Short- and Long-term Outcomes after Cesarean Section

Rosalie M Grivell; Jodie M Dodd


Expert Rev of Obstet Gynecol. 2011;6(2):205-215. 

In This Article

Maternal Psychological Wellbeing

Maternal psychological wellbeing and satisfaction are less frequently reported than physical health outcomes after cesarean birth. Di Matteo et al. conducted a review and meta-analysis of studies reporting psychosocial outcomes for women after cesarean birth compared with vaginal birth.[51] Included studies measured outcomes in a variety of ways, including self-reported satisfaction with birth, interviews and validated questionnaires, across a range of different time points postpartum. In general, women who birthed by CS described lower degrees of satisfaction with their birth experience. Additionally, women were less likely to breastfeed their infants after cesarean birth, although once breastfeeding was established there were no reported differences in duration.[51] Women who birthed by CS also experienced a longer time from birth to first interaction with their infant, less positive interactions after birth and less interaction with their infant at home.[51]

The Term Breech randomized trial reports maternal outcomes with planned vaginal birth compared with planned CS births for women with a breech presentation beyond 34 weeks.[50] Women were surveyed at 6 weeks, 3 months and 2 years postpartum to ascertain the presence of a number of adverse outcomes, including postpartum depression and perception of their birth experiences. Planned mode of birth did not influence psychological health either immediately postpartum or up until 2 years after birth.[52,53]

In a retrospective qualitative study of women's satisfaction following cesarean birth, 1661 women were asked to indicate satisfaction with their birth, as well as describe any distress experienced in association with the birth.[54] A total of 40% of women whose first birth was either by emergency or elective CS described at least one aspect of the procedure as distressing, with two thirds of women reporting poor communication, fear and other emotions contributing to their distress.[54] Despite this, over 80% of women reported satisfaction with their birth experience. Of note, this study did not involve a comparison group, and the extent of similar experiences among women birthing vaginally remains undetermined. Additionally, outcomes were assessed a number of years after birth and the results may therefore be subject to significant recall bias.

To date, there has been a relative lack of research into paternal experiences of the birthing process. However, it has been reported that first-time fathers experience greater anxiety, frustration and helplessness during an emergency birth of any type when compared with either an elective CS or spontaneous vaginal birth.[55]


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