Cesarean effects on adolescents' birth experiences: counterfactual analysis.

John P Connolly,Cheryl Anderson

doi:10.1590/2237-6089-2019-0102

John P Connolly, Cheryl Anderson

Open Access

https://doi.org/10.1590/2237-6089-2019-0102

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Abstract

IntroductionThe birth experience of adolescents is understudied even though they are a particularly vulnerable population to experience a negative birth event, given that they exhibit many known risk factors.ObjectiveTo ascertain whether a cesarean birth mediates the impact of infant complications on the birth experience of adolescent mothers.MethodsUsing a secondary analysis of data collected from 303 postpartum adolescents previously evaluated for depression and post-traumatic stress, we employed counterfactual causal analysis to determine if delivery type mediated the birth experience at different levels of depression. Noted limitations pertain to methodological assumptions and computational feasibility as well as potential sample bias.ResultsWe found that the mediating effect of delivery mode depended on the adolescent’s depression level as well as on the specific operationalization of the birth experience. At low levels of depression, the odds of a negative birth appraisal were reduced by around 30% when operationalized as a single item subjective rating. In contrast, at high levels of depression, the odds of a negative birth experience increased by 80% when operationalized as an Impact of Event Scale (IES) subconstruct.ConclusionDepression level plays a pivotal role in moderating how delivery mode mediates the birth experience. The direction of impact also depends on how the birth experience is operationalized.

Highlights

The birth experience of adolescents is understudied even though they are a vulnerable population to experience a negative birth event, given that they exhibit many known risk factors
Given that our main interest was in true causal effects that may further vary over a range of moderator values, we emphasize that the two tables do not convey this key information and that our inferences are instead to be drawn from the reported total natural indirect effect (TNIE) effects
Infant complications were predictive of a negative birth appraisal (Table 3), and were more likely to lead to a cesarean birth (CB)

Summary

Introduction

The birth experience of adolescents is understudied even though they are a vulnerable population to experience a negative birth event, given that they exhibit many known risk factors. Objective: To ascertain whether a cesarean birth mediates the impact of infant complications on the birth experience of adolescent mothers. Results: We found that the mediating effect of delivery mode depended on the adolescent’s depression level as well as on the specific operationalization of the birth experience. At high levels of depression, the odds of a negative birth experience increased by 80% when operationalized as an Impact of Event Scale (IES) subconstruct. Adolescent mothers are a vulnerable population to report a negative birth event, given an increased likelihood to experience several recognized risk factors observed among adult samples. Prior trauma, a lack of information/ awareness of events taking place during labor and birth, feelings of loss of control and powerlessness, limited support, unanticipated pain levels, and infant complications.[1,2,3,4,5,6]

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