Operative delivery and postnatal depression: a cohort study.

OBJECTIVES To assess the association between elective caesarean section and postnatal depression compared with planned vaginal delivery and whether emergency caesarean section or assisted vaginal delivery is associated with postnatal depression compared with spontaneous vaginal delivery. DESIGN Prospective population based cohort study. SETTING ALSPAC (the Avon longitudinal study of parents and children). PARTICIPANTS 14,663 women recruited antenatally with a due date between 1 April 1991 and 31 December 1992. MAIN OUTCOME MEASURE Edinburgh postnatal depression scale score > or = 13 at eight weeks postnatal on self completed questionnaire. RESULTS Albeit with wide confidence intervals, there was no evidence that elective caesarean section altered the odds of postnatal depression compared with planned vaginal delivery (adjusted odds ratio 1.06, 95% confidence interval 0.66 to 1.70, P = 0.80). Among planned vaginal deliveries there was similarly little evidence of a difference between women who have emergency caesarean section or assisted vaginal delivery and those who have spontaneous vaginal delivery (1.17, 0.77 to 1.79, P = 0.46, and 0.89, 0.68 to 1.18, P = 0.42, respectively). CONCLUSIONS There is no reason for women at risk of postnatal depression to be managed differently with regard to mode of delivery. Elective caesarean section does not protect against postnatal depression. Women who plan vaginal delivery and require emergency caesarean section or assisted vaginal delivery can be reassured that there is no reason to believe that they are at increased risk of postnatal depression.