Mode of birth may have a strong association with women’s psychological and physical outcomes in the first few months after birth. As expected, women’s symptoms were highest at 10 days after birth, and the health of most women improved emotionally and physically over the following 3 months. However, some outcomes appeared to be related to the type of delivery experienced, particularly when adjusting for sociodemographic variables and the other psychological and physical symptoms present at each time point. Specifically, women who had forceps-assisted vaginal births and unplanned caesareans appeared to have poor health and psychological wellbeing after birth. The health of women who had ventouse-assisted births appeared to be somewhat compromised, while the health of women who had unassisted vaginal births and planned caesareans did not appear to be influenced by the birth process.
Women who had a forceps-assisted vaginal birth were most likely to have ongoing psychological problems after childbirth. These women were more likely to report two or more PTSD-type symptoms at 3 months, and this may be explained by the fact that their labours were more likely to have been longer, and there may have been concern about their labour or their baby as indicated by the higher levels of constant electronic monitoring reported. A lack of control, worry and an intense period of anxiety or uncertainty during labour and birth may explain the psychological symptoms reported by these women. This, in combination with other individual factors related to the mode of birth, such as a woman’s labour and birth expectations may also predispose women to stress-related symptoms after birth, as well as factors occurring after the birth, including a lack of postnatal follow-up with a health professional when this might have been helpful
]. In our study, more than half (58%) of women who had a forceps-assisted vaginal birth reported that they spoke about their labour with a health professional. However, of those women who didn’t speak to a health professional, 43% would have liked to speak to someone. While health professionals may be more aware of the physical morbidity for women after childbirth, the ongoing psychological issues may be less clear or alternatively, perceived as more difficult to treat or beyond their area of expertise. Referral pathways need to be in place to address this point
Although caesareans section births are often described as resulting in poorer postnatal psychological outcomes for women, it seems that the outcomes for women depend on whether the caesarean section is planned or not. Women having unplanned caesarean section births were marginally more likely to report PTSD-type symptoms, however, there was no association between PTSD-type symptoms and planned caesarean section births in our study. These findings are consistent with others
] and are important for understanding the individual and social factors that may influence women’s postnatal psychological wellbeing. For a proportion of women it appears that there may be benefits of a planned caesarean birth, especially for those with health problems, previous complications or adverse experiences
]. However, a large study of 55,000 Norwegian women did not find an association between mode of birth and a measure of emotional distress at 6 months postpartum
], which suggests that symptoms of anxiety in new mothers may attenuate significantly with time. On the other hand, in our study depression was not associated with mode of birth, and this may suggest the need to distinguish between symptoms of anxiety and depression rather than using general measures of distress. It is possible that because our study differentiated between assisted vaginal births (forceps vs. ventouse) when assessing women’s psychological outcomes, this may have contributed to the difference in findings.
Birth related symptoms, such as painful stitches and wound infections after birth, were problematic for women during the first 3 months after birth. Those who had forceps-assisted vaginal births were more likely to report problems, and this may be explained by the high rates of episiotomy and third and fourth degree tears requiring perineal repair in this group. Consistent with previous research
], the risk of bodily changes such as stress incontinence and backache were higher amongst women who had assisted vaginal births whereas these symptoms were less likely to affect women who had operative births.
This is one of the few studies to use population-based data to examine women’s physical and psychological outcomes after childbirth whilst taking into account co-occurring conditions and other key sociodemographic variables. As has been reported previously, women’s physical and psychological outcomes are important to take into account when examining their overall postnatal health and wellbeing
]. In our study, we also found that women’s risk of postnatal physical symptoms was reduced when adjusting for co-occurring psychological symptoms. Our results suggest that both the psychological and physical domains need to be assessed in terms of understanding the factors influencing the duration and severity of problems affecting women’s postnatal health and wellbeing.
Although our findings are based on data from a large, national sample of women, a limitation of the study was the participation rate of 55%, a rate which is similar to that increasingly found in epidemiological studies
]. Because women who did not participate in this study were more likely to be younger, living in a more disadvantaged area and from a BME background, and because these groups tend to have higher rates of poor health and wellbeing generally, our study may underestimate the magnitude of physical and psychological outcomes. However, the similarities between our results and those of previous studies strengthen our conclusions. Another limitation of this study was the reliance on women’s retrospective self-reports of their health and wellbeing after birth. However, the timing of survey completion and return was close enough to the birth for accuracy as far as mode of delivery and other aspects of care were concerned, and for symptom reporting at three months post-partum. Nevertheless, pre-existing experiences and those occurring after birth may be significant in increasing women’s vulnerability to distress and maintaining the distress
] and we cannot be certain that women’s responses were not influenced by prior events or those occurring at the time of survey completion. It is also not clear how well the symptoms recorded in our study could relate to an actual diagnosis of PTSD, and thus we cannot comment on rates of clinical levels of PTSD in our sample. However, given that our findings do reflect those of previous research carried out using smaller samples and different study designs, it seems that the items used in our survey to assess PTSD-type symptoms appear to detect disturbances in new mothers.