Influence of elective and emergency cesarean delivery on mother emotions and bonding

Highlights

• We found significantly worse bonding in mothers who underwent emergency cesarean delivery, in comparison to vaginal delivery mothers.

• These findings support the idea that mothers which mode of delivery had to change during childbearing from the expected standard vaginal have to face a heavy psychological load.

• Emergency cesarean delivery elicits negative emotions, that impact on her ability to form a healthy bond with her newborn infant.

Abstract

Background

Previous studies have indicated that mode of delivery could have a negative effect on bonding.

Aims

To assess feelings towards newborn infants in mothers who delivered by cesarean delivery, elective (ElCD) or emergency (EmCD).

Study design

This observational prospective study took place at the Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy, from September 2014 to April 2015.

Subjects

The sample included 573 puerperae divided into three groups: women undergone ElCD (n = 73; 12.73%), women undergone EmCD (n = 81; 14.13%) and women who underwent vaginal delivery (VD) (n = 419; 73.12%).

Outcome measures

The instrument used was the Mother-to-Infant Bonding Scale (MIBS; Taylor et al., 2005), a self-report test to measure mother's feelings towards her baby. High scores indicate worse mother-to-infant bonding and a score ≥ 2, established as cut-off, indicates an altered bonding.

Results

The mean MIBS global score was 0.50 ± 1.05 in the VD mothers, 0.67 (± 1.14) for ElCD mothers and 0.92 (± 1.05) for EmCD mothers, resulting significantly higher in EmCD mothers (p < 0.001). The percentage of altered bonding (Score ≥ 2) in the three groups was of 11.21% (n = 47) in VD, 17.80% (n = 13) in ElCD and 23.45% (n = 19) in EmCD, significantly higher in EmCD women (p < 0.006). In addition, EmCD mothers scored significantly higher Joyful (0.074 ± 0.26 vs 0.185 ± 0.39; p < 0.005) and Disappointed (0.063 ± 0.25 vs 0.123 ± 0.36; p < 0.008) subscales.

Conclusions

It was found that EmCD negatively affects mother bonding and opening emotions, and originates in mother feelings like sadness and disappointment for the unplanned delivery evolution.

Introduction

The relevance of maternal bonding and its influence for the child's development has been increasingly explored over the last decades. The early postpartum period was described as a sensitive, critical period for the establishment of tight bonding [1], possibly influenced by routines separating mother and newborns at birth [2], [3], [4] and by delivery mode [5].

Although some evidence exists to show that non-vaginal birth can make bonding between mother and infant difficult, studies failed to clearly distinguish between elective (ElCD) and emergency (EmCD) cesarean deliveries [6]. This is relevant, considering that cesarean section rates are progressively rising in many high- and middle-income Countries of the World, mainly due to increase in primary ElCD [7]. EmCD is defined as an unplanned delivery performed after onset of labor, an ElCD is defined as non-emergency delivery planned for medical reasons and occurring before initiation of labor. There are many reasons why a woman might choose to have a ElCD including fear of pain from labor and body image among others. In addition, a scheduled cesarean delivery allows a woman to choose the time and date of delivery for reasons related to superstition or luck [8]. Conversely, emergency deliveries are usually carried out for maternal medical reasons (failure to progress or cephalopelvic disproportion) or fetal reasons (fetal distress). Such emergency circumstances are a significant stress factor for the women and one would anticipate that this stressful event could contribute to an increased risk of altered bonding. Much of the research findings in this setting are, however contradictory [9], given the different methods used to assess the mother–infant relationship, feelings, and emotions, based on interviews, observations, and questionnaires [10]. In addition, research on this subject also impacts on reciprocal relationship between surgical delivery, bonding, and puerperium, a period during which previously dormant psychological issues such as fears about physical changes, role adaptation, psychosocial stress, and mothering abilities come to the surface, resulting also of great importance to the psychology of bonding and has major consequences for mother, family, and child [11], [12]. Nevertheless, evidence as to the nature of these changes is equivocal and reciprocal relationships should be studied to determine their validity [13].

Hence, there is a need to see the contextual relevance of these determinants to our own puerperae population, representative of developed, industrialized country supporting advanced educational levels, good socio-economic status, low and late fertility, and high cesarean section rates. We therefore undertook an analytical study by the Mother-to-Infant Bonding Scale (MIBS, Taylor et al. 2005) [14] with a reference group of puerperae, to determine the direction and magnitude of the effect of delivery mode, vaginal delivery (VD) and ElCD or EmCD, on bonding and emotions in singleton, at term, uncomplicated pregnancies.