title: Mode of delivery and postpartum emotional distress: a cohort study of 55,814 women.
abstract: OBJECTIVE
  To assess the association between mode of delivery and maternal postpartum emotional distress.
  
  
  METHODS
  A prospective study of women from 30 weeks of gestation to 6 months postpartum.
  
  
  METHODS
  Pregnant women in Norway during the period 1998-2008.
  
  
  METHODS
  A total of 55,814 women from the Norwegian Mother and Child Cohort Study.
  
  
  METHODS
  Emotional distress was reported in a short form of the Hopkins Symptom Checklist-25 (SCL-8) at 30 weeks of gestation and at 6 months postpartum. Information on mode of delivery was obtained from the Medical Birth Registry of Norway.
  
  
  METHODS
  Changes in SCL-8 score from 30 weeks of gestation to 6 months postpartum and presence of emotional distress at 6 months postpartum.
  
  
  RESULTS
  Women with instrumental vaginal, emergency caesarean or elective caesarean deliveries had similar changes in SCL-8 score between 30 weeks of gestation and 6 months postpartum, as compared with women with unassisted vaginal delivery (adjusted regression coefficient, 0.00, 95% CI -0.01 to 0.01; 0.01, 95% CI 0.00-0.02; and -0.01, 95% CI -0.02 to 0.00, respectively). The corresponding odds ratios (ORs) associated with the presence of emotional distress at 6 months postpartum (SCL-8 ≥ 2.0) were: OR 1.01, 95% CI 0.86-1.18; OR 1.13, 95% CI 0.97-1.32; and OR 0.96, 95% CI 0.79-1.16, respectively. These estimates were adjusted for emotional distress during pregnancy and other potential confounding factors. Emotional distress during pregnancy showed the strongest association with the presence of emotional distress at 6 months postpartum (adjusted OR 14.09, 95% CI 12.77-15.55).
  
  
  CONCLUSIONS
  Mode of delivery was not associated with a change in SCL-8 score from 30 weeks of gestation to 6 months postpartum or with the presence of emotional distress postpartum.
authors.affiliation: Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway. samantha.s.adams@ahus.no
authors.forename: S S
authors.initials: SS
authors.lastname: Adams
authors.forename: M
authors.initials: M
authors.lastname: Eberhard-Gran
authors.forename: Å R
authors.initials: ÅR
authors.lastname: Sandvik
authors.forename: A
authors.initials: A
authors.lastname: Eskild
mesh_terms: D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms / Q000209:etiology*; D001007:Anxiety / Q000209:etiology; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000523:psychology*; D019052:Depression, Postpartum / Q000209:etiology*; D005239:Fear; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000523:psychology; D016017:Odds Ratio; D011247:Pregnancy / Q000523:psychology; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires; D055815:Young Adult