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One in four women undergoing unscheduled cesarean delivery develops clinical acute stress, significantly raising the likelihood of postpartum psychological disorders.
Unplanned C-sections may quadruple the risk of acute childbirth trauma and also raise the likelihood of postpartum post-traumatic stress disorder (PTSD), depression, and maternal–infant bonding problems, according to new research highlighting urgent gaps in maternal mental health screening.
In this prospective study, 1,146 women receiving routine perinatal care at a tertiary urban hospital were examined for peritraumatic stress approximately 31 hours after delivery using the peritraumatic distress inventory (PDI). A subgroup of 795 women (69.4%) completed follow-up assessments at 1.9 months postpartum. Researchers analyzed delivery mode, obstetric complications, trauma history, and antepartum and postpartum psychiatric symptoms via advanced statistical models.
Overall, 10.4% of volunteers fulfilled criteria for clinical acute stress (PDI ≥15). The prevalence was markedly greater among those undergoing unscheduled cesarean delivery, with 26.6% reporting clinical stress. Rates rose to 29.3% when cesareans were performed during labor, and greater obstetric morbidity was considerably associated with higher stress severity. Compared with vaginal delivery (6.3%), unscheduled cesarean was linked to a 4-fold higher risk of acute stress (26.6%), with a relative risk of 4.20.
This association remained significant even after controlling for demographic factors, labor induction, primiparity, obstetric complications, prior trauma exposure, antepartum mental health, and timing of stress assessment. Stress symptoms among women with unscheduled cesareans remained persistently elevated over time, while those who had vaginal deliveries illustrated significant symptom reduction. Acute peritraumatic stress strongly predicted later:
The findings underscore that unplanned cesarean delivery is not only a surgical event but also a major psychological stressor. Routine postpartum screening for acute traumatic stress during hospital stay may help identify high-risk mothers early and improve long-term maternal mental health outcomes.
Pregnancy (Hoboken)
The psychological impact of childbirth: Unscheduled cesarean delivery associates with increased risk for acute stress response
Hadas Allouche-Kam et al.
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