Prior psychiatric inpatient care and risk of cesarean sections: a registry study

Abstract

This study of 17,443 childbearing women, investigated the relationship between hospital admissions 5 years prior to index birth, type of mental disorders and risk factors for mode of delivery. Hospital based electronic perinatal medical records between 2001 and 2006, were linked with the Swedish National Inpatient Care Registry 1996-2006. Of all the women, 39.3% had had inpatient care prior to index birth (27.3% had had obstetric, 10.1% somatic, and 1.9% psychiatric inpatient care). Diagnoses of mental disorders at psychiatric admission (n=333) were categorized into five groups: personality/behavioral/unspecified disorder (30.9%), affective disorders and 'suicide attempt' (28.9%), neurotic/somatoform disorders (18.9%), substance use (17.1%) and schizophrenia (4.2%). Women with history of psychiatric care were more often smokers, below age 24 and single (p<0.001, respectively), had more markers of mental ill-health in pregnancy records (p≤0.001), compared to women without such previous care, and fewer were nulliparous (p<0.001). The results show that women with prior psychiatric inpatient care and those with identified mental ill-health in pregnancy records, were associated with increased adjusted risks of cesarean sections. Identifying a woman?s mental health status in pregnancy may predict and prevent emergency cesarean section.

Fear of Childbirth and Risk of Cesarean Delivery: A Cohort Study in Six European Countries

“…Some “nonmedically” indicated cesareans might be performed on a psychiatric indication when a concomitant severe fear of childbirth and mental illness is present. Mental illness has been associated with an increased risk of emergency cesarean . In the present study, a higher EDS score among primiparous women was associated with emergency cesarean, adjusted OR 1.62 (95% CI 1.12–2.36).…”

Do psychological factors predict caesarean delivery in Australia? A cohort study

“…Also, a single item descriptor was used to measure maternal mental health problems as a screening tool but validated screening instruments were not used and it is unclear whether women who reported mental health problems received a formal diagnosis, further investigation, or any treatment. These limitations apply to other similar studies [20,21,33] and these issues would need to be addressed in a properly-constructed prospective study.…”

“…One study linked data from the Swedish National Inpatient Care Registry 1996-2006 with hospital perinatal records for over 17,000 women, and found that hospital admissions in the five years prior to index birth were associated with an increased risk of elective CS (adjusted OR 2.16, 95% CI 1.34, 4.42), and emergency CS (adjusted OR 1.60, 95% CI 1.09, 2.37), as well as with markers of mental ill-health in pregnancy identified in perinatal records [21]. Another study examined 6,000 nulliparous women and found that report of stress (adjusted OR 1.66, 95% CI 1.34, 2.06), sleep difficulties (adjusted OR 1.57, 95% CI 1.14, 2.16), and worry (adjusted OR 1.41, 95% CI 1.10, 1.79) were all associated with an increased rate of emergency CS in first-time mothers [20].…”

“…While maternal mental health status is not often examined as a predictor of CS, findings from two recent studies provide evidence that a history of prior psychiatric conditions or mental health problems reported during pregnancy are associated with increased rates of CS [20,21]. Although anxiety and fear of childbirth were commonly reported reasons for women requesting elective cesarean delivery in several international studies [16,22], fears of 'loss of control' and pain were found to be less commonly-reported motivating factors in Australia and maternal requests for CS probably represent only a small proportion of CS overall [23].…”

Severe mental illness and induction of labour: outcomes for women at a specialist antenatal clinic in Western Australia

“…One study by Wangel et al . found an increased risk of emergency and elective caesarean section for women with a history of psychiatric inpatient care and self‐reported mental ill health during their pregnancy. In previous published research, we reported higher rates of assisted vaginal delivery and emergency caesarean rates in women with SMI attending a specialist antenatal clinic, the Childbirth and Mental Illness Clinic (CAMI clinic) at King Edward Memorial Hospital (KEMH) in Perth, Western Australia (WA).…”