Unplanned cesareans may double risk of acute stress after birth

Patients who undergo unplanned caesarean deliveries face higher odds of acute psychological stress after birth, a recent study has revealed.

The study followed more than 1,100 women who gave birth and found that over one in four patients who had an unscheduled caesarean experienced clinically significant acute stress shortly after birth, compared with about one in 16 patients who delivered vaginally.

Even after accounting for medical complications, prior trauma and mental health history, individuals who had unscheduled caesareans remained more than twice as likely to experience severe stress.

Sharon Dekel is lead investigator and member of the Postpartum Traumatic Stress Disorders Research Program in the Mass General Brigham Department of Psychiatry.

The researcher said: “Unscheduled caesarean delivery can be lifesaving, but for some patients it is also a deeply distressing experience.

“Our findings show that the emotional impact of these births is common, measurable, and clinically meaningful.

“While most patients are resilient and won’t have a stress response, we want to make sure that people who are struggling get the resources they need.”

Researchers at Mass General Brigham found that stress levels were highest when caesarean delivery occurred during labour or when there were greater obstetric complications (pregnancy and childbirth-related health issues).

These early stress reactions were not fleeting.

Women who reported high levels of acute stress shortly after childbirth were significantly more likely to develop post-traumatic stress symptoms, depression and difficulties bonding with their infants two months later.

Dekel and her colleagues are working on implementing a questionnaire that could help screen postpartum patients at Mass General Brigham and beyond.

The findings also support calls for trauma-informed obstetric and postpartum care, particularly for patients who have undergone unexpected interventions during childbirth.

Dekel noted that some patients may have an acute stress response but their symptoms may improve with time, which may mean it is important to screen both immediately after birth and later.

She said: “This study highlights the potential value of brief, low-burden screening for acute stress during postpartum hospitalisation, especially after unplanned or medically complicated deliveries.

“Sometimes, childbirth can become an event that is emotionally loaded or a traumatic experience. But we have great ways of helping people cope, which is why we want to identify patients early and help them get connected.”