Linköping University Medical Dissertations
No. 576

Psychological Aspects of Emergency Cesarean Section

Elsa Lena Ryding

Akademisk avhandling

som för avläggande av medicine doktorsexamen kommer att offentligt försvaras i Berzeliussalen, Hälsouniversitetet, Linköping, lördagen den 5 december 1998, kl. 13.00.

Fakultetsopponent: Professor Berit Schei, Instituttet for Samfundsmedicin, Universitetet, Trondheim

Abstract

According to earlier research, emergency cesarean section (EmCS) can have a deleterious effect on maternal psychological well-being. Whether the women thus delivered already had more psychological problems during pregnancy than other women, is not known.

At about 32 weeks! gestation, 1,981 Swedish-speaking women completed questionnaires concerning fear of childbirth, general anxiety, and coping with stress. Those 97 women who were subsequently delivered by EmCS were compared with 194 controls, matched for age and parity.

All told, 124 women, who underwent EmCS, participated in the study postpartum. Fiftythree of these were randomized for early postpartum counselling, which began with an interview about the delivery experience. Ale remainder (n=71) participated in comparisons with women who underwent other types of delivery. Those delivered by elective cesarean section (n=70) or who had an instrumental vaginal delivery (n=89) participated, as did 96 of those who had a completely normal vaginal delivery. Questionnaires inquiring into the birth experience, post-traumatic stress reactions, and general mental distress were filled in a few days and again at one month postpartum. The EmCS groups also completed questionnaires 6 months postpartum. Altogether 79 women who underwent EmCS completed questionnaires, both during pregnancy and up to one month postpartum.

Healthy pregnant women with a serious fear of childbirth appeared to be at greater risk of subsequent EmCS. The degree of fear of childbirth during pregnancy was the best predictor of the degree of maternal well-being after an EmCS. Many of the women had experienced during the delivery an intense fear for their own life and health and/or for that of their baby. Thus, the trauma of EmCS may well meet the stressor criterion of the Diagnostic and Statistical Manual of Mental Disorders. Appraisal of the delivery was more negative after an EmCS than after other modes of deliveries. The women reported more post-traumatic stress reactions following EmCS as well as after instrumental vaginal delivery, than after elective cesarean section or normal vaginal birth. Generally speaking, early postpartum counselling had a beneficial effect on maternal well-being and especially on appraisal of delivery. The women with most frequent symptoms of post-traumatic stress reactions and mental distress did not get adequate help.

In conclusion, an emergency cesarean section is often a traumatic experience. Antenatal fear of childbirth may increase the risk of an EmCS. More intense fear of childbirth late during pregnancy is associated with a more negative appraisal of an experienced EmCS, and also with more frequent symptoms of post-traumatic stress reactions and general mental distress following a surgical delivery. The psychological well-being of mothers is generally not so favourable after emergency cesarean section and instrumental vaginal delivery, than after elective cesarean section and normal vaginal birth.

The Division of Obstetrics and Gynaecology, Department of Health and Environment,
Faculty of Health Sciences, Linköpings universitet, 581 85 Linköping

ISBN 91-7219-318-2 ISSN 0342-0082