Mode of delivery and postpartum depression: The role of patient preferences

Kathryn A. Houston*, Anjali J. Kaimal, Sanae Nakagawa, Steven E. Gregorich, Lynn M. Yee, Miriam Kuppermann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Objective The purpose of this study was to explore the relationship between strength of preference for vaginal delivery, delivery mode undergone, and postpartum depression. Study Design We conducted a secondary analysis of data from a longitudinal study of delivery-mode preferences. During an interview between 24-36 weeks of gestation, participants were asked whether they preferred vaginal or cesarean delivery; the strength of this preference was measured by the standard gamble metric. Depression was assessed antepartum and at 8-10 weeks and 6-8 months after delivery by using the Patient Health Questionnaire (PHQ-9). The primary outcome was PHQ-9 score at 8-10 weeks after delivery. We used multivariable regression analysis to assess the effect of strength of preference for vaginal delivery and delivery mode undergone on postpartum depression. Results Of 160 participants, 33.1% were nulliparous, and 30.6% had a previous cesarean delivery. Most of the participants (92.4%) preferred vaginal delivery, but the strength of preference varied substantially. The mean strength-of-preference score (0-1 scale; higher scores denote stronger vaginal delivery preference) was 0.658 (SD, ±0.352). A significant interaction emerged between the effects of delivery mode and vaginal delivery preference score on postpartum PHQ-9 score (P =.047). Specifically, a stronger preference for vaginal delivery was associated with higher PHQ-9 scores among women who underwent cesarean delivery (P =.027) but not among women who underwent vaginal delivery (P =.761). The interaction between delivery mode and vaginal delivery preference score was no longer significant at 6-8 months after delivery. Conclusion Women who have a strong antepartum preference for vaginal delivery and deliver by cesarean may be at increased risk for depression in the early postpartum period.

Original languageEnglish (US)
Pages (from-to)229.e1-229.e7
JournalAmerican journal of obstetrics and gynecology
Issue number2
StatePublished - Feb 1 2015


  • mode of delivery
  • patient preferences
  • postpartum depression

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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