Delivery mode is associated with maternal mental health following childbirth
Delivery mode is associated with maternal mental health following childbirth
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DOI：
10.1007/s00737-019-00968-2
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发表时间：
2019-12-01
影响因子：
4.5
通讯作者：
Pitman, Roger K.
中科院分区：
文献类型：
--
作者：
Dekel, Sharon;Ein-Dor, Tsachi;Pitman, Roger K.
分娩是一个改变生活的事件，往往伴随着母亲心理脆弱性的加剧。越来越多的人认识到产科方面对产妇福祉的重要性，分娩方式可能影响分娩或分娩失败后的心理调整。对分娩方式和产后幸福感之间关系的实证研究仍然有限。我们研究了685名平均产后3个月的妇女，并收集了有关分娩方式和产前产后心理健康的信息。方差分析显示，剖宫产或阴道器械分娩的妇女有较高的躯体化，强迫，抑郁和焦虑症状水平比那些自然或阴道分娩以及整体的一般困扰，控制病前心理健康，母亲的年龄，教育，产次，新生儿的医疗并发症。接受计划外剖宫产的妇女也有较高水平的分娩相关的创伤后应激障碍症状，不包括那些阴道工具。在计划外剖宫产后，精神症状反映临床相关病例的风险增加了两倍，而可能与分娩相关的PTSD的风险增加了三倍。产妇分娩后的幸福感与有经验的分娩方式有关。需要在日常护理中提高对手术分娩和产科分娩干预对妇女心理健康影响的认识。筛查高危妇女可以提高护理质量，预防持久的症状。有必要对分娩方式所涉及的心理和生物因素及其在产后调整中的作用进行研究。
Childbirth is a life-transforming event often followed by a time of heightened psychological vulnerability in the mother. There is a growing recognition of the importance of obstetrics aspects in maternal well-being with the way of labor potentially influencing psychological adjustment following parturition or failure thereof. Empirical scrutiny on the association between mode of delivery and postpartum well-being remains limited. We studied 685 women who were on average 3 months following childbirth and collected information concerning mode of delivery and pre- and postpartum mental health. Analysis of variance revealed that women who had cesarean section or vaginal instrumental delivery had higher somatization, obsessive compulsive, depression, and anxiety symptom levels than those who had natural or vaginal delivery as well as overall general distress, controlling for premorbid mental health, maternal age, education, primiparity, and medical complication in newborn. Women who underwent unplanned cesarean also had higher levels of childbirth-related PTSD symptoms excluding those with vaginal instrumental. The risk for endorsing psychiatric symptoms reflecting clinically relevant cases increased by twofold following unplanned cesarean and was threefold for probable childbirth-related PTSD. Maternal well-being following childbirth is associated with the experienced mode of delivery. Increasing awareness in routine care of the implications of operative delivery and obstetric interventions in delivery on a woman's mental health is needed. Screening at-risk women could improve the quality of care and prevent enduring symptoms. Research is warranted on the psychological and biological factors implicated in the mode of delivery and their role in postpartum adjustment.