Vaginal delivery or caesarean section - Severity of early symptoms of postpartum depression and assessment of pain in Polish women in the early puerperium

Abstract

Objectives: The primary objective of this study is to examine the differences between women following vaginal delivery and caesarean section (elective or emergency) in terms of early symptoms of postpartum depression, and to evaluate pain during labour and in the early puerperium. An additional goal was to determine if pain evaluation is associated with depressive symptoms.

Materials and methods: A cross-sectional study was conducted among 224 women in the early puerperium recruited from a public hospital in Poland, who were divided into three groups by method of delivery: caesarean section - elective and emergency, and a vaginal delivery. The measurement tools used in the research were the Edinburgh Postnatal Depression Scale (EPDS) and a Numerical Rating Scale (NRS). A Pearson correlation analysis, a Student's t-test, a Mann-Whitney U test for independent groups and nonparametric multivariate analyses of variance (Kruskal-Wallis test) were carried out.

Results: The number of early symptoms of postpartum depression and the level of pain experienced vary depending on type of delivery. Following a caesarean section, women have more early symptoms of depression (M_CS = 7.40; SD_CS= 5.18 vs M_VD= 5.98; SD_VD = 4.19; p = 0.03) (especially an emergency CS: Mean rank_Em-CS=141.41 vs Mean rank_El-CS = 100.94 vs Mean rank_VD = 100.93; p < 0.01) and more pain on discharge (Mean rank_CC=126.51 vs Mean rank_VD = 84.11; p < 0.01) (especially after Em-CS: Mean rank_Em-CS =130.38 vs Mean rank_El-CS=123.62 vs Mean rank_VD = 84.11; p < 0.01), compared to women following a vaginal delivery. Pain in a time of discharge from hospital was found to be associated with increased frequency of EPSD but only in El-CS group (r = 0.24; p = 0.02).

Conclusions: Caesarean section (especially emergency CS) is a risk factor for postpartum depression, and the level of pain experienced is a marker of its potential severity. Evaluation of factors associated with postpartum pain and depressive symptoms can help midwives to counsel women better about their delivery alternatives and can promote improved management of women undergoing both types of delivery experiences.

Keywords: Caesarean section; Elective; Emergency; Pain evaluation; Postpartum depression; Vaginal delivery.