Group Counseling for Mothers After Emergency Cesarean Section: A Randomized Controlled Trial of Intervention

Abstract: Background : An emergency cesarean section is often a traumatic experience for women, and can be associated with postnatal depression and posttraumatic stress. Various types of interventions have been tested to prevent such consequences. The purpose of this study was to test a model of group counseling for mothers after emergency cesarean section, and to examine its possible effects. Method : After undergoing an emergency cesarean section, 162 Swedish‐speaking women were randomized to group counseling or the control group. The participation rate was 75 percent. The counseling consisted of 2 sessions, conducted at about 2 months postpartum; 72 percent of the women randomized to the counseling group actually attended the sessions. At 6 months postpartum, all study participants completed a postal questionnaire (response rates were 92% in the counseling group and 89% in the control group). Results : No difference between the groups was found in terms of the level of fear after childbirth, symptoms of posttraumatic stress, or postnatal depression at 6 months after the emergency cesarean. The group counseling was much appreciated by the participating women, some of whose experiences are reported in this paper. Conclusion : Group counseling for mothers after emergency cesarean section did not influence their views on the recent delivery or prevent symptoms of posttraumatic stress or postnatal depression. It was, however, appreciated and did no harm. In future studies, other outcomes should be measured.     

Do Women Get Posttraumatic Stress Disorder as a Result of Childbirth? A Prospective Study of Incidence

Background: Recent research suggests that a proportion of women may develop posttraumatic stress disorder after birth. Research has not yet addressed the possibility that postpartum symptoms could be a continuation of the disorder in pregnancy. This study aimed to test the idea that some women develop posttraumatic stress disorder as a result of childbirth, and to provide an estimate of the incidence using a prospective design, which controls for the disorder in pregnancy. Method: This prospective study assessed 289 women at three time points: 36 weeks gestation and 6 weeks and 6 months postpartum. The prevalence of posttraumatic stress disorder was assessed by questionnaire at each time point, and the incidence was examined after removing women who had severe symptoms of posttraumatic stress disorder or clinical depression in pregnancy. Results: After removing women at the first time point, 2.8 percent of women fulfilled criteria for the disorder at 6 weeks postpartum and this decreased to 1.5 percent at 6 months postpartum. Conclusions: The results suggest that at least 1.5 percent of women may develop chronic posttraumatic stress disorder as a result of childbirth. It is important to increase awareness about the disorder and to give health professionals access to simple screening tools. Intervention is possible at several levels, but further research is needed to guide this intervention.     

Childbirth and the Development of Acute Trauma Symptoms: Incidence and Contributing Factors

Background: Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder in women as a result of their labor and birth experiences, and to identify factors that contributed to the women's psychological distress. Method: Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Telephone interviews with 499 participants were conducted at 4 to 6 weeks postpartum to explore the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms. Results: One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty‐eight women (5.6%) met DSM‐IV criteria for acute posttraumatic stress disorder. Antenatal variables did not contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (β= 0.351, p < 0.0001)and the perception of inadequate intrapartum care (β= 0.319, p < 0.0001) during labor were consistently associated with the development of acute trauma symptoms. Conclusions: Posttraumatic stress disorder after childbirth is a poorly recognized phenomenon. Women who experienced both a high level of obstetric intervention and dissatisfaction with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. These findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the care provided to birthing women.     

A Quasi‐experimental Outcomes Analysis of a Psychoeducation Intervention for Pregnant Women with Abuse‐related Posttraumatic Stress

ObjectiveTo test the effectiveness of a trauma‐specific, psychoeducational intervention for pregnant women with a history of childhood maltreatment on six intrapartum and postpartum psychological outcomes.DesignQuasi‐experimental study comparing women from a single‐group, pretest–posttest pilot intervention study with women matched from a prospective observational study.SettingRural and university‐based prenatal clinics.ParticipantsPregnant women entered the study by responding to an advertisement or by referral from a maternity care provider. Women could take part whether or not they met posttraumatic stress disorder diagnostic criteria. Outcomes data exist for 17 pilot intervention study participants and 43 matched observational study participants.InterventionsParticipants in the observational study received usual care. Participants in the pilot intervention study received usual care plus the intervention, a fully manualized, self‐study program supported by weekly phone tutoring sessions with a health professional.Main Outcome MeasuresThe National Women's Study PTSD Module, the Peritraumatic Dissociation Experience Questionnaire, the Perception of Care Questionnaire, the Postpartum Depression Screening Scale, the Postpartum Bonding Questionnaire, and a semantic differential appraisal of the labor experience.ResultsParticipants in the intervention study had better scores on all measures. Differences in means between participants in the intervention study and participants in the observational study equated to medium effect sized for dissociation during labor, rating of labor experience, and perception of care in labor and small effect sizes for postpartum posttraumatic stress disorder (PTSD) symptoms, postpartum depression symptoms, and motherinfant bonding.ConclusionThis trauma‐specific intervention reaches and benefits pregnant women with a history of childhood maltreatment.     

Prevalence and Predictors of Women's Experience of Psychological Trauma During Childbirth

ABSTRACT: Background: The increased acceptance of the prevalence of trauma in human experience as well as its psychological consequences has led to revisions of diagnostic criteria for the disorder. The three purposes of this study were to examine the rates at which women experienced psychological trauma in childbirth, to explore possible causal factors, and to examine possible factors in the development of the disorder. Methods: One hundred and three women from childbirth education classes in the Atlanta metropolitan area completed a survey in late pregnancy and a follow‐up interview approximately 4 weeks after the birth. Results: The childbirth experience was reported as traumatic by 34 percent of participants. Two women (1.9%) developed all the symptoms needed to diagnose posttraumatic stress disorder, and 31 women (30.1%) were partially symptomatic. Regression analysis showed that antecedent factors (e.g., history of sexual trauma and social support) and event characteristics (e.g., pain in first stage of labor, feelings of powerlessness, expectations, medical intervention, and interaction with medical personnel) were significant predictors of perceptions of the childbirth as traumatic. The pain experienced during the birth, levels of social support, self‐efficacy, internal locus of control, trait anxiety, and coping were significant predictors of the development of posttraumatic stress disorder symptoms after the birth. Conclusions: These findings suggest several intervention points for health care practitioners, including careful prenatal screening of past trauma history, social support, and expectations about the birth; improved communication and pain management during the birth; and opportunities to discuss the birth postpartum. (BIRTH 30:1 March 2003)     

Posttraumatic Stress Disorder in New Mothers: Results from a Two‐Stage U.S. National Survey

Abstract: Background: Prevalence rates of women in community samples who screened positive for meeting the DSM‐IV criteria for posttraumatic stress disorder after childbirth range from 1.7 to 9 percent. A positive screen indicates a high likelihood of this postpartum anxiety disorder. The objective of this analysis was to examine the results that focus on the posttraumatic stress disorder data obtained from a two‐stage United States national survey conducted by Childbirth Connection: Listening to Mothers II (LTM II) and Listening to Mothers II Postpartum Survey (LTM II/PP). Methods: In the LTM II study, 1,373 women completed the survey online, and 200 mothers were interviewed by telephone. The same mothers were recontacted and asked to complete a second questionnaire 6 months later and of those, 859 women completed the online survey and 44 a telephone interview. Data obtained from three instruments are reported in this article: Posttraumatic Stress Disorder Symptom Scale‐Self Report (PSS‐SR), Postpartum Depression Screening Scale (PDSS), and the Patient Health Questionnaire‐2 (PHQ‐2). Results: Nine percent of the sample screened positive for meeting the diagnostic criteria of posttraumatic stress disorder after childbirth as determined by responses on the PSS‐SR. A total of 18 percent of women scored above the cutoff score on the PSS‐SR, which indicated that they were experiencing elevated levels of posttraumatic stress symptoms. The following variables were significantly related to elevated posttraumatic stress symptoms levels: low partner support, elevated postpartum depressive symptoms, more physical problems since birth, and less health‐promoting behaviors. In addition, eight variables significantly differentiated women who had elevated posttraumatic stress symptom levels from those who did not: no private health insurance, unplanned pregnancy, pressure to have an induction and epidural analgesia, planned cesarean birth, not breastfeeding as long as wanted, not exclusively breastfeeding at 1 month, and consulting with a clinician about mental well‐being since birth. A stepwise multiple regression revealed that two predictor variables significantly explained 55 percent of the variance in posttraumatic stress symptom scores: depressive symptom scores on the PHQ‐2 and total number of physical symptoms women were experiencing at the time they completed the LTM II/PP survey. Conclusion: In this two‐stage national survey the high percentage of mothers who screened positive for meeting all the DSM‐IV criteria for a posttraumatic stress disorder diagnosis is a sobering statistic. (BIRTH 38:3 September 2011)     

Impact of Postpartum Depression on the Mother‐Infant Couple

Abstract: Background : Few studies have explored the influence of postpartum depression on later life among mothers in Taiwan. The present follow‐up study aims to explore the effects of postpartum depression on the psychosocial health of mothers and on the overall development of their infants. Methods : Follow‐up evaluations were carried out on 29 postnatally depressed and 31 nondepressed mothers and their infants at 1 year after childbirth. Dependent variables were measured by means of five structured questionnaires. Results : Postnatally depressed mothers reported significantly higher perceived stress, but lower social support and self‐esteem than nondepressed mothers at 1 year after childbirth. The participants’ postpartum depression had no significant effect on their infants’ eight developmental areas, nor did depression influence their plans about the number of children to have in the future. Conclusions : Postpartum depression may have a negative influence on the psychosocial health of women, but it does not appear to influence the overall development of their infants and their family planning.     

Childhood Abuse History,Posttraumatic Stress Disorder,Postpartum Mental Health,and Bonding: A Prospective Cohort Study

Introduction: Research is needed that prospectively characterizes the intergenerational pattern of effects of childhood maltreatment and lifetime posttraumatic stress disorder (PTSD) on women's mental health in pregnancy and on postpartum mental health and bonding outcomes. This prospective study included 566 nulliparous women in 3 cohorts: PTSD‐positive, trauma‐exposed resilient, and not exposed to trauma. Methods: Trauma history, PTSD diagnosis, and depression diagnosis were ascertained using standardized telephone interviews with women who were pregnant at less than 28 gestational weeks. A 6‐week‐postpartum interview reassessed interim trauma, labor experience, PTSD, depression, and bonding outcomes. Results: Regression modeling indicates that posttraumatic stress in pregnancy, alone, or comorbid with depression is associated with postpartum depression (R²= .204; P < .001). Postpartum depression alone or comorbid with posttraumatic stress was associated with impaired bonding (R²= .195; P < .001). In both models, higher quality of life ratings in pregnancy were associated with better outcomes, while reported dissociation in labor was a risk for worse outcomes. The effect of a history of childhood maltreatment on both postpartum mental health and bonding outcomes was mediated by preexisting mental health status. Discussion: Pregnancy represents an opportune time to interrupt the pattern of intergenerational transmission of abuse and psychiatric vulnerability. Further dyadic research is warranted beyond 6 weeks postpartum. Trauma‐informed interventions for women who enter care with abuse‐related PTSD or depression should be developed and tested.     

The Patient Observer: Eye-Movement Desensitization and Reprocessing for the Treatment of Posttraumatic Stress following Childbirth

Abstract: Background: No standard intervention with proved effectiveness is available for women with posttraumatic stress following childbirth because of insufficient research. The objective of this paper was to evaluate the possibility of using eye-movement desensitization and reprocessing treatment for women with symptoms of posttraumatic stress disorder following childbirth. The treatment is internationally recognized as one of the interventions of choice for the condition, but little is known about its effects in women who experienced the delivery as traumatic. Methods: Three women suffering from posttraumatic stress symptoms following the birth of their first child were treated with eye-movement desensitization and reprocessing during their next pregnancy. Patient A developed posttraumatic stress symptoms following the lengthy labor of her first child that ended in an emergency cesarean section after unsuccessful vacuum extraction. Patient B suffered a second degree vaginal rupture, resulting in pain and inability to engage in sexual intercourse for years. Patient C developed severe preeclampsia postpartum requiring intravenous treatment. Results: Patients received eye-movement desensitization and reprocessing treatment during their second pregnancy, using the standard protocol. The treatment resulted in fewer posttraumatic stress symptoms and more confidence about their pregnancy and upcoming delivery compared with before the treatment. Despite delivery complications in Patient A (secondary cesarean section due to insufficient engaging of the fetal head); Patient B (second degree vaginal rupture, this time without subsequent dyspareunia); and Patient C (postpartum hemorrhage, postpartum hypertension requiring intravenous treatment), all three women looked back positively at the second delivery experience. Conclusions: Treatment with eye-movement desensitization and reprocessing reduced posttraumatic stress symptoms in these three women. They were all sufficiently confident to attempt vaginal birth rather than demanding an elective cesarean section. We advocate a large-scale, randomized controlled trial involving women with postpartum posttraumatic stress disorder to evaluate the effect of eye-movement desensitization and reprocessing in this patient group. (BIRTH 39:1 March 2012)     

Synthesis of Mixed Research on Posttraumatic Stress Related to Traumatic Birth

ObjectiveTo synthesize mixed-research results (quantitative and qualitative) on posttraumatic stress in women who experienced traumatic births.Data SourcesPubMed, Scopus, and PsycINFO databases.Study SelectionQuantitative and qualitative studies were included if they were published in English from January 1, 2009, through December 31, 2018, and focused on posttraumatic stress in the postpartum period related to traumatic childbirth.Data ExtractionThe final sample consisted of 59 studies: 4 qualitative and 55 quantitative. Both authors independently appraised each study using the Critical Appraisal Skills Programme. Quantitative studies were synthesized by narrative synthesis and vote counting, and qualitative studies were synthesized by content analysis.Data SynthesisIn the included studies, prevalence rates of elevated posttraumatic stress ranged from 0.8% to 26%. Significant predictors of posttraumatic stress that occurred before childbirth and those that were birth related were identified. Reports of six intervention studies to decrease posttraumatic stress symptoms after traumatic births were included. These interventions focused on postnatal debriefing, expressive writing, online cognitive behavioral therapy, a brief cognitive intervention, and the implementation of the nine instinctive stages of the infant during the first hour after birth. We created four themes from the findings of the qualitative studies: Distressing Symptoms, Detrimental Effect of Posttraumatic Stress on Women’s Relationships With Their Infants and Partners, Critical Influence of Support, and Debriefing.ConclusionWhen a woman experiences posttraumatic stress related to a traumatic birth, the entire family unit is vulnerable. Findings from quantitative predictor studies can be used to develop an instrument to screen women for risk factors for posttraumatic stress related to birth trauma. Primary interventions are needed to prevent women from experiencing traumatic births.     

Birth setting,labour experience,and postpartum psychological distress

Objectivealthough psychosocial risk factors have been identified for postpartum depression (PPD) and perinatal posttraumatic stress disorder (PTSD), the role of labour- and birth-related factors remains unclear. The present investigation explored the impact of birth setting, subjective childbirth experience, and their interplay, on PPD and postpartum PTSD.Methodin this prospective longitudinal cohort study, three groups of women who had vaginal births at a tertiary care hospital, a birthing center, and those transferred from the birthing centre to the tertiary care hospital were compared. Participants were followed twice during pregnancy (12–14 and 32–34 weeks gestation) and twice after childbirth (1–3 and 7–9 weeks postpartum).Resultssymptoms of PPD and PTSD did not significantly differ between birth groups; however, measures of subjective childbirth experience and obstetric factors did. Moderation analyses indicated a significant interaction between pain and birth group, such that higher ratings of pain among women who were transferred was associated with greater symptoms of postpartum PTSD.Conclusion and implications for practicewomen who are transferred appear to have a unique experience that may put them at greater risk for postpartum psychological distress. It may be beneficial for care providers to help prepare women for pain management and potential unexpected complications, particularly if it is their first childbirth.     

Relationships Among Infant Sleep Patterns,Maternal Fatigue,and Development of Depressive Symptomatology

ABSTRACT: Background: Postpartum depression is a serious condition for women after childbirth. Although its etiology is unclear, one potentially important predictive variable that has received little attention is maternal sleep deprivation. The objective of this study was to examine relationships among infant sleep patterns, maternal fatigue, and the development of postpartum depression in women with no major depressive symptomatology at 1 week postpartum. Methods: As part of a population‐based postpartum depression study, 505 women who had an Edinburgh Postnatal Depression Scale (EPDS) score < 13 at 1 week postpartum completed questionnaires at 4 and 8 weeks postpartum. Results: Mothers exhibiting major depressive symptomatology (EPDS > 12) at 4 and 8 weeks were significantly more likely to report that their baby cried often, be woken up 3 times or more between 10 pm and 6 am , have received less than 6 hours of sleep in a 24‐hour period over the past week, indicate that their baby did not sleep well, and think that their baby's sleep pattern did not allow them to get a reasonable amount of sleep. Consistent with these findings, mothers with an EPDS score > 12 were significantly more likely to respond that they often felt tired. Conclusions: These results suggest that infant sleep patterns and maternal fatigue are strongly associated with a new onset of depressive symptoms in the postpartum period, and provide support for the development of postpartum depression preventive interventions designed to reduce sleep deprivation in the early weeks postpartum.     

Postpartum depression and correlated factors in women who received in vitro fertilization treatment

Introduction: Postpartum depression is a significant mental health problem that occurs more frequently in the first 4 weeks postpartum and also may occur later during the first postpartum year. Women who receive in vitro fertilization (IVF) treatment have a particular perinatal experience that may create postpartum mental health concerns. The purpose of this cross‐sectional study was to evaluate factors associated with postpartum depression in women who received IVF treatment. Methods: Sixty of 71 eligible postpartum women who were treated at an infertility treatment center and who conceived by IVF were included in this study, which used a self‐administered, structured questionnaire. Results: The prevalence of postpartum depression was 25%, including mild (16.7%), moderate (6.7%), and severe (1.7%). Pearson correlation analysis showed that the frequency of receiving IVF treatment and perceived stress were positively correlated with postpartum depression, whereas family function and social support were negatively correlated with postpartum depression. Multiple regression analysis showed that the frequency of receiving IVF treatment, birth method, and social support were significant predictive factors for postpartum depression when covariates were controlled (R² 56.6%). Discussion: A higher frequency of IVF treatment, cesarean birth, and inadequate social support increase the possibility of postpartum depression, and clinicians should provide appropriate anticipatory education or counseling.     

Labour experience and postpartum stress and depression: a quantitative and qualitative examination

Objectives: The purpose of this study was to examine the relationship between qualitatively and quantitatively assessed birth experiences and rates of post-birth distress and depressive symptoms three to four weeks postpartum. Both the rates of post-birth distress and depressive symptoms represented risk factors for subsequent mental health problems in the later postpartum period. Background: Childbirth is accompanied by various stress factors. However, little is known about the relationship between stressors occurring during birth (intrapartum) and the ways women cope with them and women’s development of depressive symptoms or acute stress reactions postpartum. Methods: One hundred and twenty-seven women from two longitudinal studies were interviewed 48–96 h after childbirth. Thirty birth interviews from both samples were additionally examined for qualitative themes related to women’s reported experience in connection with mental health adaptation (i.e. without symptoms (n = 10), symptoms of depression (n = 10) and acute stress reactions (n = 10)) at three to four weeks postpartum. Results: Women with depressive symptoms reported less intimate and helpful contact with their partners and baby during labour compared with women without symptoms or with acute stress reactions. Women with acute stress reactions had less confidence in themselves, and reported disorientation during the birth process, compared with women without symptoms or with depressive symptoms. Conclusions: Recognition of how women cope with intrapartum factors during labour could help to identify psychological distress shortly after delivery, and inform the introduction of timely and appropriate psychological support for affected women.     

Maternal adjustment five months after birth: the impact of the subjective experience of childbirth and emotional support from the partner

: Recent research suggests that negative childbirth experiences may cause maternal maladjustment. The impact of intranatal emotional distress, intranatal physical discomfort and postnatal emotional evaluation of birth on symptoms of posttraumatic stress and depression is investigated with regard to the moderating role of emotional support from the partner.

Subjective childbirth experience measured with the German version of the Salmons Item List, obstetric characteristics and postnatal emotional support from the partner were assessed in 374 women six weeks after childbirth. Trauma symptoms and postnatal depression were measured five months after childbirth.

Postnatal emotional partner support acts as a moderator of the effect of the subjective childbirth experience on the development of symptoms of avoidance, intrusive thoughts and depression. The direct influence of emotional partner support is stronger regarding symptoms of depression and hyperarousal than regarding avoidance and intrusive thoughts. No direct association between intranatal physical discomfort/labour pain and later maternal adjustment could be found.

Women with a negative childbirth experience and poor emotional support from their partner are at increased risk for psychological maladjustment in the first five months after birth.     

Negative emotions,childbirth pain,perinatal dissociation and self-efficacy as predictors of postpartum posttraumatic stress symptoms

Objective: The aim of the study was to assess the contribution of negative emotions, childbirth pain, perinatal dissociation, and feelings of self-efficacy to the development of posttraumatic stress disorder (PTSD) symptoms following childbirth. Patients and methods: A prospective longitudinal study was carried out on 98 women from the south of France area. Four questionnaires were completed at 2–3 days postpartum: the Peritraumatic Emotions List (PEL), the French version of the McGill Pain Questionnaire, the Peritraumatic Dissociative Experience Questionnaire (PDEQ) and the Childbirth Self-efficacy Inventory (CBSEI). The Impact of Event Scale-Revised (IES-R) assessing posttraumatic stress symptoms was also completed 6 weeks after delivery. Results: Pain and negative emotions were significant predictors of the intensity of posttraumatic stress symptoms at 6 weeks postpartum. Although higher levels of pain contribute to increased PSTD symptoms, and higher negative emotion also contributes to PTSD symptoms, the effect of pain on PSTD is stronger when there are high levels of negative emotion. Discussion and conclusion: Our findings highlight that pain, negative emotions and their interaction were significant predictors of posttraumatic stress symptoms and confirm the importance of developing more specific treatments focusing on support and prevention.     

An educational intervention to change planned behavior concerning midwife-assisted out-of-hospital childbirth

Introduction: The Business of Being Born is a documentary film that reviews the history, economics, and culture of birth in the United States, with an emphasis on viewing low‐risk birth as a natural and reasonably safe experience that does not require medical intervention. Methods: A nonequivalent control group design with 468 American university students was used to examine the potential of The Business of Being Born for changing attitudes toward, and planned behavior concerning, midwife‐assisted out‐of‐hospital childbirth. Results: Viewing the film had a large positive effect on planned behavior concerning midwife‐assisted out‐of‐hospital childbirth. Rationales for planned behaviors indicated that trust and safety concerns accounted for the appeal of physician‐assisted hospital childbirth over midwife‐assisted out‐of‐hospital childbirth, but that viewing the film substantially tempered these concerns vis‐à‐vis midwife‐assisted out‐of‐hospital childbirth among a large portion of participants. Discussion: The results indicate that The Business of Being Born can increase awareness of and support for the midwifery profession, and that these changes may result in increased demand for midwifery services. However, proactive efforts must be taken to ensure that the film reaches its target audience.     

Effectiveness of an Exercise Support Program in Reducing the Severity of Postnatal Depression in Taiwanese Women

ABSTRACT: Background: Depression during the perinatal period should be identified as early as possible to avoid negative effects on the new family. The purpose of this study was to examine the effectiveness of an exercise support program on reducing psychological morbidity after childbirth. Methods: A controlled trial was conducted in a regional hospital in Taipei, Taiwan. Eighty primiparas with an Edinburgh Postnatal Depression Scale (EPDS) score above 10 at 4 weeks postpartum agreed to participate. They were allocated alternately to an intervention (to receive exercise support) and control group (to receive standard care) at 6 weeks postpartum. The exercise support consisted of 1 hour per week at the hospital and two sessions at home for 3 months. Sixty‐three primiparas finished the exercise support program. The main outcome measure was the EPDS score at 5 months postpartum. Results: Women who received the exercise support program were less likely to have high depression scores after childbirth when compared with the control group. Conclusions: The exercise support program given to postpartum women appeared to benefit their psychological well‐being. This promising finding should be tested in a well‐designed randomized controlled trial. (BIRTH 35:1 March 2008)     

Cesarean Section and Postnatal Sexual Health

ABSTRACT: Background: Cesarean delivery avoids perineal trauma and has therefore often been assumed to protect sexual function after childbirth. We sought to examine this assumption by using data from a study of women's sexual health after childbirth to assess whether women who underwent cesarean section experienced better sexual health in the postnatal period than women with vaginal births. Methods: A cross‐sectional study was conducted of 796 primiparous women, employing data from obstetric records and a postal survey 6 months after delivery. Results: Any protective effect of cesarean section on sexual function was limited to the early postnatal period (0–3 months), primarily to dyspareunia‐related symptoms. At 6 months the differences in dyspareunia‐related symptoms, sexual response‐related symptoms, and postcoital problems were much reduced or reversed, and none reached statistical significance. Conclusions: Outcomes from this study provide no basis for advocating cesarean section as a way to protect women's sexual function after childbirth. (BIRTH 32:4 December 2005)