Severe obstetric lacerations associated with postpartum depression among women with low resilience – a Swedish birth cohort study

Abstract

Objective Women's levels of resilience and attitudes towards perineal lacerations vary greatly. Some women see them as part of the birthing process, while others react with anger, depressed mood or even thoughts of self‐harm. A previous study has reported increased risk of postpartum depressive (PPD) symptoms in women with severe perineal lacerations. The aim of this study was to assess the association between severe obstetric perineal lacerations and PPD. A secondary objective was to assess this association among women with low resilience. Design Nested cohort study. Setting Uppsala, Sweden. Sample Vaginally delivered women with singleton pregnancies (n = 2990). Methods The main exposure was obstetric perineal lacerations. Resilience was assessed in gestational week 32 using the Swedish version of the Sense of Coherence Scale. A digital acyclic graph was used to identify possible confounders and mediators. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). A sub‐analysis was run after excluding women with normal or high resilience. Main outcome measures Postpartum depression, assessed with the Depression Self‐Reporting Scale, completed at 6 weeks postpartum. Results There was no significant association between severe obstetric perineal lacerations and PPD at 6 weeks postpartum. However, a significant association was found between severe lacerations and PPD in women with low resilience (OR = 4.8, 95% CI 1.2–20), persisting even after adjusting for confounding factors. Conclusion Healthcare professionals might need to identify women with low resilience, as they are at increased risk for PPD after a severe perineal laceration. Tweetable abstract Severe perineal lacerations associated with postpartum depression in women with low resilience in a Swedish cohort.

Early‐ and late‐onset postpartum depression exhibit distinct associated factors: the IGEDEPP prospective cohort study

“…found an association between perineal trauma and PPD at 6 weeks and 3 months postpartum, 51 a recent study found no significance 52 . The association between severe perineal trauma and early‐onset PPD became significant in the group of women presenting low resilience 52 . Resilience, considered as a moderator for both pain and depression, could modulate the link between trauma and PPD 53 .…”

“…Although Dunn et al found an association between perineal trauma and PPD at 6 weeks and 3 months postpartum, 51 a recent study found no significance. 52 The association between severe perineal trauma and early-onset PPD became significant in the group of women presenting low resilience. 52 Resilience, considered as a moderator for both pain and depression, could modulate the link between trauma and PPD.…”

“…52 The association between severe perineal trauma and early-onset PPD became significant in the group of women presenting low resilience. 52 Resilience, considered as a moderator for both pain and depression, could modulate the link between trauma and PPD. 53 Data on caesarean sections are also conflicting, with some data suggesting that emergency caesarean sections were specifically associated with PPD.…”

Women’s experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma

“…The aetiology of OASI is multifaceted and known risk factors include birthweight > 4 kg, primiparity and an instrumental (assisted) vaginal birth [3]. OASI can cause significant longterm physical and psychosocial morbidities including incontinence, chronic pain, sexual dysfunction and post-traumatic stress disorder [4][5][6][7]. In the English National Health Service (NHS) reported OASI rates tripled among primiparous women from 1.9% in 2000 to 5.9% in 2011 [8].…”

Risk factors for obstetric anal sphincter injuries during vaginal delivery: can we reduce the burden?

“…Stool and flatus incontinence occurs in up to 50% of women after OASIS [8]. These morbidities profoundly impact women's psychological wellbeing and are associated with a high risk of postpartum depression in women with lower resilience [9]. Moreover, the associated surgical repair is at high risk of needlestick injury among obstetricians [10,11].…”