Comparison of postpartum quality of life between patients with repeat cesarean delivery and vaginal birth after cesarean

Abstract

TIENTS WITH REPEAT CESAREAN DELIVERY AND VAGINAL BIRTH AFTER CESAREAN SUSAN GERBER, LISA SHARP, CHERYL O’TOOLE, Northwestern University Medical School, Obstetrics and Gynecology, Chicago, IL Northwestern University Medical School, Family Medicine, Chicago, IL OBJECTIVE: To determine whether an association exists between route of delivery and postpartum quality of life (QOL) in women with a prior cesarean delivery. STUDY DESIGN: Sixty women with one prior cesarean delivery and no prior vaginal deliveries were recruited from outpatient settings during the third trimester of a subsequent pregnancy. Telephone interviews were performed at the time of recruitment, and then at 4 weeks and 3 months post partum. Maternal quality of life was assessed using the Postpartum Quality of Life Scale (PPQOL), a 1-10 QOL self-report scale (SRS), the Short Form-36 (SF-36), and the Edinburgh Postnatal Depression Scale (EPDS) for all subjects. Postpartum interviewers were blinded as to the route of delivery. Linear regression analysis was used to evaluate the association between route of delivery and postpartum QOL. RESULTS: Fifty-onewomenwere interviewed at 4 weeks post partum. Thirtyfive women underwent repeat cesarean delivery (69%) and 16 (31%) had a vaginal birth after cesarean. Thirty-six of these women were also interviewed at 3 months post partum. Twenty-three of these women had a repeat cesarean delivery (64%). Linear regression analysis was performed, controlling for maternal age, race, income, insurance status, marital status, baseline QOL, interval since the prior delivery, and neonatal disposition. Repeat cesarean delivery was associated with higher QOL scores on both the PPQOL and the SRS at 4 weeks and at 3 months post partum (P < 0.05). Repeat cesarean delivery was also associated with higher scores on theMental Health subscale of the SF-36 at 4 weeks (P < 0.01) and 3 months (P < 0.05), and with lower scores (lower risk of depression) on the EPDS at 4 weeks (P < 0.05) and 3 months (P = 0.07). CONCLUSION: In women with one prior cesarean delivery and no prior vaginal deliveries, repeat cesarean section is associated with superior maternal QOL in the first 3 months post partum.