Background: Postpartum depression (PPD) has a complex and multifactorial etiology and it affects a mother, her child, and her family. Although rates of depression in the postpartum period are not significantly different than for the rest of the population, the risk of compromised parental bonding, child abuse, neglect and infanticide are cause for increased concern over PPD. The childbirth experience has been proposed to have a strong effect on the health of the mother and child. For years, researchers have been searching for a correlation between obstetric method of delivery and incidence of PPD. How does the incidence of PPD vary after cesarean section versus normal delivery?
Methods: An exhaustive search of medical literature was conducted using Medline-OVID, Web of Science, CINAHL, Evidence-based Medicine Review Multifile, and PsycINFO with keywords: postpartum depression, cesarean section, obstetric delivery, and birth. Articles were screened for relevance and assessed for quality using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) scale.
Results: Five studies were included in this systematic review after being screened for relevance and inclusion criteria. A case control study of 10 535 women showed that the risk of PPD increases after cesarean section. A case control study with 335 subjects showed no significant increase in PPD in those who had cesarean sections. A prospective cohort study with 2560 participants found that method of delivery did not impact PPD rates. A prospective study of 55 814 women showed that method of delivery does not affect likelihood of depression. A longitudinal prospective study of 753 women showed that method of delivery had no impact on PPD.
Conclusion: Results of this systematic review vary, with 4 studies showing no significant correlation between method of delivery and incidence of PPD. One study demonstrates an increase in PPD rates in those who delivered by cesarean when compared to normal delivery. Method of delivery should be chosen based off of many important factors discussed by the woman and her clinician. A concern over PPD may prompt them to more strongly consider normal delivery, especially if the woman has a history of mental illness.
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