Association Between Mode of Birth and Posttraumatic Stress Disorder Following Childbirth: A Prospective Cohort Study of Chinese Women

Background Previous studies on the association between mode of delivery and posttraumatic stress disorder have yielded inconsistent results. This study aimed to further investigate the association between mode of delivery and posttraumatic stress disorder in a cohort of Chinese women with a high rate of cesarean delivery.Methods We conducted a prospective cohort study in Guangdong, China between October 2019 and August 2020. Women aged 20-45 years who visited Nanhai Hospital of Southern Medical University for prenatal care and planned to give birth at the same hospital during the study period were approached and were enrolled after a written consent was obtained. Posttraumatic stress disorder was assessed by the Posttraumatic Stress Disorder Checklist-Civilian Version. We first compared the sociodemographic and obstetric characteristics between cesarean delivery group and vaginal delivery group. We then examined the independent association between mode of birth and posttraumatic stress disorder by log binomial regression analysis.Results A total of 630 women were included in the final analysis, with 385 (61%) who delivered vaginally and 245 (39%) who delivered by cesarean section. Fifty-six (8.9%) women developed posttraumatic stress disorder. Of them, 31 (12.7%) occurred in women with cesarean section, and 25 (6.5%) occurred in women with vaginal delivery. The risk of developing posttraumatic stress disorder in women with cesarean section was more than twice of that in women with vaginal delivery after adjusting for confounding variables (adjusted RR 1.91, 95% CI 1.08 to 3.36).Conclusion Cesarean section is an independent risk factor of posttraumatic stress disorder in a cohort of Chinese women with a high cesarean section rate.