PTSD and PND are not more likely with a planned cesarean

Last night, I came across this story on postpartum depression on the West Virginia Public Broadcasting website. Referring to a recent study in the Journal of Child Psychology and Psychiatry, it cites that "women who have cesarean deliveries are more likely to suffer from post partum depression than women who deliver vaginally."

What it does not make clear however is that the majority of women who suffer as a result of a traumatic cesarean experience have had emergency surgery at the end of an attempted planned vaginal delivery. Yet unfortunately, most people read articles like this and think: 'mmm, another reason not to have a cesarean - and women who choose to have are putting themselves at great risk if PTSD and PND.'

The truth about birth experiences and how they affect women's mental health.
First of all, have a look at the stories written by women on birth trauma websites - for example, in the UK and Canada. You'll see that the overwhelming majority of cases of PTSD occur following a traumatic planned vaginal delivery (whether the outcome was vaginal or abdominal in the end) and not a planned cesarean delivery.

The medical evidence.
Secondly, look at other evidence and reviews on this subject before drawing any final conclusions. For example, a 2006 New Zealand review that found no such link has been established between cesarean delivery and postpartum depression.

That is not to say that PND or PTSD cannot occur following a planned cesarean delivery, but evidence shows that PTSD in particular is far less likely. The studies below highlight that part of the problem is the correlation between a woman's birth expectations and the actual outcome. As I've highlighted before, compared with planned vaginal delivery and its potential outcomes, a planned cesarean delivery is more likely to have the outcome of a cesarean delivery. Studies have shown that in cases where women have personally chosen to have a planned cesarean delivery, their psychological outcome in so far as it relates specifically to the birth (remember, PND has many other potential triggers) is positively enhanced.

*Elective caesarean delivery at maternal request: A preliminary study of motivations influencing women's decision-making. Robson et al, Australia.
*Cesarean section on maternal request: reasons for the request, self-estimated health, expectations, experience of birth and signs of depression among first-time mothers. Wiklund et al, Sweden.
*Psychologic effects of traumatic live deliveries. Pantlen and Rohde, Germany.
*An investigation of women's involvement in the decision to deliver by caesarean section. Graham et al, UK.
*Psychological Aspects of Emergency Cesarean Section. Ryding EL, Sweden.
*Women's involvement with the decision preceding their caesarean section and their degree of satisfaction. Mould et al, UK.
*More in hope than expectation: a systematic review of women's expectations and experience of pain relief in labour. Lally et al, UK.