title: Depressive symptoms, pain, and sexual dysfunction over the first year following vaginal or cesarean delivery: A prospective longitudinal study.
abstract: BACKGROUND
  Childbirth has a significant impact on maternal health, and the high rate of cesarean delivery is a global health concern. Few studies have used validated measures to explore depression, pain, and sexual dysfunction following vaginal or cesarean delivery over a prolonged time period.
  
  
  OBJECTIVE
  We examined the associations between vaginal and cesarean delivery and depressive symptoms, pain, and sexual function during the 1-year postpartum period.
  
  
  METHODS
  A prospective, five-time-point longitudinal study.
  
  
  METHODS
  Maternity unit at a medical center.
  
  
  METHODS
  A total of 351 of 736 women completed a questionnaire that described demographic characteristics, depressive symptoms, and pain levels at 3-5 days postpartum, and updated personal data, depressive symptoms, pain levels, and sexual function at 4-6 weeks and at 3, 6, and 12 months after delivery.
  
  
  METHODS
  Differences between the vaginal and cesarean groups in depressive symptoms, pain, and sexual function and trends of changes in these factors over the first postpartum year were examined.
  
  
  RESULTS
  Compared with the vaginal birth group, the cesarean birth group had a significantly higher prevalence of depressive symptoms at 3 months (p=0.03); higher scores for non-localized pain at 3-5 days (p<0.001), 4-6 weeks (p=0.03), and 3 months (p=0.046); higher scores for abdominal pain at 3-5 days (p<0.001), 4-6 weeks (p<0.001), and 6 months (p=0.01); lower perineal pain scores at 3-5 days (p <0.001); and higher sexual desire scores (p=0.04) but lower sexual satisfaction scores (p=0.02) at 4-6 weeks. Differences between the vaginal and cesarean groups were significant (p=0.01, p=0.049, respectively) in terms of the decrease in non-localized pain from 3-5 days to 4-6 weeks postpartum and the increase in sexual desire from 4-6 weeks to 3 months postpartum.
  
  
  CONCLUSIONS
  Cesarean delivery was associated with an increased prevalence of depressive symptoms at 3 months and higher pain levels that persisted at 6 months postpartum in Taiwan. We found no difference in sexual function between vaginal and cesarean delivery after 6 weeks postpartum, and no differences in the trends related to depressive symptoms or in sexual functioning (except for desire) within 1 year postpartum.
authors.affiliation: School of Nursing, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan. Electronic address: srchang@ntu.edu.tw.
authors.forename: Shiow-Ru
authors.initials: SR
authors.lastname: Chang
authors.affiliation: Central Taiwan University of Science and Technology, Taichung, Taiwan.
authors.forename: Kuang-Ho
authors.initials: KH
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Hong-Nerng
authors.initials: HN
authors.lastname: Ho
authors.affiliation: School of Nursing, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Yeur-Hur
authors.initials: YH
authors.lastname: Lai
authors.affiliation: Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Ming-I
authors.initials: MI
authors.lastname: Lin
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Chien-Nan
authors.initials: CN
authors.lastname: Lee
authors.affiliation: Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wei-An
authors.initials: WA
authors.lastname: Lin
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D019052:Depression, Postpartum / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D010146:Pain / Q000453:epidemiology*; D011247:Pregnancy; D011446:Prospective Studies; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology
keywords: CES-D; Cesarean delivery; Depression; FSFI; Mode of delivery; Pain; Sexual function; Vaginal delivery