Archives of Women's Mental Health

, Volume 22, Issue 6, pp 817–824 | Cite as

Delivery mode is associated with maternal mental health following childbirth

  • Sharon DekelEmail author
  • Tsachi Ein-Dor
  • Zohar Berman
  • Ida S. Barsoumian
  • Sonika Agarwal
  • Roger K. Pitman
Original Article


Childbirth is a life-transforming event often followed by a time of heightened psychological vulnerability in the mother. There is a growing recognition of the importance of obstetrics aspects in maternal well-being with the way of labor potentially influencing psychological adjustment following parturition or failure thereof. Empirical scrutiny on the association between mode of delivery and postpartum well-being remains limited. We studied 685 women who were on average 3 months following childbirth and collected information concerning mode of delivery and pre- and postpartum mental health. Analysis of variance revealed that women who had cesarean section or vaginal instrumental delivery had higher somatization, obsessive compulsive, depression, and anxiety symptom levels than those who had natural or vaginal delivery as well as overall general distress, controlling for premorbid mental health, maternal age, education, primiparity, and medical complication in newborn. Women who underwent unplanned cesarean also had higher levels of childbirth-related PTSD symptoms excluding those with vaginal instrumental. The risk for endorsing psychiatric symptoms reflecting clinically relevant cases increased by twofold following unplanned cesarean and was threefold for probable childbirth-related PTSD. Maternal well-being following childbirth is associated with the experienced mode of delivery. Increasing awareness in routine care of the implications of operative delivery and obstetric interventions in delivery on a woman’s mental health is needed. Screening at-risk women could improve the quality of care and prevent enduring symptoms. Research is warranted on the psychological and biological factors implicated in the mode of delivery and their role in postpartum adjustment.


Delivery mode Childbirth Mental health Postpartum depression Postpartum PTSD 



The authors would like to thank Ms. Shannon Hennig for her generous support in initiating this research project. We also would like to thank Gabriella Dishy for developing the online survey and Philip Mayopoulos for assisting with manuscript editing.


Dr. Dekel was supported by a grant from the National Institute of Child Health and Human Development (R21 HD090396) and an award from the MGH Center for Faculty Development. Dr. Dekel also recieved the Susan A. Hickman Memorial Research Award from Postpartum Support International.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Partners (Massachusetts General Hospital) Human Research Committee granted this study exemption.

Informed consent

This study entailed an anonymous online survey, no personal identifiable information was collected. Participants were informed that by agreeing to complete the study survey, they are implying their consent to participate in the study.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Sharon Dekel
    • 1
    • 2
    Email author
  • Tsachi Ein-Dor
    • 3
  • Zohar Berman
    • 1
    • 2
  • Ida S. Barsoumian
    • 1
  • Sonika Agarwal
    • 1
  • Roger K. Pitman
    • 1
    • 2
  1. 1.Department of PsychiatryMassachusetts General HospitalCharlestownUSA
  2. 2.Harvard Medical SchoolHarvard UniversityBostonUSA
  3. 3.Interdisciplinary CenterHerzliyaIsrael

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