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

Prevalence and risk factors for postpartum depression 2 months after cesarean delivery: a prospective multicenter study

BACKGROUND

The prevalence and risk factors of postpartum depression after cesarean delivery remain unclear.

OBJECTIVE

To assess the prevalence of postpartum depression and its risk factors 2 months after cesarean delivery.

STUDY DESIGN

Prospective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery trial, conducted in 27 French hospitals in 2018 to 2020 and enrolling women undergoing cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery, postpartum blood loss, and immediate postpartum period, including memories of delivery and postoperative pain, were prospectively collected. Women's characteristics, particularly any psychiatric history, were collected from medical records. Two months after childbirth, a postpartum depression provisional diagnosis was defined as a score of 13 or higher on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Multivariate logistic regression analyzed associations between potential risk factors and postpartum depression. A sensitivity analysis used an Edinburgh Postnatal Depression Scale cutoff value of 11 or higher.

RESULTS

The questionnaire was returned by 2793/4431 women (63.0% response rate). The corrected prevalence of postpartum depression provisional diagnosis was 16.4% (95% confidence interval, 14.9%-18.0%) with an Edinburgh Postnatal Depression Scale score of 13 or higher and 23.1% (95% confidence interval, 21.4%-24.9%) with a cutoff value of 11 or higher. Characteristics associated with a higher risk of postpartum depression were prepregnancy characteristics such as young age (adjusted odds ratio 0.83, 95% confidence interval 0.74-0.93 for each 5-year increase in maternal age) and non-European country of birth (adjusted odds ratio 2.58, 95% confidence interval 1.85-3.59 for North Africa; adjusted odds ratio 1.57, 95% confidence interval 1.09-2.26 for Sub-Saharan Africa and adjusted odds ratio 1.99, 95% confidence interval 1.28-3.10 for other country of birth; reference: Europe) and some aspects of the cesarean delivery, notably its timing and context, emergency before labor (adjusted odds ratio 1.70, 95% confidence interval 1.15-2.50; reference: before labor without emergency) and during labor after induction of labor (adjusted odds ratio 1.36, 95% confidence interval 1.03-1.84; reference: before labor without emergency). Also at higher risk were women reporting high intensity pain during the postpartum stay (adjusted odds ratio 1.73, 95% confidence interval 1.32-2.26) and bad memories of delivery on day 2 postpartum (adjusted odds ratio 1.67, 95% confidence interval 1.14-2.45). Conversely, women who had social support in the operating room had a lower risk of postpartum depression (adjusted odds ratio 0.73, 95% confidence interval 0.53-0.97).

CONCLUSION

Around one woman in 6 had postpartum depression symptoms 2 months after cesarean delivery. Some cesarean-related obstetric factors may increase this risk: cesareans before labor for emergency situations or during labor after medically indicated induction of labor, severe postoperative pain, and bad memories of delivery before discharge. Specific subgroups of at-risk women could benefit from early screening or intervention to reduce the onset of postpartum depression. Perinatal professionals should pay particular attention to postoperative pain management.

Impact of esketamine intravenous analgesic pump on pain and depression post-cesarean

BACKGROUND

Postoperative pain and psychological well-being in postpartum women following cesarean section are critical for optimal maternal recovery. Traditional analgesics often have limitations and side effects, prompting the need for alternative solutions. This study evaluates the impact of an esketamine intravenous analgesic pump on postoperative pain and psychological status in postpartum women following cesarean section.

METHODS

A comprehensive retrospective evaluation was conducted at our institution from October 2021 to July 2023, including 168 patients who underwent cesarean delivery. The observation group (n = 82) received esketamine via an intravenous analgesic pump, while the control group (n = 86) received traditional analgesic therapy. Data collected included demographic information, surgical details, postoperative pain (assessed using the Visual Analog Scale, VAS), psychological status (assessed using the Edinburgh Postnatal Depression Scale, EPDS), recovery metrics, and adverse reactions.

RESULTS

The observation group demonstrated consistently lower VAS scores at all postoperative time points compared to the control group, indicating superior pain control. EPDS scores were significantly lower in the observation group at 3, 5, and 14 days postoperatively, suggesting better psychological outcomes. The incidence of postpartum depression was also lower in the observation group at 3, 5, and 14 days. Recovery metrics such as time to first ambulation, first flatus, and initiation of lactation were significantly improved in the observation group. There were no significant differences in the incidence of adverse reactions between the groups.

CONCLUSIONS

The use of the Esketamine Intravenous Analgesic Pump significantly reduces postoperative pain and the incidence of postpartum depression within the first 14 days. It promotes early recovery and breastfeeding in postpartum women without significant adverse reactions, making it a valuable addition to postoperative care.

Socio-demographic factors, informal payments and satisfaction with childbirth in the Hungarian context

OBJECTIVE

This study aims to investigate the impact of socio-demographic factors on childbirth satisfaction in Hungary, with a particular focus on the role of informal payments. While previous research has extensively examined maternal satisfaction, the specific influence of socio-demographic characteristics on childbirth experiences remains insufficiently explored, particularly in Hungary, where informal payments and a dual healthcare system coexist. By addressing this gap, the study seeks to provide a deeper understanding of the factors that shape birth satisfaction.

METHODS

This study examines satisfaction with childbirth using a representative sample of the Hungarian adult population surveyed between February and April 2024. Descriptive statistics (chi-square test) and factor analysis were applied to understand perceptions of quality obstetric care, including responses from childless women and men on general attitudes towards obstetric services (N = 1360). Logistic regression examined socio-demographic predictors of satisfaction with obstetric care among mothers and fathers who evaluated their partners' experiences (N = 772).

RESULTS

Findings underscore the significance of financial factors in childbirth care. Individuals with lower education levels often consider informal payments and private doctors essential for quality care (χ² = 18.0, p < 0.05). Factor analysis revealed two key dimensions: financial and competency. Emphasis on financial aspects correlated with dissatisfaction (Financial components, Factor 1: OR = 0.74, 95%, p < 0.05) while prioritizing competency was linked to higher satisfaction (Competence, Factor 2: OR = 1.54, 95%, p < 0.01). The percentage of women dissatisfied with their childbirth experience was 13.8%, compared to 6.1% of men.

CONCLUSION

Efforts to reduce reliance on informal payments and enhance equitable access to high-quality obstetric care are critical for improving childbirth satisfaction in Hungary.

Obstetric quality of recovery: A weak surrogate measure of psychological distress and psychological wellness for cesarean delivery parturients-A prospective observational study

The obstetric quality of recovery score (ObsQoR-11) is a widely used self-report assessment in obstetric settings following cesarean deliveries (CD). However, this measure may not assess psychological variables as originally intended, which may inform quality care. The primary aim of this study was to explore the relationship between ObsQoR-11 and validated scales that measure peritraumatic distress and psychological wellness. 220 Canadian patients who underwent scheduled or unscheduled CD (Mage = 35.00 years, SD = 4.18) completed self-report surveys assessing: obstetric quality of recovery, peritraumatic distress, and psychological wellness. ObsQoR-11 exhibited significant but weak correlations with peritraumatic distress and psychological wellness. Peritraumatic distress and psychological wellness are independent constructs that should be measured separately in clinical practice outside of routine assessments using ObsQoR-11. As there was low convergent construct validity with these two measures, these psychological assessments may assist in providing additional assessments of holistic outcomes following cesarean delivery.

Impact of Affirmation Relaxation and Back Massage on Depression, Anxiety, and Stress in Mothers Who Have Undergone Caesarean Section

Introduction The postpartum psychological well-being and quality of life of mothers after caesarean section are poor when compared to mothers following vaginal delivery. Therefore, the study aimed to evaluate the impact of a combination of back massage and affirmation relaxation technique on depression, anxiety, and stress experienced by mothers who had undergone caesarean section. Methodology This interventional study used a pretest-posttest control group design and was quantitative in nature. Twenty-four caesarean section mothers, with 12 in the experimental group and 12 in the control group, were chosen by a purposive sampling technique at Fatima Hospital, Mau, Uttar Pradesh, India, from July 1, 2022, to August 14, 2022. A structured questionnaire on sociodemographic data and a standardised tool, DASS-21 (Depression, Anxiety and Stress Scale, 21 items), were used to gather the data. Data collection was done from the experimental and control groups on the 3rd and 6th post-operative days. The experimental group was given a back massage and affirmation relaxation four times a day for 10 minutes each on the 4th, 5th, and 6th post-operative days. The control group mothers received routine health assessment and health education on postnatal care and breastfeeding. Descriptive and inferential statistics were used to analyse the data using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York). The analysis of categorical data was done using frequency and percentage distribution, whereas the analysis of continuous variables was done using mean and standard deviation. The Wilcoxon signed rank test and the Mann-Whitney U test were employed to evaluate the intervention's efficacy. The significance level was set at p < 0.05. Results A total of 24 mothers who have undergone caesarean section participated in the study. Baseline characteristics such as age, type of family, education, parity, type of LSCS, gender of the newborn, birthweight of the newborn, and timing of initiation of breastfeeding were homogeneously distributed in both experimental and control groups. Before intervention, the mean depression score of both the experimental group (8 ± 2.09) and the control group (8.50 ± 2.28), the mean anxiety score of the experimental group (11.67 ± 3.06) and the control group (11.50 ± 2.97), and the mean stress score of the experimental group (10.33 ± 3.17) and the control group (11.00 ± 2.63) were comparable. After intervention, there was a significant reduction in the maternal stress score in the experimental group (6 ± 2.83) compared to the control group (8.67 ± 2.31), which was statistically significant at p < 0.05. The anxiety score was also reduced after intervention in the experimental group (6.50 ± 3.53) compared to the control group (9.17 ± 1.99), which was nearly significant (p = 0.052). The mean depression score between the experimental group (6.50 ± 1.93) and the control group (7 ± 2.49) was not statistically significant (p > 0.05). Conclusion The study findings highlight the potential benefits of affirmation relaxation and back massage for improving the psychological well-being of postpartum women who have had caesarean sections. The advantages of this mother-friendly, cost-effective method should prompt hospitals and health centres to incorporate it into standard postpartum care. Nursing students should also be taught about it as part of their midwifery education.

Esketamine reduces the risk of postpartum depression in women undergoing cesarean section: A systematic review and meta-analysis

BACKGROUND

Postpartum depression (PPD) is a prevalent and debilitating disorder that occurs in 14% of women after giving birth.

OBJECTIVES

We aimed to assess the efficacy and safety of perioperative esketamine for preventing PPD in women undergoing cesarean section.

SEARCH STRATEGY

We performed a systematic literature search in five medical databases - MEDLINE, Cochrane Library, Embase, Scopus, and Web of Science on the 12th of January 2025.

SELECTION CRITERIA

We searched for trials on the efficacy and safety of esketamine for preventing PPD.

DATA COLLECTION AND ANALYSIS

We collected data on rates of PPD, Edinburgh Postnatal Depression Scale (EPDS) scores, and adverse effects. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model.

RESULTS

Our systematic search provided 2681 records; we screened 1336 duplicate-free records. A total of 17 eligible studies were identified after title, abstract, and full-text selection. Esketamine administration was associated with a lower rate of PPD at postpartum days 3-7 and 28-42 (OR = 0.43; 95% CI: 0.31-0.59 and OR = 0.59; 95% CI: 0.39-0.87, respectively). Esketamine administration was associated with significantly lower EPDS scores at postpartum days 3-7 (MD = -1.32; 95% CI: 1.84 to -0.80).

CONCLUSIONS

Our findings suggest that perioperative administration of esketamine was associated with lower PPD rates and lower scores on the EPDS questionnaire and was considered safe compared to placebo/standard care.

Genetic Variants in Oxytocinergic System Genes and Their Association with Postpartum Depression Susceptibility

One of the most frequent forms of maternal morbidity following childbirth is postpartum depression. Postpartum depression (PPD), a disabling condition as a major public health concern, has a significant negative impact on the child's emotional, mental as well as intellectual development if left undiagnosed and untreated, which can later have long-term complications. The oxytocin system is an excellent candidate gene system in the maternal context. Differences in vulnerability of mothers for the onset of postpartum psychiatric disorders could be influenced by individual differences in the genetic profile of each one. In this original research, we aimed to explore if there are any possible contributions of genetic variation on both the oxytocin receptor gene (OXTR) and the oxytocin gene (OXT) to the occurrence of postpartum depression, aiming to provide the latest evidence and determine which genetic polymorphisms significantly create a susceptibility for this condition. A total of 100 mothers were preliminarily genotyped before they completed the Edinburgh Postnatal Depression Scale Questionnaire (EPDS) at 6 weeks postpartum. DNA was extracted from peripheral blood samples of the participants (N = 100) and evaluated for the oxytocin gene (OXT_rs2740210; OXT_rs4813627) and oxytocin receptor gene (OXTR_ rs237885) single nucleotide polymorphisms. The results highlighted a significant interaction between the oxytocin OXT_rs2740210 genotype and maternal postpartum depression in mothers with the CC genotype but not in those with AA/AC genotypes. This reveals that an interaction of vulnerable genotypes (CC genotype of OXT_rs2740210, C allele in genotype of OXT_rs2740210, G allele in genotype of OXT_rs4813627) with an environmental burden or other risk factors would predispose the mothers to develop postpartum depression. We found no significant association between the interaction effect of the oxytocin receptor gene OXTR_rs237885 genotype depending on the occurrence of maternal postpartum depression. These findings prove the implication of the oxytocinergic system gene variants in vulnerability for postpartum depression and indicate the need for future studies adopting a multilevel approach in order to increase understanding.

Parents' Experiences With Couplet Care Following Caesarean Section in an Integrated Neonatal and Maternity Unit

BACKGROUND

Couplet Care, which allows mothers and newborns to receive treatment together, has gained prominence in neonatal and maternity care settings. This model supports early bonding, skin-to-skin contact, and breastfeeding, benefiting both preterm and sick newborns.

PURPOSE

The study aims to explore parents' experiences with Couplet Care after a caesarean section in an integrated neonatal and maternity unit, where both mother and newborn required treatment.

METHODS

A qualitative, semi-structured interview approach was employed. Eight mothers and 6 fathers participated, sharing their perspectives on Couplet Care through interviews conducted at a Danish hospital setting providing Couplet Care in 6 family rooms in a level II neonatal intensive care unit. Data were analyzed using content analysis inspired by Graneheim and Lundman.

RESULTS

Parents initially relied heavily on nurses, gradually gaining autonomy as their hospital stay progressed. Fathers played an essential role in caregiving, especially when mothers were immobile post-surgery. The study highlighted the importance of clear communication from nurses, which fostered parental confidence.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Couplet Care offers a supportive environment that promotes parental autonomy and emphasizes the critical role fathers play in caregiving. Future research should investigate the long-term effects on family dynamics and the mental health of both mothers and fathers following caesarean sections in similar settings.

Prevalence and correlates of postpartum PTSD following emergency cesarean sections: implications for perinatal mental health care: a systematic review and meta-analysis

BACKGROUND

The increasing awareness of the emotional consequences of emergency cesarean deliveries (C-sections) highlights their substantial role in fostering postpartum post-traumatic stress disorder (PTSD). This systematic review and meta-analysis aim to evaluate the prevalence and determinants of PTSD following emergency C-sections, as well as the implications of these events on maternal mental health and welfare.

METHODS

Undertaking extensive searches of Scopus, PubMed, PsycINFO, and Google Scholar, we have incorporated studies published from 2013 onwards that examined the occurrence of PTSD following emergency C-sections. Our primary focus was on the prevalence of PTSD at 6 weeks and up to 12 months postpartum. To evaluate the quality of these studies, we employed the Newcastle-Ottawa Scale (NOS) and the CEBM Critical Appraisal Tools.

FINDINGS

We included a total of 10 studies with 4,995 participants. The prevalence of PTSD following emergency C-sections ranged from 2.2 to 41.2%, compared to 0-20% in elective cesarean sections. A meta-analysis revealed a significant rise in the number of people with PTSD in the emergency C-section group compared to the elective C-section group six weeks after giving birth (OR = 2.74; 95% CI = 1.13 to 6.64; p = 0.03) and six weeks to 12 months later (OR = 3.68; 95% CI = 2.63 to 5.15; p < 0.00001). The emergency C-section group also had a higher PTSD prevalence compared to vaginal birth six weeks to 12 months after birth (OR 3.16; 95% CI 1.51 to 6.60; p = 0.02). Risk factors included poor social support, maternal and neonatal complications, and prior psychiatric history.

CONCLUSIONS

Emergency C-sections are significantly associated with an increased risk of postpartum PTSD, necessitating targeted psychological support and interventions. Future research should aim for standardized diagnostic criteria and explore the long-term psychological outcomes of emergency C-sections.

Merits and demerits of administering esketamine in preventing postpartum depression following cesarean section

Emergency cesarean section is associated with the development of postpartum depression. Esketamine has been demonstrated to have a rapid onset of antidepressant effects. Randomized controlled trials and meta-analyses have demonstrated the efficacy of esketamine in preventing postpartum depression after cessarean section. However, the data included in these analyses were derived from elective cesarean sections and differed in the dose and timing of esketamine administration. Esketamine is a dissociative anesthetic with a dose-dependent risk of inducing psychotic symptoms, including hallucinations. In the setting of cesarean section, esketamine should be administered with caution and only if the potential benefits outweigh the risks.

The risks of emergency C-section, infant health conditions and postpartum complications in Taiwanese primiparous women with gestational diabetes mellitus: A propensity matched cohort study

OBJECTIVE

Gestational diabetes mellitus (GDM) is a disorder that can occur during the second trimester of pregnancy. Our main objective was to perform a retrospective propensity-score matched analysis of a general population and to examine commonly occurring adverse maternal and infant outcomes in Taiwanese primiparous women with GDM.

MATERIALS AND METHODS

We conducted a nationwide population-based, retrospective propensity-score matched cohort study using the claims data from the Taiwan's National Health Insurance program between 2000 and 2015. A 1:4 propensity matched cohort of women who aged 18 years or older with GDM (n = 5981) were compared with women without GDM (n = 23,924). Propensity score was calculated based on women's age, residential urbanicity, delivery mode, antepartum comorbidity, and index year of delivery.

RESULTS

The GDM group had a significantly higher risk of overall emergency caesarean section, infant health conditions, and postpartum complications than the comparison group. Women in the GDM group were more likely to undergo emergency C-section for fetal distress, uterine atony, obstructed labor, delayed delivery, failed induction of labor, and umbilical cord prolapse. Infants of women with GDM were also more likely to encounter pregnancy complications of malpresentation, pre-maturity and post-maturity. Being the most common infant conditions, roughly one-third (36.41%) of all infant were affected by jaundice, particularly in women with GDM than those without GDM (45.96% vs 34.02%). There were also significant differences in perinatal period infection, congenital anomalies, transitory tachypnea, fetal distress and asphyxia, respiratory distress, and birth injury between the groups. Women with GDM were associated with increased risks of developing postpartum complications in perineum laceration, mastitis, postpartum hemorrhage, and subinvolution of uterus.

CONCLUSION

The present study suggests that GDM is associated with increased risks of adverse maternal and infant outcome in primiparous women without pre-existing mental diseases.

Identification of risk loci for postpartum depression in a genome-wide association study

AIM

Genome-wide association studies (GWAS) of postpartum depression (PPD) based on accumulated cohorts with multiple ethnic backgrounds have failed to identify significantly associated loci. Herein, we conducted a GWAS of Japanese perinatal women along with detailed confounding information to uncover PPD-associated loci.

METHODS

The first and second cohorts (n = 9260 and n = 8582 perinatal women enrolled in the Tohoku Medical Megabank Project) and the third cohort (n = 997), recruited at Nagoya University, underwent genotyping. Of them, 1421, 1264, and 225 were classified as PPD based on the Edinburgh Postnatal Depression Scale 1 month after delivery. The most influential confounding factors of genetic liability to PPD were selected, and logistic regression analyses were performed to evaluate genetic associations with PPD after adjusting for confounders.

RESULTS

A meta-analysis of GWAS results from the three cohorts identified significant associations between PPD and the following loci (P < 5 × 10-8) by integrating the number of deliveries and the number of family members living together as the most influential confounders: rs377546683 at DAB1, rs11940752 near UGT8, rs141172317, rs117928019, rs76631412, rs118131805 at DOCK2, rs188907279 near ZNF572, rs504378, rs690150, rs491868, rs689917, rs474978, rs690118, rs690253 near DIRAS2, rs1435984417 at ZNF618, rs57705782 near PTPRM, and rs185293917 near PDGFB. Pathway analyses indicated that SNPs suggestively associated with PPD were mostly over-represented in categories including long-term depression, GnRH signaling, glutamatergic synapse, oxytocin signaling, and Rap1 signaling.

CONCLUSION

The current GWAS study identified eight loci significantly associated with PPD, which may clarify the genetic structure underlying its pathogenesis.

Prevalence of postpartum post-traumatic stress disorder and associated factors among postnatal mothers in West Arsi zone, South West Ethiopia, 2024: a community-based cross-sectional study

Background

Up to one-third of women globally experience giving birth as traumatic, which can lead to postpartum post-traumatic stress disorder. Postpartum post-traumatic stress disorders have significant health consequences for the mother, child, and other family members. Although it has tragic health impacts, little is known about this problem in the study area.

Objectives

The study aimed to assess the prevalence of postpartum posttraumatic stress disorder and associated factors among postnatal mothers.

Methods

A community-based cross-sectional study was employed among 635 mothers in the first year after childbirth by using simple random sampling techniques from March 20 to April 20, 2024 in West Arsi zone, Ethiopia. Face-to-face interviewers administered structured questionnaires that were used to collect the data. The collected data were cleaned, coded, and entered into Epidata and exported to Statistical Package for Social Sciences for further analysis. Both bivariate and multivariable analyses were done by using binary logistic regression.

Result

Out of 635, 624 postnatal mothers participated in the study, for a response rate of 98.27%. The prevalence of postpartum post-traumatic stress disorder was 21.60% (95% CI: 18.40%, 24.87%). Primiparous mothers (AOR = 2.26, 95% CI: 1.38, 3.70), have no antenatal care follow-up (AOR = 2.48, 95% CI: 1.47, 4.20), cesarean section delivery (AOR = 2.86, 95% CI: 1.50, 5.61), instrumental delivery (AOR = 3.06, 95% CI: 1.75, 5.34), maternal morbidity (AOR = 2.94, 95% CI: 1.71, 5.05), and postpartum intimate partner violence (AOR = 7.43, 95% CI: 4.53, 12.20) were the identified factors.

Conclusion and recommendation

As identified, one out of five mothers had postpartum posttraumatic stress disorder. Thus, healthcare providers should focus on identified factors like cesarean section and instrumental deliveries while counseling, as this enhances the mothers' psychological readiness. In addition, the West Arsi Zonal Health Office should develop effective strategies to alleviate the problem by focusing on the identified factors.

Cesarean birth is associated with lower motor and language development scores during early childhood: a longitudinal analysis of two cohorts

With global C-section rates rising, understanding potential consequences is imperative. Previous studies suggested links between birth mode and psychological outcomes. This study evaluates the association of birth mode and neurodevelopment in young children across two prospective cohorts, using repeated psychometric assessments. Data from the ELEMENT (Early Life Exposures in Mexico to Environmental Toxicants) and PROGRESS (Programming Research in Obesity, Growth, and Environment and Social Stress) cohorts, comprising 7158 and 2202 observations of 1402 children aged 2 to 36 months, and 726 children aged 5 to 27 months, respectively, were analyzed. Exclusion criteria for the cohorts were maternal diseases such as preeclampsia, renal or heart disease, gestational diabetes, and epilepsy. Neurodevelopment was gauged via Bayley's Scales of Infant Development: 2nd edition for ELEMENT and 3rd edition for PROGRESS. Mixed-effects models longitudinally estimated associations between birth mode and neurodevelopment scores, adjusting for cofounders. In ELEMENT, psychomotor development composite scores were significantly affected by birth mode from ages 2 to 8 months; the largest estimate within this range was at 2 months (β =-1.93; 95% CI: [-3.64, -0.22], reference: vaginal delivery). For PROGRESS, a negative association was found with motor development composite scores over all the studied age range (β=-1.91; 95% CI: [-3.01, -0.81]). The association was stronger between ages 6 to 18 months, with the strongest estimate at 11 months (β=-2.58; 95% CI: [-4.37, -0.74]). A negative impact of C-section on language scores in girls was estimated for the PROGRESS cohort (β=-1.92; 95% CI: [-3.57, -0.27]), most marked in ages 22 to 25 months (largest β at 24.5 months=-3.04; 95% CI: [-5.79, -0.30]). Children born by C-section showed lower motor and language development scores during specific age windows in the first three years of life. Further research is necessary to understand the complexities and implications of these findings.

COVID-19 lockdowns affected birthing outcomes in a regional New South Wales Health District

INTRODUCTION

The 400 000 residents of the Illawarra Shoalhaven Local Health District (ISLHD) experienced two distinct lockdowns aimed at mitigating the transmission of severe acute respiratory syndrome coronavirus 2 infection. Analysing effects of these lockdowns on maternal and neonatal outcomes presents a valuable opportunity to assess the impact of pandemic-level restrictions on maternal and neonatal outcomes.

AIM

Evaluate the impacts of restrictions from two lockdown periods on maternal, birthing, and neonatal outcomes within a regional local health district.

MATERIALS AND METHODS

The study included 22 166 women who gave birth within ISLHD between 2017 and 2022. Groups included for analysis: Control Group - mothers pregnant before the pandemic (conception before 3 April 2019); Exposure Group 1 - mothers pregnant during the first lockdown (conception date 22 January 2020 to 5 May 2020); and Exposure Group 2 - mothers pregnant during the second lockdown (conception date 30 April 2021 to 13 Sep 2021).

RESULTS

Odds of adverse birthing outcomes including non-reassuring fetal status (odds ratio (OR) 1.34; 95% CI 1.14-1.56 and OR 1.20; 95% CI 1.03-1.40), and postpartum haemorrhage (OR 2.04; 95% CI 1.73-2.41 and OR 1.74; 95% CI 1.48-2.05) were substantially increased in Exposure Groups 1 and 2, respectively. Gestational diabetes, gestational hypertension, low birth weight and admission to neonatal intensive care rates improved.

CONCLUSIONS

Pregnant women exposed to pandemic restrictions within ISLHD had decreased odds of adverse antenatal and neonatal outcomes, but increased odds of poor peripartum outcomes.

Effectiveness of Psychological Counseling Intervention in High-Risk Pregnancies in Italy

BACKGROUND

The longitudinal study examines the effectiveness of a psychological support treatment for high-risk pregnancies using a between-groups design. It assesses the treatment's impact on depression and fear of COVID-19 at three time points, and on prenatal attachment between the 20th and 24th weeks of gestation (T0), postnatal attachment 15-20 days after birth (T1), and three months after birth (T2). Additionally, the study evaluates the treatment's effectiveness on PTSD related to childbirth and parental distress at T1 and T2.

METHODS

The study involved 117 parents experiencing high-risk pregnancies from a Sicilian hospital: 84 mothers (40 in the experimental group, 44 in the control group) and 33 fathers (19 in the experimental group, 14 in the control group).

RESULTS

ANOVA results showed that the psychological treatment was effective for maternal variables such as postnatal attachment and parental distress, and for paternal variables such as depression, prenatal attachment, PTSD symptoms, and parental distress (ANOVA, p < 0.05).

CONCLUSIONS

The study highlights the growing evidence for providing continuous psychological support to couples with high-risk pregnancies, emphasizing that this support should extend beyond childbirth to assist families through this transition.

Incidence of postpartum depression among women with postpartum haemorrhage in Kano, northern Nigeria

The burden of postpartum depression (PPD), an important but largely neglected cause of maternal morbidity, is often increased by the presence of common co-morbidities, such as postpartum haemorrhage (PPH). Additionally, stress and the absence of social support can amplify PPD risk. Understanding the relationship between these conditions will help identify at-risk women and allow prompt intervention. Using a prospective cohort design, we recruited 72 women who had experienced PPH and another 72 women who had not within 24 h of delivery to assess the risk of PPD among them. The cumulative incidence of PPD among all participants was 15.3% (19/124). There was insufficient evidence to suggest that women with PPH have a higher risk of PPH than women without PPH (OR: 1.32; 95% CI: 0.55-3.13). Poor social support and high perceived stress increased the risk of PPD. We recommend screening for PPD among women with high perceived stress and low social support.

Early detection of perinatal depression in couples: a single-center prospective study

OBJECTIVE

This prospective study aimed to assess couples' psychological status during the perinatal period to identify those at risk for postpartum depression.

METHODS

Conducted at Lyon University Hospital from March to July 2022, the study enrolled pregnant women without progressive psychiatric disorders or obstetric risk factors, and their partners. Participants completed the Edinburgh Postnatal Depression Scale (EPDS) at three points: during the 9th month of pregnancy, immediate postpartum, and 6-8 weeks after delivery. A score ≥10 on the EPDS indicated depression risk. A score ≥10 on the EPDS indicate depression risk. The primary endpoint was EPDS scores throughout the perinatal period.

RESULTS

Ninety-five couples participated; 96% of patients and 68% of partners completed pre-delivery questionnaires, 81% and 71% during maternity stay, and 64% and 46% postpartum, respectively. Overall, 15% of patients and 1% of partners had EPDS scores >10 in the postpartum period. Psychiatric history and emergency cesarean sections were associated with higher immediate postpartum EPDS scores in patients [Beta 3.7 points, 95% CI 0.91; 6.4 and Beta 5.2 points, 2.2; 8.1, respectively]. Episiotomy was associated with higher EPDS scores in partners. No significant association between the different factors studied and the EPDS score was found at 6-8 weeks postpartum in patients nor their partners.

CONCLUSIONS

While specific risk factors for persistent perinatal depression in couples were not identified, a notable proportion of patients exhibited high EPDS scores. Screening all couples during prepartum and postpartum periods is crucial, regardless of identified risk factors.

Systematic review and meta-analysis of postpartum depression and its associated factors among women before and after the COVID-19 pandemic in Uganda

OBJECTIVE

This meta-analysis aimed to estimate the national prevalence of postpartum depression (PPD) in Uganda and identify predictors in both pre-COVID-19 and post-COVID-19 eras.

DESIGN

Used a systematic review and meta-analysis methodology.

DATA SOURCES

Reviewed papers were sourced from Medline/PubMed, PsycINFO, CINAHL/EBSCOhost, Google Scholar, ScienceDirect and African Journals Online.

ELIGIBILITY CRITERIA FOR SELECTED STUDIES

The review encompassed observational studies published on PPD in Uganda from 1 January 2000 to 30 November 2023.

RESULTS

11 studies (involving 7564 participants) published from 1 January 2000 to 30 November 2023 were reviewed. The pooled prevalence of PPD in Uganda was 29% (95% CI 21% to 37%, I2=98.32%). Subgroup analysis indicated a similar prevalence before (29%, 95% CI 20% to 39%) and during (28%, 95% CI 22% to 32%) the COVID-19 period. Special groups exhibited a higher prevalence (32%, 95% CI 16% to 47%) than general postpartum women (28%, 95% CI 19% to 37%). Factors associated with PPD included poor social support (OR 1.19, 95% CI 1.17 to 1.22, I2=96.8%), maternal illness (OR 1.22, 95% CI 1.19 to 1.26, I2=96.9%), poor socioeconomic status (OR 1.43, 95% CI 1.40 to 1.46, I2=99.5%) and undergoing caesarean section (OR 1.15, 95% CI 1.12 to 1.17, I2=80.6%). Surprisingly, there was a marginal decrease in PPD during the COVID-19 period. Subgroup analysis highlighted a higher prevalence among mothers with HIV.

CONCLUSION

This study underscores the significant prevalence of PPD in Uganda, with sociodemographic factors increasing risk. Despite a slight decrease during the COVID-19 period, the importance of prioritising maternal mental health is emphasised, considering sociodemographic factors and pandemic challenges, to improve maternal and child health outcomes and overall well-being.

Efficacy and safety of peri-partum Esketamine for prevention of post-partum depression in women undergoing caesarian section: A meta-analysis and systematic review of randomized controlled trials

Postpartum depression (PPD) is a psychiatric condition affecting women post-childbirth. Medication combined with psychotherapy, is the current protocol for its treatment. A meta-analysis was conducted using RevMan 5.4 to explore the efficacy and safety of peri-partum administration of esketamine for preventing PPD. After searching several databases to retrieve the relevant RCTs, seven were included in this analysis, with dichotomous data presented as risk ratio and continuous data as mean difference. The study found a lower incidence of PPD in the esketamine group compared to the control group (RR= 0.37), with significant difference in EPDS scores between the two groups (MD= -1.23) in the first week postpartum. The esketamine group reported a lower prevalence of PPD 4-6 weeks postpartum (RR= 0.48), and no significant difference in EPDS scores after 4 weeks postpartum (MD = -0.10). The esketamine group had a significantly higher incidence of hallucination (RR= 13.85). Other adverse effects, such as dizziness (RR= 4.09), nausea (RR= 0.88), vomiting (RR=0.74), headache (RR=1.52), nightmares (RR=1.22), pruritus (RR=0.29), and drowsiness (RR=1.57) did not show significant differences between the two groups. The study found that esketamine, with manageable side effects, reduces the prevalence of post-partum depression (PPD) after one week as well as after four to six weeks. However, the findings are limited by the limited number of available RCTs, and future research should determine the ideal dosage, the most effective method of administration and the long-term safety profile of esketamine so that it may be considered as an adjunct therapy or a potential sole treatment option.

Problem-solving model guided by stimulus-organism-response theory: State of mind and coping styles of depressed mothers after cesarean delivery

BACKGROUND

The use of a problem-solving model guided by stimulus-organism-response (SOR) theory for women with postpartum depression after cesarean delivery may inform nursing interventions for women with postpartum depression.

AIM

To explore the state of mind and coping style of women with depression after cesarean delivery guided by SOR theory.

METHODS

Eighty postpartum depressed women with cesarean delivery admitted to the hospital between January 2022 and October 2023 were selected and divided into two groups of 40 cases each, according to the random number table method. In the control group, the observation group adopted the problem-solving nursing model under SOR theory. The two groups were consecutively intervened for 12 weeks, and the state of mind, coping styles, and degree of post-partum depression were analyzed at the end of the intervention.

RESULTS

The Edinburgh Postnatal Depression Scale and Hamilton Depression Scale-24-item scores of the observation group were lower than in the control group after care, and the level of improvement in the state of mind was higher than that of the control group (P < 0.05). The level of coping with illness in the observation group after care (26.48 ± 3.35) was higher than that in the control group (21.73 ± 3.20), and the level of avoidance (12.04 ± 2.68) and submission (8.14 ± 1.15) was lower than that in the control group (15.75 ± 2.69 and 9.95 ± 1.20), with significant differences (P < 0.05).

CONCLUSION

Adopting the problem-solving nursing model using SOR theory for postpartum depressed mothers after cesarean delivery reduced maternal depression, improved their state of mind, and coping level with illness.

Posttraumatic stress disorder prevalence and childbirth: update meta-analysis after the introduction of the DSM-5 and COVID-19 pandemic

PURPOSE

Meta-analyses were previously performed to estimate PTSD prevalence in the postpartum period. Significant events that could impact this outcome occurred in the last decade, such as the publication of the DSM-5 in 2013 and the COVID-19 pandemic in 2020. This systematic literature review with a meta-analysis addressed studies published after 2014 to estimate PTSD prevalence after childbirth.

METHOD

The methodological guidelines recommended by PRISMA were followed. The meta-analysis estimate was the proportion of PTSD cases. The restricted maximum likelihood (REML) was the method adopted for estimation in addition to multilevel random effect models. Subgroup analyses were performed to assess the impact of interest variables.

RESULTS

The estimated prevalence was 0.10 (95%CI: 0.8-0.13; I2 = 98.5%). No significant differences were found regarding the introduction of the DSM-5 (p = 0.73) or COVID-19 (p = 0.97), but instead, between low- and middle-income countries, e.g., the Middle East presents a higher prevalence (p < 0.01) than European countries.

CONCLUSIONS

There is a potential increase in PTSD prevalence rates after childbirth in the last decade not associated with the pandemic or the current diagnostic classification. Most studies showed a methodological fragility that must be overcome to understand this phenomenon better and support preventive actions and treatment for puerperal women.

The Role of Skin-to-Skin Contact and Breastfeeding in the First Hour Post Delivery in Reducing Excessive Weight Loss

BACKGROUND AND AIMS

An excessive weight loss (EWL) of >10% after birth is associated with serious health outcomes. The aim of this study was to determine factors that can reduce weight loss in full-term, exclusively breastfed infants after birth.

METHODS

This is a retrospective, observational, single-center study. We included 642 healthy, full-term, exclusively breastfed neonates born in 2019 in a baby-friendly hospital, and their healthy mothers. The exclusion criteria were as follows: supplementation with formula, multiple pregnancies, and neonates or mothers with health issues.

RESULTS

The mean percentage of neonatal weight loss after 24 h of life was 5.13%, and that after 48 h was 6.34%. Neonates delivered via a caesarean section lost more weight after 24 and 48 h of life than those delivered via vaginal delivery (p < 0.01). There is a noticeable pattern that neonates tend to lose more weight if they do not get skin-to-skin contact (SSC) and breastfeeding within the first hour after birth (p > 0.05).

CONCLUSIONS

Neonates born via a CS tend to lose more weight after 24 and 48 h of life. Immediate SSC and breastfeeding in the first hour after delivery may decrease the excessive weight loss.

"We hear and we fear" - Insights of 1203 Women on Personnel Conversations During Cesarean Delivery

OBJECTIVE

To assess the preferences of women undergoing cesarean delivery regarding intraoperative conversations among healthcare personnel.

METHODS

This cross-sectional study was conducted by distribution of an open anonymous questionnaire on social media platforms during March 2022, targeting respondents with a history of cesarean delivery. The primary outcome was patients' experience of "being disturbed by professional and casual conversations of the personnel", rated on a 1-5 Likert scale.

RESULTS

1203 participants completed the questionnaire, with 97.6% reporting intraoperative conversations among personnel. Casual conversations were perceived as "disturbing" by more respondents vs. professional talk (33.4% vs. 27.6%, respectively, p = 0.0077). Logistic regression analysis revealed associations between feeling disturbed and higher intraoperative stress and pain - adjusted Odds Ratio (OR) 3.1, 95% confidence interval (CI) 2.1-4.5, and OR 2.7, 95%CI 1.8-4.0, respectively, for professional conversations; OR 3.0, 95%CI 2.0-4.4, and OR 1.7, 95%CI 1.1-2.7, respectively, for casual conversations. Feeling disturbed by professional conversations was also associated with urgent vs. elective operations (OR 2.0, 95%CI 1.4-3.0). Direct personnel-patient communication was associated with significantly lower stress levels (60.8% vs. 72.5% in the remaining cohort, p < 0.001).

DISCUSSION

Intraoperative conversations of the personnel occur during vast majority of cesarean deliveries. Given that a substantial proportion of patients find these conversations disturbing, it is advisable to conduct a preliminary assessment of maternal preferences. This proactive step can help tailor communication strategies to individual patient comfort and preferences, ultimately enhancing the birthing experience and maternal well-being.

The Association between Cesarean Section Delivery and Child Behavior: Is It Mediated by Maternal Post-Traumatic Stress Disorder and Maternal Postpartum Depression?

Cesarean sections (C-sections) account for up to 21% of births worldwide. Studies have linked delivery via C-section with an increased risk of child behavior problems, such as internalizing and externalizing behaviors. Maternal postpartum depression (PPD) is also linked to child behavioral problems and may play a mediating role in the association between the mode of delivery and child behavior. Mixed findings between mode of delivery and PPD may be due to a failure to distinguish between C-section types, as unplanned/emergency C-sections are linked to post-traumatic stress disorder (PTSD), which has been linked to PPD. The objectives of this study were to determine whether, (1) compared with spontaneous vaginal delivery (SVD) and planned C-section, unplanned/emergency C-sections are associated with increased child behavior problems at two to three years of age and (2) maternal PTSD and PPD mediate the association between delivery type and child behavior problems. A secondary data analysis was conducted on 938 mother-child dyads enrolled in the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Conditional process modeling was employed. Child behavior was assessed using the Child Behavior Checklist (CBCL) 1.5-5 years, and maternal PPD and PTSD were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Psychiatric Diagnostic Screening Questionnaire (PDSQ), respectively. No associations were found between delivery type and child behaviors; however, the indirect effect of emergency C-section on child behaviors was significant via the mediating pathway of maternal PTSD on PPD symptoms.

Home Birth in the United States: An Evidence-Based Ethical Analysis

AbstractThe assumption in current U.S. mainstream medicine is that birthing requires hospitalization. In fact, while the American College of Obstetricians and Gynecologists supports the right of every birthing person to make a medically informed decision about their delivery, they do not recommend home birth owing to data indicating greater neonatal morbidity and mortality. In this article, we examine the evidence surrounding home birth in the United States and its current limitations, as well as the ethical considerations around birth setting.

The Relation between Birth with Cesarean Section and Posttraumatic Stress in Postpartum Women

Objective: The aim of this study was to investigate the relation between cesarean section and postpartum posttraumatic stress disorder as well as the factors that contribute to the development of posttraumatic symptoms in mothers. Materials and methods: A sample of 538 women who gave birth with emergency and elective cesarean section in a University Hospital of Thessaly, Greece, have consented to participate in a two-phase prospective study. A socio-demographic questionnaire, the stressor Criterion A, the Life Events Checklist and the Posttraumatic Checklist of the fifth edition of the Diagnostic and Statistical Manual (DSM-5) were used to diagnose posttraumatic symptoms in Greek postpartum mothers. Results:Out of 538 mothers, 37.2% had an emergency cesarean section and the remaining 62.8% an elective one. Posttraumatic stress was seen in 26 (26%) of women with emergency surgery and three (3%) of those with elective surgery. The present study also found that the inclusion of a neonate to the NICU, complications during pregnancy and delivery, lack of breastfeeding and lack of support from the partner were strongly associated with the development of posttraumatic symptoms. Conclusions:The results of the current study indicate the need to take measures to reduce cesarean section rates and promote vaginal delivery. The high posttraumatic stress rates make it imperative to take additional measures for the mental health of women after cesarean section, especially in those with a traumatic birth experience.

Psychometric analysis of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) and determinants of psychopathology in two outpatient clinics in Navarre (Spain)

BACKGROUND

The self-report Psychiatric Diagnostic Screening Questionnaire PDSQ is designed to screen Axis I psychiatric disorders. We aim to determine its psychometric properties in Spanish outpatients and assess its relationship with two interviews (for psychopathology and for personality disorders) and clinical/demographic variables.

METHODOLOGY

We administered the study questionnaire, the Mini International Neuropsychiatric Interview Plus (MINI-Plus), the Standardised Assessment of Personality Abbreviated Scale (SAPAS), and the List of Threatening Experiences Questionnaire (LTE-Q) to 375 patients at two public outpatient centres. Reliability of the study questionnaire was evaluated (Cronbach's alpha, ?) and known-group validity measured by comparing groups based on demographic and clinical variables (binary logistic regression analysis) and MINI-Plus diagnoses (Mann-Whitney U). The diagnostic accuracy of the study questionnaire score was analysed taking the MINI-Plus diagnoses as the gold standard (ROC analysis).

RESULTS

Internal consistency was adequate across all PDSQ scales (? >0.7; mean ?=0.85). Known-group comparisons were satisfactory. Female and male patients showed higher prevalence of internalizing and externalizing diagnoses, respectively. Younger age, more life events and limitations, higher SAPAS scores, and lower economic levels were linked to a greater number of PDSQ diagnoses. Inter-group differences were found for all PDSQ scales based on the corresponding MINI-Plus diagnoses. Mean values of sensitivity, AUC, and negative predictive value were 88.7, 0.82, and 96.7, respectively.

CONCLUSIONS

When applied to a sample of Spanish outpatients, the PDSQ exhibits satisfactory psychometric properties and adequate relationships with the psychopathology and personality interviews, and clinical and demographic variables. The study questionnaire is suitable for assessing comorbidity and psychopathology dimensions.

The Relation between Neonatal Intensive Care Units and Postpartum Post-Traumatic Stress Disorder after Cesarean Section

BACKGROUND

The experience of a neonate hospitalized in the NICU is an understandably traumatic experience for parents, especially for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalization can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 version). The aim of this study is to investigate the impact of the admission of a neonate to the NICU (forany reason) on the development of postpartum PTSD in a sample of women after cesarean section.

METHODS

A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study out of the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire and the post-traumatic stress checklist (PCL-5) from the Diagnostic and Statistical Manual of Mental Disorders DCM-5 version.

RESULTS

In total,11.7% of the sample experienced postpartum PTSD. There is a strong relationship between the inclusion of a neonate to the NICU due to perinatal stress, breathing difficulties, infections, and IUGR with postpartum PTSD (37.7%) in relation to the perinatal stress Criterion A (fear for the life of the neonate), the first criterion of postpartum PTSD.

CONCLUSIONS

Additional measures must be taken for mothers of children who have been admitted to the neonatal intensive care unit with psychological support interventions and a reassessment of their mental state.

The Involvement of Neonatal Intensive Care Unit and Other Perinatal Factors in Postpartum PTSD After Cesarean Section

BACKGROUND

The experience of a neonate hospitalised in the Neonatal Intensive Care Unit (NICU) is an understandably traumatic experience for the parents, especially, for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalisation can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual-5 version. The aim of this study is to investigate the impact of the admission of a neonate to the NICU (from any reason) on the development of postpartum post-traumatic stress disorder (PTSD) in a sample of women after cesarean sections.

MATERIAL AND METHODS

A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study, from the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire, the past traumatic Life Events Checklist, the perinatal stressor Criterion A, and the Post-Traumatic Stress Checklist from the Diagnostic and Statistical Manual-5 version.

RESULTS

A percentage of 46.64% of sample experienced postpartum PTSD. Factors associated with PTSD were placenta previa type4, abruption, bleeding (β = .07, p = .049), premature contractions (β = .08, p = .039), heavy medical history or previous gynecological history and preeclampsia (β = .08, p = .034), abnormal heart rate, premature rupture of membrane, premature contractions, infections (β = .14, p = .004), life of child in danger (β = .12, p = .025), complications involving child (β = .15, p = .002), complications involving both (child and mother) (β = .12, p = .011), traumatic cesarean section (β = .041, p < .001) and prematurity (β = .12, p = .022).

CONCLUSIONS

Additional measures must be taken for mothers of children who have been admitted to the NICU with psychological support interventions and reassessment of their mental state.

Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic

Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.

Timing of Breastfeeding Initiation Mediates the Association between Delivery Mode, Source of Breastfeeding Education, and Postpartum Depression Symptoms

Background: Emergency cesarean section (EMCS) and breastfeeding difficulties increase the risk of postpartum depressive (PPD) symptoms. Early initiation of breastfeeding (EIBF) may not only alleviate PPD symptoms but also facilitate subsequent breastfeeding success. EMCS is a risk factor for not practicing EIBF. Therefore, it is important to understand the relationship between EMCS, EIBF, and PPD symptoms. Methods: We conducted a prospective cohort study in three areas of China. At baseline, a total of 965 mothers completed electronic questionnaires within 72 h postpartum. Women were screened for PPD symptoms using the Edinburgh Postpartum Depression Scale (EPDS). Multivariate logistic regression was used to identify the determinants of PPD symptoms. Mediation analysis was used to determine if EIBF mediated the relationship between delivery mode or breastfeeding education source and PPD symptoms. Results: The prevalence of EIBF was 40.6%; 14% of 965 mothers experienced EMCS, and 20.4% had PPD symptoms. The risk factors for developing PPD symptoms were excessive gestational weight gain (adjusted odds ratio [aOR] = 1.55, confidence interval [95% CI]: 1.03−2.33, p = 0.037) and EMCS (aOR = 2.05, 95% CI: 1.30−3.25, p = 0.002). The protective factors for developing PPD symptoms were monthly household income over CNY 10000 (aOR = 0.68, 95% CI: 0.47−0.97, p = 0.034), EIBF (aOR = 0.49, 95% CI: 0.34−0.72, p < 0.001), and prenatal breastfeeding education from nurses (aOR = 0.46, 95% CI: 0.29−0.73, p = 0.001). EIBF indirectly affected PPD symptoms in patients who had undergone EMCS (percentage mediated [PM] = 16.69, 95% CI: 7.85−25.25, p < 0.001). The source of breastfeeding education through EIBF also affected PPD symptoms (PM = 17.29, 95% CI: 3.80−30.78, p = 0.012). Conclusion: The association between EMCS on PPD symptoms was mediated by EIBF. By providing breastfeeding education, nurses could also help alleviate PPD symptoms.