Elective cesarean section on psychiatric indications - the phenomenon analysis, report of two cases and psychiatric clinical recommendations.

OBJECTIVES In Poland, no guidelines concerning the mode of delivery in patients with psychiatric disorders have so far been developed. The most common psychiatric diagnosis discussed in the Polish literature in the context of the indications for the elective caesarean section is tokophobia. It was confirmed in recent studies that intense fear of childbirth, requiring medical interventions is an important predictor of postpartum depression. Other studies have shown that emergency delivery causes long lasting posttraumatic stress disorder symptoms. The aim of this paper is to discuss the different mental disorders, which may determine psychiatric indications for elective CS. METHODS A literature review and analysis of two cases. Review of the literature was made via MEDLINE and based on such a keywords as: mental health, mode of delivery, caesarean section, psychiatric indications for CS. In the analysis, papers based on population studies and essential because of the potential clinical decisions concerning psychiatric indications for CS were taken into account first. RESULTS Psychiatric indications for the preferred type of delivery are determined individually. They are mainly based on the ability of the psychiatric patient to cooperate with obstetric staff during vaginal delivery. The second area of psychiatric indications is a strong fear of labour that results in the need for psychiatric consultation in the last trimester of pregnancy or the perinatal period. CONCLUSIONS Antenatal care of women with mental disorders requires close cooperation between the obstetricians and psychiatrists specialised in the mental disorders due to somatic state. Such cooperation should lead to preventing both obstetric and psychiatric complications during the pregnancy and labour in women experiencing symptoms of mental disorders.