Childbirth-related posttraumatic stress disorder and postpartum depression following cesarean delivery
Maternal mental health disorders are fairly common during the perinatal period, predominantly mood- and trauma-related disorders, whether first episodes or relapses. Untreated, these conditions can significantly affect the health of the mother, her child, and family functioning, yet they remain underdiagnosed during the postpartum period. Obstetric care providers must understand the stakes involved and recognize the need to assess mothers’ emotional well-being after childbirth—an essential opportunity for early detection and intervention.
Identifying women at risk is a major challenge. Cesarean delivery has been associated with a higher prevalence of psychiatric disorders, and given the continuously rising cesarean birth rates, improved understanding of its maternal mental health outcomes is essential.
Childbirth-related posttraumatic stress disorder (PTSD) and postpartum depression (PPD) are among the disorders receiving deserved attention in recent years. They frequently overlap, share common risk factors, and may have linked pathophysiological mechanisms. Childbirth-related PTSD can arise from experiencing a traumatic birth, with incidence rates after cesarean delivery reported between 4% and 20% in the first postpartum year. Several obstetric interventions and adverse events may influence this risk, including labor induction, postpartum hemorrhage, absence of immediate skin-to-skin contact, and postoperative pain.
Postpartum depression is defined by clinically significant depressive symptoms or a major depressive episode within the first 12 months after delivery. As a major cause of postpartum morbidity and mortality, its early diagnosis and management are crucial. With a reported prevalence of 20% to 40% after cesarean delivery, this mode of birth represents a high-risk situation. Beyond psychosocial factors, specific cesarean-related elements are also associated with increased PPD symptoms, including emergency cesareans before or during labor, lack of social support, severe postoperative pain, and possibly postpartum anemia.
Two general screening strategies for PTSD and PPD exist: universal screening for all postpartum women, or targeted approaches focused on those with cumulative risk factors or who perceived the birth as traumatic. Self-administered questionnaires can serve as an initial step to identify patients with symptoms who can then be referred for more complete psychological assessment.
Screening, prevention, and early management of these disorders after cesarean delivery should be integral to perinatal care. Immediate postpartum care before discharge and the comprehensive postpartum visit offer key opportunities to assess and prevent mood- and trauma-related disorders. In informed decision-making about mode of delivery, intermediate-term maternal mental health should be weighed alongside short-term maternal and fetal outcomes.
By Alizée FROELIGER, Catherine DENEUX-THARAUX
