The end of gestation or pregnancy phase is marked by the birth of the baby, either through vagina or through a Cesarean section. Childbirth is also known as delivery or labor. The most common type of childbirth is the vaginal birth, a natural mode of childbirth. Cesarean Birth, commonly known as C-section is a surgical method of childbirth in which incisions are made on the abdomen and uterus of the mother. C-sections are performed usually when complications arise during vaginal birth or when either the mother or the baby, or both have a risk. Although the feeling of childbirth is euphoric; a complete rush and sense of accomplishment, it is a very painful experience irrespective of the mode of childbirth. The long term effects of trauma on millions of women are still ignored to a great extent. Many women experience feelings of unhappiness, worry, and fatigue after having a baby, which are generally called as “Baby Blue”. As babies require a lot of care, it’s normal for mothers to be worried about, or tired from, providing that care. Up to 80 percent of mothers experience baby blues’ feelings that are somewhat mild, last a week or two, and go away on their own.
However, some women experience extreme feelings of anxiety, sadness, changes in eating and sleeping patterns, and irritability that interfere with their abilities to take care of themselves, the baby and of the family. This condition is termed as Postpartum Depression. This condition effects nearly 15 - 20% of mothers; beginning shortly before or anytime after childbirth. The symptoms commonly begin to appear within the firth month of childbirth.
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What really causes postpartum depression is still unknown. Studies show that there can be a combination of various factors that can contribute to Postpartum Depression. These factors include hormonal, physical and emotional changes in women. Women who are at a higher risk of developing Postpartum Depression are:
- The ones who have had unwanted or unplanned pregnancy and childbirth.
- The ones who consume alcohol, illegal drugs or smoke.
- The ones who have experienced pregnancy loss or any complications during the process of childbirth
- The ones who have experienced a stressful or a traumatic event like loss of a loved one, divorce, loss of job, etc, soon after childbirth.
- The ones who have had a history of depression, anxiety, bipolar disorder.
- The ones who have relationship conflicts with their partners, financial difficulties, etc
- The ones who lack moral and social support from family and friends.
With the high prevalence of Postpartum Depression and the associated serious and multidimensional risks it poses towards the mother and the child, the causal factors need to be focused on. Since there are a limited number of studies explaining how the mode childbirth effects postpartum depression, this study hopes to add up to the existing literature.
Review of Literature
Kaya and Cigdem (2019) conducted a study to investigate the impact of the mode of delivery on the occurrence of PD in primiparous mothers. The study was performed on 244 primiparous women (aged 15-49 years) in 17 primary health-care centers. The Edinburgh Postnatal Depression Scale (EPDS) was used to gather data from women during the 1st and 3rd months after delivery. The relationship between the obstetric features and EPDS scores were evaluated thereby revealing that the desired and performed modes of delivery, induction, episiotomy, and spinal anesthesia were not linked with EPDS scores. The study concluded that Effective measures must be established for early recognition of factors affecting the occurrence of PD. The study concluded that efforts must be made by health planners and policymakers to promote the knowledge and attitudes of mothers during pregnancy.
Eckerdal P et.al (2018) conducted a study to explore the association between mode of delivery and postpartum depression, considering the potentially mediating or confounding role of several covariates. A longitudinal-cohort study in Uppsala, Sweden, on 3888 unique pregnancies followed up postpartum, the effect of mode of delivery (spontaneous vaginal delivery, vacuum extraction, elective cesarean section, and emergency cesarean section) on self-reported postpartum depressive symptoms at 6 weeks after childbirth was investigated through logistic regression models and path analysis. In comparison to vaginal birth, women who delivered by emergency cesarean section were at higher risk for postpartum depression 6 weeks after delivery in crude (odds ratio 1.45, 95% confidence interval 1.04 - 2.01) but not in adjusted analysis. However, the path analysis revealed that emergency cesarean section and vacuum extraction were indirectly associated with increased risk of postpartum depression, by leading to postpartum complications, self-reported physical symptoms postpartum, and therefore a negative delivery experience. On the contrary, the odds of postpartum depression increased with a history of depression and fear of delivery, which furthermore led to elective cesarean section; however, it was associated with a positive delivery experience. The study concluded that the mode of delivery has no direct impact on risk of postpartum depression; nevertheless, several modifiable or non-modifiable mediators are present in this association. Women delivering in an emergency setting by emergency cesarean section or vacuum extraction, and reporting negatively experienced delivery, constitute a high-risk group for postpartum depression.
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