C-section won't increase depression

The mode of delivery doesn't influence a woman's risk of developing postpartum depression at six weeks, a new Canadian prospective study shows.

However, the investigation did reveal that women with urinary incontinence were nearly twice as likely to have postpartum depression.

Several other factors were also tied to postpartum depression risk in the study, especially maternal age younger than 25 and maternal hospital readmission.

"The fact that we didn't find an association between the type of delivery is rather in keeping with most of the other research," said Dr Wendy Sword of McMaster University in Hamilton, Ontario, the study's first author. "Probably the most unique finding for us is something that hasn't been widely studied, this whole issue of incontinence."

The research

Dr Sword and her colleagues looked at 1,897 women age 16 and older who delivered a singleton infant at full term at 11 different hospitals in Ontario. They were able to interview the women six weeks after discharge. One-third had C-section deliveries.

Using a score of 12 or greater on the Edinburgh Postnatal Depression Scale as a cut-off, the researchers found 7.6% of the women had postpartum depression when they were interviewed.

Thirty-four factors (of a total of 56 tested) had a significant relationship with postpartum depression risk on bivariate analysis, while multivariate analysis found 11 variables remained significant.

The strongest five were young age (OR 5.27); maternal hospital readmission (OR 3.02); non-initiation of breastfeeding (OR 2.02); good, fair or poor self-reported health, versus excellent or very good (OR 1.82) and urinary incontinence (OR 1.79).

All but one of the other factors, having a high number of unmet learning needs in the hospital (OR 1.12), had previously been linked to postpartum depression risk, such as low social support and multiparity.

Stress could be responsible

While the study didn't look at why incontinence might increase depression risk, Dr Sword noted that the stress of having incontinence could be responsible. Also, she added, women may be reluctant to talk to their caregiver about this issue, so it goes untreated.

Medical changes in surgical delivery, such as use of regional rather than general anesthesia, as well as greater societal acceptance of C-section delivery, have likely reduced the vulnerability of women to mood problems afterward as compared to decades ago, the researchers note.

The findings underscore the importance of health professionals following up with women postpartum, at their ob-gyn visits or even during well-child visits, to determine if they are having emotional and mood problems, and if so to help them to get treatment, Dr Sword said.

(Reuters Health, Anne Harding, May 2011)

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Depression centre

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