Mode of delivery and postpartum emotional distress: a cohort study of 55 814 women

OBJECTIVE: To assess the association between mode of delivery and maternal postpartum emotional distress. DESIGN: A prospective study of women from 30 weeks of gestation to 6 months postpartum. SETTING: Pregnant women in Norway during the period 1998-2008. POPULATION: A total of 55,814 women from the Norwegian Mother and Child Cohort Study. METHODS: Emotional distress was reported in a short form of the Hopkins Symptom Checklist-25 (SCL-8) at 30 weeks of gestation and at 6 months postpartum. Information on mode of delivery was obtained from the Medical Birth Registry of Norway. MAIN OUTCOME MEASURES: Changes in SCL-8 score from 30 weeks of gestation to 6 months postpartum and presence of emotional distress at 6 months postpartum. RESULTS: Women with instrumental vaginal, emergency caesarean or elective caesarean deliveries had similar changes in SCL-8 score between 30 weeks of gestation and 6 months postpartum, as compared with women with unassisted vaginal delivery (adjusted regression coefficient, 0.00, 95% CI -0.01 to 0.01; 0.01, 95% CI 0.00-0.02; and -0.01, 95% CI -0.02 to 0.00, respectively). The corresponding odds ratios (ORs) associated with the presence of emotional distress at 6 months postpartum (SCL-8 ≥ 2.0) were: OR 1.01, 95% CI 0.86-1.18; OR 1.13, 95% CI 0.97-1.32; and OR 0.96, 95% CI 0.79-1.16, respectively. These estimates were adjusted for emotional distress during pregnancy and other potential confounding factors. Emotional distress during pregnancy showed the strongest association with the presence of emotional distress at 6 months postpartum (adjusted OR 14.09, 95% CI 12.77-15.55). CONCLUSIONS: Mode of delivery was not associated with a change in SCL-8 score from 30 weeks of gestation to 6 months postpartum or with the presence of emotional distress postpartum.