Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study


Dr W Sword, School of Nursing 3H48B, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada. Email


Please cite this paper as: Sword W, Kurtz Landy C, Thabane L, Watt S, Krueger P, Farine D, Foster G. Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study. BJOG 2011;118:966–977.

Objective  To examine the relationship between delivery mode and postpartum depression at 6 weeks following hospital discharge.

Design  A prospective cohort study.

Setting  Eleven hospitals in Ontario, Canada.

Sample  A total of 2560 women ≥16 years of age who delivered singleton, live infants at term.

Methods  Women completed a questionnaire in hospital and 74% (n = 1897) participated in a structured telephone interview 6 weeks after discharge. Additional data were extracted from labour and delivery records. Generalised estimating equations (GEEs) were used to investigate factors associated with postpartum depression.

Main outcome measure  Women were screened for depression at 6 weeks following hospital discharge using the Edinburgh Postnatal Depression Scale (EPDS). A score of ≥12 on the EPDS was used as a measure of the primary outcome, depression.

Results  Mode of delivery was not independently associated with postpartum depression, and did not factor into the main-effects model. The multivariable analysis identified 11 predictor variables for depression: young maternal age (OR 5.27; 95% CI 2.73–10.15); maternal hospital readmission (OR 3.02; 95% CI 1.46–6.24); non-initiation of breastfeeding (OR 2.02; 95% CI 0.99–4.11); good, fair, or poor self-reported postpartum health (OR 1.82; 95% CI 1.19–2.80); urinary incontinence (OR 1.79; 95% CI 1.06–3.03); multiparity (OR 1.59; 95% CI 1.22–2.08); low mental health functioning (OR 1.20; 95% CI 1.15–1.25); low subjective social status (OR 1.16; 95% CI 1.02–1.33); high number of unmet learning needs in hospital (OR 1.12; 95% CI 1.03–1.22); low social support (OR 1.06; 95% CI 1.03–1.09); and low physical health functioning (OR 1.03; 95% CI 1.003–1.055). An exploratory interaction model revealed that caesarean section was associated with higher odds of becoming depressed in Canadian-born women, but that in women born outside of Canada it was associated with a lower risk of becoming depressed.

Conclusions  Delivery mode had no significant impact on the development of postpartum depression in the main-effects model. However, it may interact with place of birth and other unmeasured factors to create a risk for depression.