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Mode of delivery doesn't affect later maternal stress

By Andrew M. Seaman

NEW YORK (Reuters Health) - Whether a woman gives birth by elective C-section or vaginal delivery may not affect her anxiety or stress levels afterward, suggests a new study that questions the idea of using C-sections just for the sake of a mother's mental well-being.

Looking at more than 55,000 women in Norway who gave birth between 1998 and 2008, researchers found the strongest determinant of a woman's postpartum emotional distress was her state of mind during pregnancy. Mode of delivery made no difference in the women's stress levels six months later.

"Often in the delivery ward the remark might be that this was a tough delivery...that in itself doesn't affect the mental health afterwards," said the study's lead author Dr. Samantha Adams, of the Akershus University Hospital Health Services Research Centre in Norway.

According to Adams and her colleagues, it's becoming more common for women to choose a C-section over traditional vaginal delivery as a means of improving their psychological well-being, even if there appears to be no medical benefit.

Their study assessed the mental health of participants in the Norwegian Mother and Child Cohort Study, using a self-administered test that each woman took 30 weeks into her pregnancy and six months after her child was born.

In both tests, each mother ranked her feelings on a scale between one and four, in response to questions such as whether she was feeling fearful, nervous or scared.

In the study group, 78 percent of women had a normal vaginal delivery, nine percent had vaginal birth with the help of instruments, eight percent had an emergency C-section and five percent elected to have a C-section. Just over 44 percent were first-time mothers.

As a group, women who chose to have a C-section had a slightly higher - that is, more distressed -- median score on their mental well-being tests before and after delivery than other women.

However, after adjusting the findings for emotional distress levels during pregnancy and other possible confounding factors like a mother's age and any illnesses during pregnancy, the researchers found little connection between the type of delivery a woman had and her stress or anxiety level at six months postpartum.

That finding included women who needed an emergency C-section or traditional vaginal birth with the help of instruments, both situations that suggest stressful conditions during delivery itself.

In contrast, emotional distress during pregnancy was strongly linked to distress after birth. Women with the highest pregnancy distress levels were 14 times more likely than women with the lowest levels to be distressed at six months postpartum.

Previous research has already shown that maternal distress during pregnancy is a risk factor for distress afterwards, the researchers note in BJOG: An International Journal of Obstetrics and Gynecology.

They conclude, "Concern for maternal mental health after delivery should not influence clinical decision regarding mode of delivery."

SOURCE: http://bit.ly/sa0RJD BJOG, online November 15, 2011.

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