Obstetric Complications and Psychological Well-being: Experiences of Bangladeshi Women during Pregnancy and Childbirth

Abstract

Women in developing countries experience postnatal depression at rates that are comparable with or higher than those in developed countries. However, their personal experiences during pregnancy and childbirth have received little attention in relation to postnatal depression. In particular, the contribution of obstetric complications to their emotional well-being during the postpartum period is still not clearly understood. This study aimed to (a) describe the pregnancy and childbirth experiences among women in Bangladesh during normal childbirth or obstetric complications and (b) examine the relationship between these experiences and their psychological well-being during the postpartum period. Two groups of women—one group with obstetric complications (n=173) and the other with no obstetric complications (n=373)—were selected from a sample of women enrolled in a community-based study in Matlab, Bangladesh. The experiences during pregnancy and childbirth were assessed in terms of a five-point rating scale from ‘severely uncomfortable=1’ to ‘not uncomfortable at all=5’. The psychological status of the women was assessed using a validated local version of the Edinburgh Postnatal Depression Scale (EPDS) at six weeks postpartum. Categorical data were analyzed using the chi-square test and continuous data by analysis of variance. Women with obstetric complications reported significantly more negative experiences during their recent childbirth [95% confidence interval (CI) 1.36-1.61, p<0.001] compared to those with normal childbirth. There was a significant main effect on emotional well-being due to experiences of pregnancy [F (4,536)=4.96, p=0.001] and experiences of childbirth [F (4,536)=3.29, p=0.01]. The EPDS mean scores for women reporting severe uncomfortable pregnancy and childbirth experiences were significantly higher than those reporting no such problems. After controlling for the background characteristics, postpartum depression was significantly associated with women reporting a negative childbirth experience. Childbirth experiences of women can provide important information on possible cases of postnatal depression.

Childbirth and symptoms of postpartum depression and anxiety: a prospective birth cohort study

“…Since 2006, a methodologically strong study ( n =55,814) by Adams et al (2012) has corroborated this null relationship between mode of delivery and elevated symptoms of depression. Similarly, most authors report no increased likelihood of elevated symptoms of depression after exposure to birth complications or interventions; however, studies differ widely in their defining variables and how variables are scored (e.g., labor dystocia, eclampsia, infection, epidural, artificial rupture of membranes, labor induction/augmentation, episiotomy, hemorrhage, newborn in special care) (Blom et al 2010; Fairbrother and Woody 2007; Fisher et al 1997; Gausia et al 2012; Johnstone et al 2001; Murray and Cartwright 1993; Rowe-Murray and Fisher 2001). Only a few authors have reported on elevated symptoms of depression after exposure to labor pain medication; findings are inconsistent and inconclusive due to wide variation in sample size, assessment of antenatal mood, and bivariate versus multivariate analyses (Astbury et al 1994; Hiltunen et al 2004; Righetti-Veltema et al 1998).…”

“…Likewise, many studies suggest that the likelihood of elevated symptoms of depression is lower in women reporting birth as a positive birth experience (Gausia et al 2012; Giakoumaki et al 2009; Gurber et al 2012; Sorenson and Tschetter 2010; Weisman et al 2010), greater labor support from care providers (Cigoli et al 2006; Sorenson and Tschetter 2010), greater involvement with labor management decisions (Green and Baston 2003; Green et al 1990), and a less difficult birth (Tuohy and McVey 2008), although the studies typically did not control for antenatal symptoms of depression.…”

“…While the weight of the evidence supports no association between mode of delivery and elevated postpartum symptoms of depression (Adams et al 2012; Carter et al 2006), due to methodological limitations, there is insufficient evidence to know whether other types of birth events (such as interventions, complications, pain medication, and delayed mother-infant contact after birth) are related to elevated postpartum symptoms of depression (Astbury et al 1994; Blom et al 2010; Fairbrother and Woody 2007; Fisher et al 1997; Gausia et al 2012; Hiltunen et al 2004; Johnstone et al 2001; Murray and Cartwright 1993; Righetti-Veltema et al 1998; Rowe-Murray and Fisher 2001). In contrast to objectively measured childbirth variables, the literature suggests that women's perception of their recent birth experience (measured by global scales of satisfaction and by specific elements within the experience) may be a predictor of elevated postpartum symptoms of depression (Cigoli et al 2006; Gausia et al 2012; Giakoumaki et al 2009; Green and Baston 2003; Green et al 1990; Gurber et al 2012; Neter et al 1995; Saisto et al 2001; Sorenson and Tschetter 2010; Tuohy and McVey 2008; Weisman et al 2010). Risk factors for postpartum anxiety are understudied; however, the weight of the limited evidence suggests no association between mode of delivery and risk of postpartum anxiety and there are no investigations we are aware of on the relationship between other types of birth events and postpartum anxiety (Bradley et al 1983; Fatoye et al 2006; Giakoumaki et al 2009; Weisman et al 2010).…”

Factors of psychiatric morbidity during perinatal period

“…16 Another study in rural area of Bangladesh revealed that highest respondents had primary education. 17 This inconsistent finding might be due to the difference of selection of study places. In the view of economic condition, more (7.1%) psychiatric disorders were found in the income group more than 15000 TK.…”

Risk of Depressive Symptoms Associated with Morbidity in Postpartum Women in Rural Bangladesh

“…In addition to research on postpartum conditions, literature is accumulating about the effects of birth complications on depressive symptoms. In Asia, pregnancy complications, negative childbirth experiences, and severe morbidity at the time of childbirth have been associated with subsequent postpartum depressive symptomatology (Gausia et al, 2012; Giri et al, 2015; Lyengar, Yadav, & Sen, 2012; Shivalli & Gururaj, 2015). Some studies, however, have not found a significant relation between severe medical complications during or immediately after pregnancy with postpartum depressive symptoms, perhaps because the occurrence of severe morbidity is quite rare (Norhayati, Nik Hazlina, Aniza, & Asrenee, 2016).…”