title: Mode of delivery and postpartum depression: the role of patient preferences.
abstract: OBJECTIVE
  The purpose of this study was to explore the relationship between strength of preference for vaginal delivery, delivery mode undergone, and postpartum depression.
  
  
  METHODS
  We conducted a secondary analysis of data from a longitudinal study of delivery-mode preferences. During an interview between 24-36 weeks of gestation, participants were asked whether they preferred vaginal or cesarean delivery; the strength of this preference was measured by the standard gamble metric. Depression was assessed antepartum and at 8-10 weeks and 6-8 months after delivery by using the Patient Health Questionnaire (PHQ-9). The primary outcome was PHQ-9 score at 8-10 weeks after delivery. We used multivariable regression analysis to assess the effect of strength of preference for vaginal delivery and delivery mode undergone on postpartum depression.
  
  
  RESULTS
  Of 160 participants, 33.1% were nulliparous, and 30.6% had a previous cesarean delivery. Most of the participants (92.4%) preferred vaginal delivery, but the strength of preference varied substantially. The mean strength-of-preference score (0-1 scale; higher scores denote stronger vaginal delivery preference) was 0.658 (SD, ±0.352). A significant interaction emerged between the effects of delivery mode and vaginal delivery preference score on postpartum PHQ-9 score (P = .047). Specifically, a stronger preference for vaginal delivery was associated with higher PHQ-9 scores among women who underwent cesarean delivery (P = .027) but not among women who underwent vaginal delivery (P = .761). The interaction between delivery mode and vaginal delivery preference score was no longer significant at 6-8 months after delivery.
  
  
  CONCLUSIONS
  Women who have a strong antepartum preference for vaginal delivery and deliver by cesarean may be at increased risk for depression in the early postpartum period.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA. Electronic address: houstonk@obgyn.ucsf.edu.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Houston
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Anjali J
authors.initials: AJ
authors.lastname: Kaimal
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Sanae
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gregorich
authors.affiliation: Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Yee
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000523:psychology; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology*; D019052:Depression, Postpartum / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D015999:Multivariate Analysis; D010298:Parity; D057240:Patient Preference / Q000523:psychology*; D011247:Pregnancy; D011446:Prospective Studies; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: mode of delivery; patient preferences; postpartum depression