Psychosocial risk factors for emergency cesarean section

Česká verzia

Authors: L. Takács ¹; J. Mlíková Seidlerová ²; P. Čepický ³
Authors place of work: Katedra psychologie FF UK, Praha, vedoucí katedry doc. PhDr. MUDr. R. Bahbouh, Ph. D. ¹; II. interní klinika FN a LF UK, Plzeň, přednosta prof. MUDr. J. Filipovský, CSc. ²; Gynekologicko-porodnická klinika, Nemocnice Na Bulovce, 1. LF UK, Praha, přednosta prof. MUDr. M. Zikán, Ph. D. ³
Published in the journal: Ceska Gynekol 2019; 84(1): 33-39
Category: Original Article

Summary

Objective: To compare the effects of childbirth fear and trait anxiety on the risk of emergency cesarean section; to analyze whether emergency cesarean section is associated with low mastery and maternal self-esteem; to examine whether stress and low social support in pregnancy may be considered risk factors for emergency cesarean section.

Design: Original study.

Setting: Department of Psychology, Faculty of Arts, Charles University, Prague.

Methods: The study sample consisted of 447 women who gave birth at a maternity hospital in Vysočina Region (Havlíčkův Brod, Jihlava, Pelhřimov, Třebíč, Nové Město na Moravě) between October 2013 and September 2014. In the last trimester of pregnancy, the women completed validated questionnaires designed to assess fear of childbirth, general anxiety, maternal self-esteem, mastery, perceived stress and social support. Data regarding the course of labor were extracted from medical records. The association between the psychosocial factors and the risk of delivery via emergency cesarean section was analyzed using multiple logistic regression adjusted for marital status, parity, child‘s sex and epidural anesthesia.

Results: A total of 73 women (16.3%) delivered by emergency cesarean section. The only statistically significant psychosocial predictor of emergency cesarean section was fear of childbirth (the women with strong fear had a twice higher risk; OR = 2.01; p = 0.021), whereas low maternal self-esteem was marginally significant (OR = 1.68; p = 0.082) in the adjusted analysis. No association between emergency cesarean section and general anxiety, mastery, stress or social support in pregnancy was found. The risk of cesarean section was higher for primiparous women and lower for women who gave birth to a girl.

Conclusion: Fear of childbirth but not general anxiety is associated with a higher risk of emergency cesarean section. The women who experience strong fear of childbirth during pregnancy should be recommended to attend antenatal classes or, in case of extremely severe childbirth fear, to seek psychological counseling.

Keywords:

pregnancy – childbirth – psychosocial aspects – fear of childbirth – cohort studies

Zdroje

1. Ambroz, P., Janoutová, J., Machaczka, O., et al. [Are risk factors in prenatal and perinatal period important for develompent of schizophrenia?] Ces Gynek, 2017, 82(1), p. 24–27.

2. Athukorala, C., Rumbold, AR., Willson, KJ., Crowther, CA. The risk of adverse pregnancy outcomes in women who are overweight or obese. BMC Pregnancy Childbirth, 2010, 10, p. 56.

3. Bayrampour, H., Salmon, C., Vinturache, A., Tough, S. Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions. J Obstet Gynaecol Res, 2015, 41(7), p. 1040–1048.

4. Berentson-Shaw, J., Scott, KM., Jose, PE. Do self-efficacy beliefs predict the primiparous labour and birth experience? A longitudinal study. J Reprod Infant Psychol, 2009, 27(4), p. 357–373.

5. Betrán, AP., Ye, J., Moller, A-B., et al. The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PloS one, 2016, 11(2), p. e0148343.

6. Campillo-Artero, C., Serra-Burriel, M., Calvo-Perez, A. Predictive modeling of emergency cesarean delivery. PLoS One, 2018, 13(1), p. e0191248.

7. Carlsson, IM., Ziegert, K., Nissen, E. The relationship between childbirth self-efficacy and aspects of well-being, birth interventions and birth outcomes. Midwifery, 2015, 31(10), p. 1000–1007.

8. Cohen, S., Kamarck, T., Mermelstein, R. Perceived stress scale. Measuring stress: A guide for health and social scientists, 1994.

9. Costa, PT., McCrae, RR. The revised neo personality inventory (neo-pi-r). The SAGE handbook of personality theory and assessment, 2008, 2(2), p. 179–198.

10. Curran, EA., Khashan, AS., Dalman, C., et al. Obstetric mode of delivery and attention-deficit/hyperactivity disorder: a sibling-matched study. Inter J Epidemiol, 2016, 45(2), p. 532–542.

11. Curran, EA., O‘Neill, SM., Cryan, JF., et al. Research review: Birth by caesarean section and development of autism spectrum disorder and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Child Psychol Psychiat Allied Disciplines, 2015, 56(5), p. 500–508.

12. Essex, HN., Green, J., Baston, H., Pickett, KE. Which women are at an increased risk of a caesarean section or an instrumental vaginal birth in the UK: an exploration within the Millennium Cohort Study. BJOG, 2013, 120(6), p. 732–742; discussion p. 742–733.

13. Farrow, C., Blissett, J. The development of maternal self-esteem. Infant Ment Health J, 2007, 28(5), p. 517–535.

14. Ferreira, CR., Orsini, MC., Vieira, CR., et al. Prevalence of anxiety symptoms and depression in the third gestational trimester. Arch Gynecol Obstet, 2015, 291(5), p. 999–1003.

15. Gagnon, AJ., Merry, L., Haase, K. Predictors of emergency cesarean delivery among international migrant women in Canada. Int J Gynaecol Obstet, 2013, 121(3), p. 270–274.

16. Haines, HM., Rubertsson, C., Pallant, JF., Hildingsson, I. The influence of women’s fear, attitudes and beliefs of childbirth on mode and experience of birth. BMC Pregnancy Childbirth, 2012, 12(1), p. 55.

17. Handelzalts, JE., Becker, G., Ahren, M-P., et al. Personality, fear of childbirth and birth outcomes in nulliparous women. Arch Gynecol Obstet, 2014, 291(5), p. 1055–1062.

18. Heretik, A., Ritomsky, A., Novotny, V., et al. Restandardization of state-trait anxiety inventory X-2-trait-anxiety. CS Psychol, 2009, 53(6), p. 587–599.

19. Hyde, MJ., Modi, N. The long-term effects of birth by caesarean section: the case for a randomised controlled trial. Early human development, Early Hum Dev 2012, 88(12), p. 943–949.

20. Chong, SC., Broekman, BF., Qiu, A., et al. Anxiety and Depression during Pregnancy and Temperament in Early Infancy: Findings from a Multi-Ethnic, Asian, Prospective Birth Cohort Study. Infant Ment Health J, 2016, 37(5), p. 584–598.

21. Chu, S., Zhang, Y., Jiang, Y., et al. Cesarean section without medical indication and risks of childhood allergic disorder, attenuated by breastfeeding. Sci Reports, 2017, 7(1), p. 9762–9762.

22. Johnston, RG., Brown, AE. Maternal trait personality and childbirth: the role of extraversion and neuroticism. Midwifery, 2013, 29(11), p. 1244–1250.

23. Keag, OE., Norman, JE., Stock, SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS medicine, 2018, 15(1), p. e1002494.

24. Kjerulff, KH., Brubaker, LH. New mothers‘ feelings of disappointment and failure after cesarean delivery. Birth, 2018, 45(1), p. 19–27.

25. Ko, YL., Lin, PC., Chen, SC. Stress, sleep quality and unplanned Caesarean section in pregnant women. Int J Nurs Pract, 2015, 21(5), p. 454–461.

26. Koelewijn, JM., Sluijs, AM., Vrijkotte, TGM. Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study. BMJ Open, 2017, 7(5), p. e013413.

27. Laursen, M., Johansen, C., Hedegaard, M. Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort. BJOG, 2009, 116(10), p. 1350–1355.

28. Lobel, M., DeLuca, RS. Psychosocial sequelae of cesarean delivery: Review and analysis of their causes and implications. Social Sci Med, 2007, 64(11), p. 2272–2284.

29. Moyer, CA., Elsayed, Y., Zhu, Y., et al. Is generalized maternal optimism or pessimism during pregnancy associated with unplanned cesarean section deliveries in China? J Pregnancy, 2010, 2010, p. 754938.

30. Newham, JJ., Westwood, M., Aplin, JD., Wittkowski, A. State–trait anxiety inventory (STAI) scores during pregnancy following intervention with complementary therapies. J affective Disorders, 2012, 142(1), p. 22–30.

31. Noyman-Veksler, G., Herishanu-Gilutz, S., Kofman, O., et al. Post-natal psychopathology and bonding with the infant among first-time mothers undergoing a caesarian section and vaginal delivery: sense of coherence and social support as moderators. Psychol Health, 2015, 30(4), p. 441–455.

32. Pearlin, LI., Schooler, C. The structure of coping. J Health social Behav, 1978, p. 2–21.

33. Reck, C., Zimmer, K., Dubber, S., et al. The influence of general anxiety and childbirth-specific anxiety on birth outcome. Arch Womens Ment Health, 2013, 16(5), p. 363–369.

34. Robson, SJ., Vally, H., Mohamed, AL., et al. Perinatal and social factors predicting caesarean birth in a 2004 Australian birth cohort. Women Birth, 2017, 30(6), p. 506–510.

35. Rowe-Murray, HJ., Fisher, JR. Operative intervention in delivery is associated with compromised early mother-infant interaction. Brit J Obstet Gynaecol, 2001, 108(10), p. 1068–1075.

36. Ryding, E., Wijma, B., Wijma, K., Rydhström, H. Fear of childbirth during pregnancy may increase the risk of emergency cesarean section. Acta Obstet Gynecol Scand, 1998, 77(5), p. 542–547.

37. Spielberger, CD. State-Trait anxiety inventory: Wiley Online Library; 2010.

38. Takács, L., Smolík, F., Mlíková Seidlerová, J., et al. [Postpartum blues – a Czech adaptation of the Maternity Blues Questionnaire]. Ces Gynek, 2016, 81(5), p. 355–368.

39. Urbánek, S., Brádková, H., Beroušková, P., Farajpour, F. [Severe bleeding one year after a cesarean section caused by placenta increta persistens]. Ces Gynek, 2012, 77(3), p. 187–189.

40. Van de Pol, G., De Leeuw, J., Van Brummen, H., et al. Psychosocial factors and mode of delivery. J Psychosomat Obstet Gynecol, 2006, 27(4), p. 231–236.

41. Wangel, AM., Molin, J., Ostman, M., Jernstrom, H. Emergency cesarean sections can be predicted by markers for stress, worry and sleep disturbances in first-time mothers. Acta Obstet Gynecol Scand, 2011, 90(3), p. 238–244.

42. Xu, H., Ding, Y., Ma, Y., et al. Cesarean section and risk of postpartum depression: A meta-analysis. J Psychosomat Res, 2017, 97, p. 118–126.

43. Yip, BHK., Leonard, H., Stock, S., et al. Caesarean section and risk of autism across gestational age: a multi-national cohort study of 5 million births. Inter J Epidemiol, 2017, 46(2), p. 429–439.

44. Zar, M., Wijma, K., Wijma, B. Relations between anxiety disorders and fear of childbirth during late pregnancy. Clin Psychol Psychother, 2002, 9(2), p. 122–130.

45. Zimet, GD., Dahlem, NW., Zimet, SG., Farley, GK. The multidimensional scale of perceived social support. J personality Ass, 1988, 52(1), p. 30–41.