C-sections and PPD

Many mothers look back on their birth experiences and instead of having the incredulous feelings of coming home with a new baby, they can only remember the trauma around giving birth. If these negative feelings continue for more than a few weeks, and result in stronger feelings of detachment/disgust towards the baby, or thoughts of self-harm (or many other symptoms that are listed here), it may be the case that the mother is experiencing postpartum depression.

 

The risk of postpartum depression (PPD) and other postpartum disorders is seen in about 1 of every 7 women of live births but also seems to be greater in the case of mothers who have undergone Cesarean sections 4, or who have had some sort of vaginal instrumental intervention.2 It is speculated that this is the case because during intense medical intervention-related births, the mother often is not attended to with the same level of gentleness or not able to see and hold her baby after the process. She may also feel more disconnected from her body post-birth due to the medications used or may generally feel as though her body has been violated. A lot of moms also harbor guilt that they were not able to give birth “naturally”, and feel as though their bodies, and therefore they, have somehow failed their baby.

 

When a group of over 24,000 women was studied (half who had had C-sections and half who had had vaginal births), the women who had C-sections had higher risk of stress symptoms, anxiety, and depression than the vaginal birth group.3 This was after the groups were matched for age, comorbidities, and socioeconomic status. Because of these findings, it was advised that unnecessary C-sections be avoided, and that women who did need them be given the attention and interventions they needed to help their mental health post-surgery.

 

Some interventions proposed include better assistance with breastfeeding, as there have been correlations with moms who had C-sections also having more difficulty with breastfeeding. C-sections often require varying amounts of anesthesia, which can make skin-to-skin contact difficult for the mom after the birth and is one of the proposed reasons for why mothers may have more difficulty breastfeeding.6 On top of that, the hormones from birth and the potential stress, especially if the C-section was unplanned, may cause the mother to feel inadequate for not being able to do something that our society calls “natural” and therefore believes should be easy (breastfeeding). Many hospitals and birth clinics have adopted the recommendations to facilitate increased skin-to-skin contact of the mom and her baby after C-sections, as well as improved the awareness about how surgery can impact breastfeeding.

 

Note: While some studies showed that breastfeeding moms who had vaginal births had lower occurrences of PPD than moms who had C-sections and didn’t breastfeed, there doesn’t seem to be a lot of studies looking just the population of mothers who had C-sections, and then comparing within that group, those who did or didn’t breastfeed. This is one area that needs to be studied more thoroughly to better understand the relationship of C-sections, PPD, and breastfeeding.1

 

Some other suggestions for decreasing the risk of PPD include giving mothers training on birth preparation as well as making regulations to enforce creating positive birth experiences in the delivery room.5 More sensitivity trainings have been recommended to help the providers be more attentive to the mothers, so that the stress around having a major surgery is not compounded by more fear due to being and feeling neglected.

 

Also it is important to note that it is okay to want to discuss what happened to you during your birth, and that they are trained professionals, as well as support groups specifically designed to be there for moms.

 

 

References

  1. Nam JY, Choi Y, Kim J, Cho KH, Park EC. The synergistic effect of breastfeeding discontinuation and cesarean section delivery on postpartum depression: A nationwide population-based cohort study in Korea. K Affect Disord. 2017 Aug 15; 218: 53-58.
  2. Dekel S, Ein-Dor T, Berman Z, Barsoumian IS, Agarwal S, Pitman RK. Delivery mode is associated with maternal mental health following childbirth. Arch Womens Ment Health. 2019 Apr 30.
  3. Chen HH, Lai JC, Hwang SJ, Huang N, Chou YJ, Chien LY. Understanding the relationship between cesarean birth and stress, anxiety, and depression after childbirth: A nationwide cohort study. Birth. 2017 Dec; 44(4): 369-376.
  4. Xu H, Ding Y, Ma Y, Xin X, Zhang D. Cesarean section and risk of postpartum depression: A meta-analysis. J Psychosom Res. 2017 Jun; 97: 118-126.
  5. Unsal Atan S, Ozturk R, Gulec Satir D, Ildan Calim S, Karaoz Weller B, Amanak K, Saruhan A, Sirin A, Akercan F. Relation between mothers’ types of labor, birth interventions, birth experiences and postpartum depression: A multicenter follow-up study. Sex Reprod Healthc. 2018 Dec; 18: 13-18.
  6. Chaplin J, Kelly J, Kildea S. Maternal perceptions of breastfeeding difficulty after caesarean section with regional anaesthesia: A qualitative study. Women Birth. 2016 Apr; 29(2): 144-152.

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