to reduced quality of parent-child interaction, and adverse effects on maternal and child health. New mothers’ perceptions of more negative childbirth experiences, such as unplanned/emergency C-sections, are linked to post-traumatic stress disorder (PTSD), which in turn is related to PPD. Our objectives were to determine: (1) the association between C-section type (unplanned/emergency vs. planned) and PPD symptoms, and (2) if postnatal PTSD symptoms mediate this association. Employing secondary analysis of prospectively collected data from 354 mother-child dyads between 2009 and 2013 from the Alberta Pregnancy Outcomes and Nutrition (APrON) study, conditional process modeling was employed. The Edinburgh Postnatal Depression Scale (EPDS) and the Psychiatric Diagnostic Screening Questionnaire (PDSQ) were administered at three months postpartum, to assess for postpartum depressive and post-traumatic stress symptoms. The direct effect of emergency C-section on PPD symptoms was non-significant in adjusted and non-adjusted models; however, the indirect effect of emergency C-section on PPD symptoms with PTSD symptoms as a mediator was significant after controlling for prenatal depression symptoms, social support, and SES (β = 0.17 ( SE = 0.11), 95% CI [0.03, 0.42]). This suggests that mothers who experienced an emergency or unplanned C-section had increased PTSD scores of nearly half a point (0.47) compared to mothers who underwent a planned C-section, even after adjustment. Overall, emergency C-section was indirectly associated with PPD symptoms, through PTSD symptoms. Findings suggest that PTSD symptoms may be a mechanism through which emergency C-sections are associated with the development of PPD symptoms.

Keywords: caesarean section; postpartum depression; post-traumatic stress disorder; mode of delivery; maternal mental health; conditional process modeling; APrON study (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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