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Evaluation of psychosocial and biological parameters in women seeking for a caesarean section and women who are aiming for vaginal delivery: a cross-sectional study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To investigate psychosocial and biological parameters that may influence decision-making concerning the mode of delivery in women with caesarean section on maternal request (CSMR).

Methods

Two hundred and two women were enrolled prospectively. The study sample (n = 93) consisted of women who aimed for CSMR, the control sample were women who seeked for vaginal delivery (n = 109). Parturients of both samples were enrolled during the pre-birth counselling at the delivery room at the University Medical Centre Mannheim, University Heidelberg, Germany. Women completed standardised questionnaires regarding psychosocial burden (SCL-R 90), fear of childbirth (W-DEQ) and anxiety (STAI), personality structure (HEXACO-Pi-R), and ambiguity tolerance (PFI, PNS, and NFC), social support (F-SozU) as well as one questionnaire assessing demographic parameters and further factors potentially influencing their choice of the mode of delivery. Hair cortisol concentration as a marker for chronic psychological stress and pressure pain threshold with a pressure algometer was assessed.

Results

Women in the CSMR sample had less social support (F-SozU: 2.99 ± 0.52 vs. 3.12 ± 0.32; p = 0.043) and were less educated (high school or university degree: 37 vs. 71%, p = 0.001) compared to parturients of the control sample. Women who underwent CSMR were less open-minded (HEXACO-Pi-R: 3.08 ± 0.57 vs. 3.26 ± 0.50; p = 0.016) and less extroverted (HEXACO-Pi-R: 3.34 ± 0.36 vs. 3.46 ± 0.41; p = 0.041). The control collective showed higher scores in negative appraisal of the birth (‘W-DEQ-negative appraisal’: 2.5 ± 0.8 vs. 2.2 ± 0.9; p = 0.006), whereas “lack of positive anticipation” was higher in the study collective (‘W-DEQ-lack of positive anticipation’: 3.2 ± 1.2 vs. 2.8 ± 0.8; p = 0.015). The study collective had higher pressure pain threshold values (5.07 ± 2.06 vs. 4.35 ± 1.38; p = 0.007), while no significant differences were observed in hair cortisol concentration comparing both groups (5.0 ± 11.4 vs. 4.9 ± 8.3; p = 0.426). The majority of the control collective (80%) had chosen the vaginal route as their mode of delivery before pregnancy, whereas only 21% of the women in the study collective decided to undergo CSMR before conception. The advice of social sources including both medical and non-medical aspects was rated less important in the study sample, with significant differences indicating a lower relevance of counsel from friends (p = 0.002) and midwives (p < 0.001).

Conclusion

Women who inquired a CSMR had lower social support, were less educated, more anxious, and had a lower sensitivity for physical pain compared to women seeking for spontaneous delivery. This should be considered when counselling women requiring CSMR and could be leverage points to intervene to reduce the continuously increasing CSMR rate.

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Funding

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Author notes

  1. Benjamin Tuschy and Sebastian Berlit contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Benjamin Tuschy, Sebastian Berlit, Paul Stützer & Marc Sütterlin

  2. Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Stefanie Lis

  3. Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany

    Christian Schmahl

  4. Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Christian Schmahl

  5. Department of Neurophysiology, Medical Faculty Mannheim, Centre of Biomedicine and Medical Technology Mannheim, Heidelberg University, Mannheim, Germany

    Ulf Baumgärtner

Authors
  1. Benjamin Tuschy
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  4. Stefanie Lis
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Contributions

BT: project development, data analysis, and manuscript writing. SB: project development, data analysis, and manuscript editing. PS: data collection, data analysis, and manuscript writing. SL: data analysis and manuscript editing. CS: project development. UB: manuscript editing. MS: project development.

Corresponding author

Correspondence to Benjamin Tuschy.

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All authors declare that they have no conflict of interest.

Human and animal rights statement

No animals were involved.

Ethical approval

The study was approved by the Ethics Committee II of the Medical Faculty Mannheim, Heidelberg University (2013-588 N-MA).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Tuschy, B., Berlit, S., Stützer, P. et al. Evaluation of psychosocial and biological parameters in women seeking for a caesarean section and women who are aiming for vaginal delivery: a cross-sectional study. Arch Gynecol Obstet 297, 897–905 (2018). https://doi.org/10.1007/s00404-018-4654-3

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  • DOI: https://doi.org/10.1007/s00404-018-4654-3

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