The influence of mistreatment during childbirth on postpartum depression: Findings from the 2015 Pelotas (Brazil) birth cohort study

Abstract

Background Women worldwide face diverse forms of mistreatment during childbirth that puts their lives and well-being at-risk. Minimal research has focused on the impact of mistreatment experiences during childbirth on adverse maternal and perinatal health outcomes. Aims To determine whether there is an association between mistreatment of women during facility-based childbirth and postpartum depression occurrence. Methods We used data from the 2015 Pelotas (Brazil) Birth Cohort Study. Women who had given birth in a local medical hospital facility (either public or private) under the supervision of a skilled birth attendant in the year 2015 were considered eligible to take part in the study, as well as their newborns (cohort members). Self-report mistreatment experiences during childbirth (disrespect and abuse) and postpartum depressive symptoms were assessed by household interviews three months after delivery. Mistreatment included information on physical abuse, verbal abuse, denial of care, and undesired procedures. Binary variables were created to indicate the occurrence of at least one, and at least two mistreatment experiences. The Edinburgh Postnatal Depression Scale to assess postpartum depression. A positive screening was defined as EPDS ≥ 15. We used multivariable logistic regression to determine the odds of having a positive screening for postpartum depression between women who experienced mistreatment during childbirth and those who did not. We adjusted for potential confounders including family income, maternal education, age, skin color, parity, marital status, desire for pregnancy, fathers’ reaction when discovering the pregnancy, previous depression, pregnancy morbidities, and deliver type (C-section or vaginal). We tested for interaction between antenatal depression (EPDS ≥ 10) and mistreatment experiences on the occurrence of postpartum depression. Results A total of 4275 cohort members took part in the perinatal follow-up. The three-month follow-up interviewed 4087 biological mothers; 18.3% and 5.1% reported having experienced at least one and at least two types of mistreatment forms during childbirth, respectively; 6.8% screened positive for postpartum depression (EPDS ≥ 15). Women reported having experienced at least one type of mistreatment presented higher odds for postpartum depression (OR: 1.53; 95% CI: 1.07–2.20) as well as the women who reported at least two mistreatment forms (OR: 1.85; 95% CI: 1.06–3.24). We observed an interaction between antenatal depression and mistreatment during childbirth on postpartum depression. We found higher odds of postpartum depression among women who did not experienced antenatal depression (OR: 2.32; 95% CI: 1.05–5.14) when compared those who did (OR: 1.26; 95% CI: 0.81–1.90) for at least one mistreatment experience. The odds of postpartum depression among women reporting both antenatal depression and mistreatment during childbirth was 15.5 (95% CI: 9.6–25.0). Conclusions Mistreatment during childbirth higher the odds of postpartum depression three months after birth. The independent effect of having experienced mistreatment during childbirth on postpartum depression is greater for women not presenting depression during pregnancy. Strategies to promote high-quality and respectful maternal healthcare are essential to prevent mother–child adverse outcomes. Women presenting antenatal depression are a priority group for interventions.