Whelan Anna R, Recabo Olivia, Ayala Nina K, Clark Melissa A, Lewkowitz Adam K
Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University.
New York Medical College.
Res Sq. 2023 May 9:rs.3.rs-2849715. doi: 10.21203/rs.3.rs-2849715/v1.
Unplanned operative delivery is associated with postpartum depression (PPD), but the mechanism is unknown. We aimed to assess the sense of control over labor for those who had unplanned delivery (unplanned cesarean or operative vaginal delivery: uCD/OVD) versus spontaneous vaginal delivery (SVD).
Secondary analysis of a cross-sectional survey study of term patients admitted for delivery at a tertiary center. After delivery, patients completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor and birth. Demographics, obstetric and neonatal outcomes and LAS scores were compared between patients who underwent uCD/OVD versus SVD. Multivariable logistic regression to assess the relationship between uCD/OVD and LAS score controlling for confounders that differed in the bivariate analysis.
Of the 149 patients, 50 (33.6%) underwent uCD/OVD. There were no differences in maternal age, race/ethnicity, insurance status or education level between those who had uCD/OVD versus SVD. Patients who had uCD/OVD had higher median body mass index (BMI) than those who had SVD (33.2 vs 30.1 kg/m, p = 0.03). There were no differences in rate of medical or psychiatric morbidity between groups. Additionally, there were no differences in reason for admission, however those who had uCD/OVD had significantly longer times to delivery than those who underwent SVD (22 vs 14 hrs, p < 0.01). Gestational age at delivery was also significantly higher for those who underwent uCD/OVD compared to SVD (40.2 vs 39.6 wks, p = 0.02). For the primary outcome, LAS scores were lower for those who underwent uCD/OVD compared to SVD (146 vs. 164, p < 0.01). This remained significant even after controlling for length of labor, BMI and gestational age at delivery (p < 0.01).
Even after accounting for length of labor, uCD/OVD is associated with a reduction in perceived control over labor, which may mediate the known increased risk of PPD. Further qualitative research is needed to examine how to better support patients' wellbeing after uCD/OVD.
非计划分娩与产后抑郁（PPD）相关，但机制尚不清楚。我们旨在评估非计划分娩（非计划剖宫产或手术阴道分娩：uCD/OVD）与自然阴道分娩（SVD）的产妇对分娩的控制感。
对一家三级中心收治的足月分娩患者进行的横断面调查研究进行二次分析。分娩后，患者完成分娩自主性量表（LAS），这是一种经过验证的评估对分娩和生产的感知控制的工具。比较接受uCD/OVD与SVD的患者的人口统计学、产科和新生儿结局以及LAS评分。进行多变量逻辑回归分析，以评估uCD/OVD与LAS评分之间的关系，并控制双变量分析中存在差异的混杂因素。
149例患者中，50例（33.6%）接受了uCD/OVD。接受uCD/OVD与SVD的患者在产妇年龄、种族/民族、保险状况或教育水平方面无差异。接受uCD/OVD的患者的中位体重指数（BMI）高于接受SVD的患者（33.2 vs 30.1 kg/m²，p = 0.03）。两组之间的医疗或精神疾病发病率无差异。此外，入院原因无差异，但接受uCD/OVD的患者的分娩时间明显长于接受SVD的患者（22小时 vs 14小时，p < 0.01）。与SVD相比，接受uCD/OVD的患者的分娩孕周也明显更高（40.2周 vs 39.6周，p = 0.02）。对于主要结局，接受uCD/OVD的患者的LAS评分低于接受SVD的患者（146 vs. 164，p < 0.01）。即使在控制了产程、BMI和分娩孕周后，这一差异仍然显著（p < 0.01）。
即使在考虑了产程之后，uCD/OVD仍与对分娩的感知控制降低有关，这可能介导了已知的PPD风险增加。需要进一步进行定性研究，以探讨如何在uCD/OVD后更好地支持患者的健康。
