Objective

There is increasing evidence that operative obstetric procedures such as caesarean surgery and instrumental assistance in vaginal delivery exert at least short-term adverse effects on women's postpartum mental health. Australia's rates of use of these procedures are amongst the highest in the world and exceed World Health Organization recommendations for best practice. Most of the existing research into the psychological aspects of giving birth has only examined first-time mothers or has not explored the effects of parity. This paper reports a recently completed prospective longitudinal study into the determinants of both psychological well being and emotional distress in women during a second or subsequent pregnancy, birth and postpartum interval. In particular it investigated whether previous experiences of childbirth exerted effects on mental health in subsequent pregnancies.

Method

In this study, 320 multiparous pregnant women completed telephone interviews and standardised self-report questionnaires in each trimester of pregnancy and at 2 and 8 months postpartum. Sociodemographic and personality factors, obstetric history and social and marital support were assessed at the beginning of pregnancy and after giving birth. Mood and self-reported physical and psychological symptomatology were assessed at each point.

Results

It was found that multiparous parturient womens' psychological functioning is primarily governed by personality characteristics, the quality of relationship with partner and socioeconomic status. The effects of having had a previous instrumentally assisted vaginal or emergency caesarean delivery were complex, given that in Australia they are used disproportionately among those of high socioeconomic status. They were associated with an increase in late pregnancy anxiety, but significant adverse effects were not apparent until 8 months after giving birth. These psychological sequelae of operative intervention appear to be evidence for Posttraumatic Distress of delayed onset.

Conclusions

These findings provide further evidence that operative obstetric procedures are not psychologically benign and that health policies to reduce their use to WHO recommended levels in Australia should be developed.