[Is there an association between psychological stress and request for caesarian section?]

Abstract

Background: Caesarean section rates have increased in Norway, as in the rest of the western world since the beginning of the 1970s, and further explanations are needed to understand this development. The study aimed to examine whether demographic or psychological burdens differed among women who feared childbirth, according to whether or not they requested caesarean section.

Material and methods: In the period 2000-02, 164 pregnant women who feared childbirth were referred for counselling with two midwives (specialized in mental health) at the antenatal clinic at the University Hospital of North Norway. Data were retrieved from counselling sessions, referral letters, antenatal and intrapartum care records. The group that wished to have caesarean sections (n = 86) was compared with the one that did not (n = 78).

Results: 80% of the women had previously experienced anxiety and/or depression, 32% had eating disturbances and 72% reported having been abused. In the group requesting caesarean section the women had more severe fear of childbirth, previous traumatic birth experiences, previous anxiety and depression, lack of confidence in the professional staff and fewer had been treated for their psychological problems. At the onset of labour, 86% who initially requested a caesarean delivery were prepared for a vaginal birth. The overall caesarean rate for both groups was 32%.

Interpretation: The women who feared childbirth generally had a larger burden of psychosocial and psychiatric problems than others, and those who requested a caesarean delivery had most. Charting and processing these burdens is presumably of significance for the birth outcome.