Examination of the Impact of Emergent vs. Scheduled Cesarean Delivery on Postpartum Depression (PPD) in a Diverse Urban Sample

Introduction: Adverse birth experiences may contribute to loss of autonomy and patient dissatisfaction. Existing research is mixed as to whether an emergent cesarean delivery (CD) increases the risk for postpartum depression (PPD) compared to a scheduled CD. This may be due in part to study demographics of racial/ethnic minority representation, screening timepoints in the acute versus subacute period following CD, and PPD operationalization. Previous correlation between emergent CD and PPD was demonstrated when PPD risk was evaluated within four days of delivery in the hospital setting. This investigation aims to explore the relationship between PPD and emergent CD among a diverse urban population in the 6 weeks following CD. Methods: Data were collected from the electronic medical records of 537 postpartum patients (36.7% Black, 25.5% publicly insured) who underwent a CD and completed PPD screening with the Edinburgh Postpartum Depression Scale (EPDS) within 6 weeks of delivery. Among the sample, 231 (43%) had an emergent CD, and 306 (57%) had a scheduled CD, with clinical factors such as non-reassuring fetal heart rate, arrest of labor, and breech presentation in labor contributing to categorization. PPD was operationalized as an EPDS score ≥ 13. Bivariate analyses examined differences in demographic and psychological characteristics between groups. Results: 57 (9.7%) patients were identified to have PPD. There were no statistically significant differences between emergent/urgent vs. scheduled CD groups in rates of PPD, race, ethnicity, employment, type of health insurance, age, history of mood disorder, or prescription of psychiatric medications at screening. Individuals with an emergent CD had higher rates of preterm birth compared to those with a scheduled CD (25.9% vs. 13.2%, p<0.001). Conclusion: In this diverse urban sample, patients who delivered by emergent CD were not found to have higher rates of PPD in the 6 weeks following delivery than those who had a scheduled CD. Although prior data has demonstrated that emergent CD may influence depression risk, particularly when assessed during the acute hospital stay, our data suggests that it may not influence PPD risk after hospital discharge. These findings reinforce the importance of the provision of anticipatory guidance by hospital-based providers regarding warning signs and prevention strategies to all postpartum patients, as it is difficult to determine which patients are at elevated risk for PPD based on delivery factors (e.g., if their CD was emergent or scheduled) alone. Continued research is needed to elucidate how, and for whom, delivery mode impacts risk of PPD.