Abstract
BackgroundPsychiatric illness before delivery increases the risk of giving birth by caesarean section on maternal request (CSMR) but little is known about these women’s mental health after childbirth. In this study we aimed to compare the prevalence of psychiatric disorders five years before and after delivery in primiparae giving birth by CS on maternal request to all other primiparae giving birth, indifferent on their mode of delivery.MethodsThe study population comprised all women born in Sweden 1973–1983 giving birth for the first time in 2002–2004. Psychiatric diagnoses, in- and outpatient care were retrieved from the National Patient Register in Sweden. The risk of psychiatric care after childbirth was estimated using CSMR, previous mental health and sociodemographic variables as covariates.ResultsPsychiatric disorders after childbirth were more common in women giving birth by CSMR compared to the other women (11.2% vs 5.5%, p < 0.001). CSMR increased the risk of psychiatric disorders after childbirth (aOR 1.5, 95% CI 1.2–1.9). The prevalence of psychiatric disorders had increased after compared to before childbirth (mean difference 0.02 ± 0.25, 95% CI 0.018–0.022, p < 0.001). Women giving birth by CSMR tended to be diagnosed in the inpatient care more often (54.9% vs. 45.8%, p = 0.056) and were more likely to have been diagnosed before childbirth as well (39.8% vs. 24.2%, p < 0.001).ConclusionsWomen giving birth by CSMR more often suffer from psychiatric disorders both before and after delivery. This indicates that these women are a vulnerable group requiring special attention from obstetric- and general health-care providers. This vulnerability should be taken into account when deciding on mode of delivery.
Highlights
Psychiatric illness before delivery increases the risk of giving birth by caesarean section on maternal request (CSMR) but little is known about these women’s mental health after childbirth
Psychiatric illness was defined as in- and/or outpatient care registered together with a psychiatric diagnosis according to the International Classification of Diseases (ICD)
Of all the women in the study, 2316 (3.6%) women had been diagnosed with one or more psychiatric disorder during the five years before first childbirth [16] and 3607 (5.6%) women had been diagnosed during the five years after first childbirth
Summary
Psychiatric illness before delivery increases the risk of giving birth by caesarean section on maternal request (CSMR) but little is known about these women’s mental health after childbirth. Comparisons of sociodemographic variables and psychiatric illness five years before delivery between CSMR women and the reference group have been published earlier [16]. CSMR women were older (68.4 vs 64.7% >25 years, p < 0.001), used tobacco more often (18.3 vs 13.0%, p < 0.001), had a lower educational attainment (16.0 vs 10.1% elementary school, p < 0.001), were more often married (36.2 vs 32.8%, p < 0.001), unemployed (13.1 vs 8.6%, p < 0.001), had a higher BMI (p < 0.001) and more often parents born outside of Scandinavia (9.1 vs 6.0%, p < 0.001) compared to the reference group. The prevalence of each category of psychiatric disorder, the distribution of in- and outpatient care as well as the prevalence of any psychiatric disorder in CSMR women was compared to the reference group five years after delivery using Pearson’s Chi square test.
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