Depressive symptoms, pain, and sexual dysfunction over the first year following vaginal or cesarean delivery: A prospective longitudinal study

Abstract

Background

Childbirth has a significant impact on maternal health, and the high rate of cesarean delivery is a global health concern. Few studies have used validated measures to explore depression, pain, and sexual dysfunction following vaginal or cesarean delivery over a prolonged time period.

Objective

We examined the associations between vaginal and cesarean delivery and depressive symptoms, pain, and sexual function during the 1-year postpartum period.

Design

A prospective, five-time-point longitudinal study.

Setting

Maternity unit at a medical center.

Participants

A total of 351 of 736 women completed a questionnaire that described demographic characteristics, depressive symptoms, and pain levels at 3–5 days postpartum, and updated personal data, depressive symptoms, pain levels, and sexual function at 4–6 weeks and at 3, 6, and 12 months after delivery.

Methods

Differences between the vaginal and cesarean groups in depressive symptoms, pain, and sexual function and trends of changes in these factors over the first postpartum year were examined.

Results

Compared with the vaginal birth group, the cesarean birth group had a significantly higher prevalence of depressive symptoms at 3 months (p = 0.03); higher scores for non-localized pain at 3–5 days (p < 0.001), 4–6 weeks (p = 0.03), and 3 months (p = 0.046); higher scores for abdominal pain at 3–5 days (p < 0.001), 4–6 weeks (p < 0.001), and 6 months (p = 0.01); lower perineal pain scores at 3–5 days (p <0.001); and higher sexual desire scores (p = 0.04) but lower sexual satisfaction scores (p = 0.02) at 4–6 weeks. Differences between the vaginal and cesarean groups were significant (p = 0.01, p = 0.049, respectively) in terms of the decrease in non-localized pain from 3–5 days to 4–6 weeks postpartum and the increase in sexual desire from 4–6 weeks to 3 months postpartum.

Conclusions

Cesarean delivery was associated with an increased prevalence of depressive symptoms at 3 months and higher pain levels that persisted at 6 months postpartum in Taiwan. We found no difference in sexual function between vaginal and cesarean delivery after 6 weeks postpartum, and no differences in the trends related to depressive symptoms or in sexual functioning (except for desire) within 1 year postpartum.

Introduction

Childbirth has a significant impact on maternal health. Depression, pain, and sexual dysfunction are major postpartum health problems (Hannah et al., 2002, Leeman and Rogers, 2012, Wisner et al., 2002). Cesarean delivery is associated with increased risks of infant mortality (Xie et al., 2015) and complications in subsequent pregnancies (ACOG, 2007, Downes et al., 2015). This is of concern, because the cesarean delivery rate is increasing worldwide (Declercq et al., 2011, Niino, 2011). Postpartum depression influences not only maternal health but also infant or child growth (Nasreen et al., 2013, Surkan et al., 2012) and development (Ali et al., 2013, Fihrer et al., 2009) and paternal depression (Pinheiro et al., 2006). Factors associated with postpartum depression include demographic and obstetric characteristics (Howell et al., 2009, Lacoursiere et al., 2006), endocrine aspects (Glynn et al., 2013), genetic factors (Figueira et al., 2010), and the extent of social support (Xie et al., 2009). Additionally, some studies have found that the mode of delivery was associated with the extent of postpartum depression (Rauh et al., 2012, Yang et al., 2011), whereas others found no such association (Eisenach et al., 2008, Sadat et al., 2014).

Pain after delivery, including headache, perineal pain, abdominal pain, back pain, and nipple pain (Cheng and Li, 2008, Woolhouse et al., 2014), is one of the most prevalent postpartum symptoms (Nikpour et al., 2013, Woolhouse et al., 2014) and is negatively associated with the quality of life after delivery (Baghirzada et al., 2013). A history of pain is associated with postpartum depression (Eisenach et al., 2008, Watkins et al., 2011). Additionally, a fear of perceived pain during vaginal delivery or after cesarean delivery may influence the choice of delivery method (Ecker, 2013, Huang et al., 2013). One study reported a high incidence (79%) of pain in the region of the abdominal incision in mothers who underwent cesarean sections, and 48% of mothers who underwent vaginal delivery complained of perineal pain over the first 2 months postpartum (Declercq et al., 2008). Differences have been reported in the incidence of perineal or abdominal pain, but not in the incidence of general pain, at 3 months postpartum in both mothers who underwent cesarean delivery and those who gave birth vaginally (Hannah et al., 2002). However, few comparisons of pain severity within the first postpartum year between mothers delivering vaginally and those delivering by cesarean section have been made using validated measures subjected to statistical testing.

Sexual functioning during the postpartum period is an issue for both women and their partners (Pastore et al., 2007). Childbirth is associated with anatomical changes in the lower genitourinary tract (Rogers and Leeman, 2007). Women often develop sexual complaints and problems after childbirth (Signorello et al., 2001). Female sexual function after childbirth may be affected by postpartum depression (Chivers et al., 2011). The delivery mode has been associated with sexual function/dysfunction (Baksu et al., 2007, Safarinejad et al., 2009), and dyspareunia-related problems (Barrett et al., 2005). One possible reason for choosing a cesarean delivery may be a fear of sexual dysfunction caused by loss of vaginal muscle tone (Huang et al., 2013). Cesarean delivery has often been assumed to protect postpartum sexual function because it avoids trauma to the genital tract (Barrett et al., 2005). Studies found no association between the delivery mode and sexual function (Klein et al., 2009, Lurie et al., 2013). However, reports on the association between delivery mode and female sexual function are contradictory.

This study compared maternal health in terms of depressive symptoms, pain levels, and sexual function at 3–5 days, 4–6 weeks, and 3, 6, and 12 months postpartum between women who underwent vaginal delivery and those who experienced cesarean delivery. We also compared the trends in the changes in maternal health between the two groups over the first postpartum year.