Monday, February 12, 2007

Type of birth has no impact on postpartum depression

Many homebirth advocacy websites and many homebirth midwives claim that homebirth reduces the risk of postpartum depression. In reviewing the scientific literature on postpartum depression, I could find no evidence that place of birth or type of birth has any impact on the risk of postpartum depression.

Blues and depression during early puerperium: home versus hospital deliveries, Pop et al., Br J Obstet Gynaecol. 1995 Sep;102(9):701-6:
Of the 293 women who completed the study, 52% gave birth at home. Significantly more nullipara gave birth in hospital. Parturition occurred where it had been planned in 77% of women; referral occurred later on in pregnancy in 11% and during labour in 12%. Nullipara had to be referred significantly more often than multipara. In general, there was no difference in the incidence of blues and depression between women who gave birth at home and those who gave birth in hospital. Obstetric factors were not related to the occurrence of blues or depression in the early puerperium. CONCLUSIONS: Women who gave birth in hospital are no more prone to postpartum mood disturbances, such as blues and depression, than women who give birth at home.
Indeed, mode of delivery appears to have no impact on postpartum depression.

Operative delivery and postnatal depression: a cohort study, Patel et al., BMJ 2005;330:879:
Conclusions There is no reason for women at risk of postnatal depression to be managed differently with regard to mode of delivery. Elective caesarean section does not protect against postnatal depression. Women who plan vaginal delivery and require emergency caesarean section or assisted vaginal delivery can be reassured that there is no reason to believe that they are at increased risk of postnatal depression.
Cesarean Section and Postpartum Depression: A Review of the Evidence Examining the Link, Carter et al., Psychosomatic Medicine 68:321-330 (2006):
Of the 24 studies that have examined the association between cesarean section and postpartum depression, five found a significant adverse association, 15 found no significant association, and four found mixed results. With only one exception, methodologically superior studies found either no significant association or mixed evidence for an association between cesarean section and postpartum depression. Meta-analyses of suitable studies failed to find evidence for a significant association between cesarean section and postpartum depression.
Interestingly, the most significant predictor of postpartum depression is prepartum depression. Not only is a history of depression a predictor of postpartum depression, but it is also a predictor for disappointment in the delivery experience.

Psychosocial predictors of disappointment with delivery and puerperal depression, Saisto et al., Acta Ob et Gyn Scandinavica, Vol 80 Issue 1 p. 39, January 2001:
Results. The women who were disappointed with their delivery or suffered from puerperal depression had been more depressed already in early pregnancy. Regression analysis showed that the strongest predictors of disappointment with delivery were labor pain (increase in R2=0.14, p<0.001) and emergency Cesarean (increase in R2=0.18, p<0.001).

Puerperal depression was predicted by depression (increase in R2=0.16, p<0.001), and by personal traits such as general anxiety, vulnerability and neuroticism (increase in R2=0.32, p<0.001), both before 30 weeks of pregnancy and prior to the delivery (for depression increase in R2=0.05, p<0.001, and for anxiety and vulnerability increase in R2=0.04, p<0.01). The strongest predictors were depression at both time points before delivery (beta=0.51, p<0.001, and beta=0.39, p<0.001). Pregnancy- and delivery-related anxiety prior to the delivery also predicted puerperal depression, but complications of the pregnancy and delivery did not.

Conclusions. Depression in early pregnancy predicts disappointment with the delivery and is a strong predictor of puerperal depression.

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