Table 1.
Summary characteristics of included studies
| Author/Year | Aim | Study Design | Study Location | Participants | Time frame | Study Period | Measure | Psychosocial Outcomes | Relevant Key Findings | MMAT QARa |
|---|---|---|---|---|---|---|---|---|---|---|
| Adams, 2012 | To assess the association between mode of delivery (MoD) and maternal postpartum emotional distress. | Prospective Cohort | Norway | 55, 814 | 17 & 30 weeks gestation and 6 months postpartum | 1998–2008 | Short form of the Hopkins Symptom Checklist-25 (SCL-8) | Emotional Distress | MoD was not associated with the presence of emotional distress postpartum. | ***** |
| Adewuya, 2006 | To estimate the prevalence PTSD after childbirth and to examine associated factors. | Cross-sectional | Nigeria | 876 | 6 weeks postpartum | 2004 | MINI International Neuropsychiatric Interview, Index of marital satisfaction, Medical Outcomes Study Social Support Survey, Life events scale, Labour agentry scale | PTSD | Instrumental delivery and Emergency Caesarean Section (EmCS) were associated with PTSD, while elective caesarean section (ElCS) sections showed no significant effect. | ***** |
| Ahluwalia, 2012 | To assess the relationship between MoD and breastfeeding. | Prospective longitudinal | United States | 3026 | Before birth and 10 times during the year after birth. | 2005–2006 | Study specific | Breastfeeding | Median breastfeeding duration was 20.6 weeks for EmCS. Breastfeeding duration among women who initiated breastfeeding show that the prevalence of breastfeeding at any time through 60 weeks after delivery was lowest for those who had induced VD or EmCS than among those in the other two groups (spontaneous VD or planned CS). | |
| Beck, 2008 | To explore the impact of birth trauma on mothers’ breast feeding experiences. | Qualitative | New Zealand, US, Australia, UK, Canada | 52 | Unspecified | Unspecified | Study specific | Infant feeding | Women repeatedly explained that their decision to breastfeed was driven by their need to make amends to the infants for the traumatic way they had arrived into the world, for example, by EmCS. | ***** |
| Baas, 2017 | To understand the relationship between client-related factors and the experience of midwifery care during childbirth to improve care. | Prospective longitudinal | Netherlands | 2377 | 20 and 34 weeks pregnant and 6 weeks postpartum | 2009–2011 | Study specific and Labour Agency Scale | Experience of care | MoD effected experiences of care. Women who had an unplanned CS were more likely to indicate that they had received “less than good” midwifery care during childbirth. | **** |
| Baston, 2008 | To examine what factors relate to women’s appraisal of their birth three years later. | Prospective Cohort | England and Netherlands | 2048 | 3 years postpartum | 2003–2004 | Study specific | Satisfaction of experience | EmCS was a factor contributing to a negative appraisal of birth in England and the Netherlands. | **** |
| Bergant, 1998 | To study the subjective psychological and physical stressful experience of childbirth burden. | Cross-sectional | Austria | 1250 | 5 days postpartum | 1993–1994 | EPDS, Trait-Anxiety Inventory, Burden of childbirth | Burden of childbirth | Women who experienced emergency surgical intervention (EmCS and vacuum extraction) demonstrated higher childbirth burden scores. | **** |
| Bryanton, 2008 | To determine factors that predict women’s perceptions of the childbirth experience and to examine whether these vary with the type of birth a woman experiences. | Prospective cohort | Canada | 652 | 12–47 h postpartum | 2004–2005 | Questionnaire Measuring Attitudes About Labour and Delivery | Perceptions of birth | Women who had a planned CS birth scored significantly lower on birth perception than those who had an EmCS or a VD. | **** |
| Burcher, 2016 | To elicit women’s narratives of their unplanned CS births to identify potentially alterable factors that contribute to CS regret. | Qualitative | United States | 14 | 2–6 weeks postpartum | Unspecified | Study specific | Regret and dissatisfaction | Four key themes emerged from patients’ unplanned CS narratives: poor communication, fear of the operating room, distrust of the medical team, and loss of control. | ***** |
| Carquillat, 2016 | To compare subjective childbirth experience according to different delivery methods. | Cross-sectional | Switzerland and France | 291 | 4–6 weeks postpartum | 2014–2015 | Questionnaire for Assessing Childbirth Experience | Childbirth Experience | Women who had an EmCS were at highest risk of experiencing childbirth in a negative way. | **** |
| Chen, 2002 | To compare women who had a VD with those who had a CS in depression, perceived stress, social support, and self-esteem. | Cross-sectional | Taiwan | 357 | 6-weeks postpartum | 1999 | The Beck Depression Inventory, The Perceived Stress Scale, The Interpersonal SupportEvaluation List (ISEL) Short Form, Coopersmith’s Self-Esteem Inventory | Depression, perceived stress, social support, self-esteem | There was no association found in this study between the type of CS (planned or emergency) and psychosocial measures. | ***** |
| Creedy, 2000 | To determine the incidence of acute trauma symptoms and PTSD in women as a result of their labour and birth experiences, and to identify factors that contributed to the women’s psychological distress. | Prospective Longitudinal | Australia | 499 | 4–6 weeks postpartum | 1997–1998 | Posttraumatic Stress Symptoms interview | PTSD | The experience of an EmCS was correlated with the development of trauma symptoms. | **** |
| Durick, 2000 | To examine if unplanned CS would be related to less optimal outcomes and that this relationship would be mediated by mother’s appraisal of the delivery and would attenuate over time. | Longitudinal cohort | United States | 570 | 4 and 12 months postpartum | Unspecified | The Eysenck Personality Inventory Form, The Centre for Epidemiologic Studies Depression Scale, Rosenberg’s (1965) self-esteem scale | Mother-infant interactions, Neuroticism, Depression, Self-esteem, appraisal of the birth experience. | The psychological experiences associated with delivery by unplanned CS, by planned CS, or VD are distinct, and unplanned CS deliveries are appraised most negatively. | **** |
| Eckerdal, 2017 | To explore the association between MoD and postpartum depression. | Longitudinal cohort | Sweeden | 3888 | 118th gestational week, the 32nd week of pregnancy, at 6 weeks, 6months postpartum | 2009–2014 | EPDS | Postpartum depression | A higher prevalence of depressive symptoms at 6 weeks postpartum was noted among women who delivered by EmCS, whereas no significant association with MoD was found regarding PPD at six months postpartum. | ***** |
| Enabudoso, 2011 | To assess the prevalence of satisfaction, and associated factors, among women who had recently delivered by CS. | Cross-sectional | Nigeria | 211 | 2–5 days postpartum | 2010 | Study sepcific | Satisfaction | Satisfaction with CS was significantly higher among women who had ElCS as compared with EmCS. | *** |
| Fenaroli, 2016 | To explore the influence of cognitive and emotional variables on labour and delivery outcomes and examine how individual characteristics, couple adjustment, and medical factors influence the childbirth experience. | Longitudinal cohort | Italy | 121 | Between 32 and 37 weeks of pregnancy and 30–40 days postpartum | 2010–2012 | Wijma Delivery Expectancy Questionnaire, EPDS, Dyadic Adjustment Scale | Childbirth expectations, depression | There was no relationship found between MoD and perceived emotional experience. | **** |
| Fenwick, 2009 | To explore women’s experiences of CS. | Qualitative | England | 21 | Between 7 and 32 weeks postpartum | 1999–2000 | Experiences | Feelings of failure were present whether or not the CS was planned or an emergency, and these feelings had an impact on their status passage to motherhood for several reasons. The surgery resulted in the loss of women’s familiar, normal, healthy body. From their perspective, their body had let them down, denying them a normal birth. | ***** | |
| Forti-Buratti, 2017 | To compare the mother-to-infant bond of mothers who gave birth by elective C-section versus EmCS. | Prospective cohort | Spain | 116 | 48–72 h and 10–12 weeks after delivery | Not specified | Mother-to-Infant Bonding Scale, responses to separation | Mother-infant bonding | No significant differences between the two CS in bonding, newborn response to separation or type of feeding were observed at any time points. | **** |
| Furuta, 2016 | To identify factors associated with birth-related post-traumatic stress symptoms during the early postnatal period. | Prospective cohort | England | 1824 | 6–8 weeks postpartum | 2010 | Impact of Event Scale | PTSD | EmCS was a high risk factor for post-traumatic stress symptoms. | ***** |
| Gamble, 2005 | To examine the relationship between MoD and symptoms of psychological trauma at 4–6 weeks postpartum | Prospective cohort | Australia | 400 | 72 h and 4–6 weeks postpartum | 2001–2002 | Mini-International Neuropsychiatric Interview-Post-Traumatic Stress Disorder(MINI-PTSD) | PTSD | Women who had an EmCS or operative VD were more likely to meet the diagnostic criteria for PTSD than women who had an ElCS section or spontaneous VD. | **** |
| Gaillard, 2014 | To identify socio-demographic, psychosocial and obstetrical risk factors of postpartum depression. | Prospective cohort | France | 312 | 32–41 weeks gestation, and6–8 weeks postpartum | 2007–2009 | EPDS (French version) | Depression | Women with PND did not differ from the others in MoD (spontaneous vaginal, assisted vaginal, EmCS or ECS). | **** |
| Gibbins, 2001 | To explore, describe and understand the expectations during pregnancy and subsequent experiences of childbirth in women. | Qualitative | England | 8 | 2 weeks post birth | Unspecified | Study specific | Experiences | Women expressed positive feelings about their labours, even though all women felt that labour was different to what they had expected. | ***** |
| Goker, 2012 | To determine the effect of MoD on the risk of postpartum depression. | Cross-sectional | Turkey | 318 | 6 weeks postpartum | Unspecified | EPDS | Depression | Delivering by spontaneous VD, ECS, or EmCS had no effect on EPDS scores. | *** |
| Graham, 1999 | To assess the degree and nature of women’s involvement in the decision to deliver by CS section, and women’s satisfaction with this involvement. | Qualitative | Scotland | 166 | 3–4 days and 6–12 weeks postpartum | 1995–1996 | Study specific | Satisfaction and decision making | Women undergoing ElCS section generally received adequate information; however, with EmCS, half of the women had not received enough information during pregnancy. A significant proportion of women experienced negative feelings, particularly with EmCS (30%). | **** |
| Guittier, 2014 | To determine important elements associated with first delivery experience according to the MoD. | Qualitative | Switzerland | 24 | 4–6 weeks postpartum | 2012 | Study specific | Experiences | The MoD directly impacted on key delivery experience determinants as perceived control, emotions, and the first moments with the newborn. | **** |
| Handelzalts, 2017 | To compare the impacts on childbirth experience of `planned’ delivery (elective CS and vaginal delivery) versus `unplanned’ delivery (vacuum extraction or EmCS). | Cross-sectional | Israel | 469 | Up to 72 h postpartum | 2014–2015 | Subjective Childbirth Experience Questionnaire and Personal Information Questionnaire | Experience | Unexpected MoD (EmCS) results in a more negative birth experience than a planned MoD. | ***** |
| Herishanu-Gilutz, 2009 | To examine the significance of the subjective experience of mothers who gave birth by an EmCS. | Qualitative | Finland | 10 | 4–6 months | Unspecified | Study specific | Experiences | Themes were identified related to the traumatic experience of the operation, e.g. sense of loss of control regarding the decision to operate, feeling of fear and anger toward the caretaking staff. | ***** |
| Hobbs, 2016 | To examine MoD and breastfeeding initiation, duration, and difficulties reported by mothers at 4 months postpartum. | Prospective Cohort | Canada | 3021 | 34–36 weeks gestation and 12–14 months postpartum | 2008 | Unspecified | Infant feeding | Women who delivered by EmCS had a higher proportion of breastfeeding difficulties (41%), and used more resources before (67%) and after (58%) leaving the hospital, when compared to VD (29, 40, and 52%, respectively) or planned CS (33, 49, and 41%, respectively). | **** |
| Iwata, 2015 | To identify factors for predicting post-partum depressive symptoms after childbirth in Japanese women. | Prospective Cohort | Japan | 479 | 1 day before hospital discharge, 1, 2, 4, and 6 months post-partum. | 2012–2013 | EPDS, The Postnatal Accumulated Fatigue Scale, The Postpartum Maternal Confidence Scale, The Childcare Value Scale | Depression | Six variables reliably predicted the risk of postpartum depression including EmCS. | ***** |
| Jansen, 2007 | To investigate fatigue and HRQoL in women after VD, ElCS, and EmCs. | Prospective cohort | Netherlands | 141 | 12–24 h after VD and 24-48 h after CS and 1,3, weeks postpartum | 2003–2004 | The Multidimensional Fatigue Inventory, EuroQoL 5D, Short-Form 36 | HRQoL | Patients after VD had higher mean physical HRQoL scores than after CS. The average period to reach full physical recovery was 3 weeks after VD, 6 weeks after elective CS, and 6 weeks after EmCS. | ***** |
| Karlström, 2017 | To compare self-reported birth outcomes for women undergoing birth through spontaneous onset of labour between those who actually had a vaginal birth and those who eventually had an EmCS. | Prospective Longitudinal | Sweden | 870 | Mid pregnancy (18–19 weeks), late pregnancy (32–34 weeks), 2 months and 1 year postpartum/ | Unspecified | Study specific | Birth fear and experience | Birth experience were more among women having an EmCS. | **** |
| Karlstrom, 2007 | To investigate women’s experience of postoperative pain and pain relief after CS and factors associated with pain assessment and the birth experience. | Cross-sectional | Sweden | 60 | 2–9 days postpartum | 2004 and 2005 | The Visual Analog Scale, and study specific | Experiences | The risk of a negative birth experience was 80% higher for women undergoing an EmCS compared with elective CS. | *** |
| Loto, 2010 | To examine the association between the MoD, self-esteem, and parenting self-efficacy both at delivery and at 6 weeks postpartum. | Prospective cohort | Nigeria | 115 | Prior to hospital discharge and 6 weeks postpartum | 2007–2008 | Rosenberg self-esteem scale and parent–child relationship questionnaire | Self-esteem | Factors that were significantly associated with low self-esteem include being single and having EmCS. | *** |
| Loto, 2009 | To assess the level of self-esteem of newly delivered mothers who had CS andevaluate the sociodemographic and obstetrics correlates of low self-esteem in them. | Cross-sectional | Nigeria | 109 | 2007–2008 | Rosenberg self-esteem scale | Self-esteem | EmCS closely correlated with low self-esteem in women who had CS. | **** | |
| Lurie, 2013 | To evaluate sexual behaviour longitudinally in the postpartum period by MoD. | Prospective cohort | Israel | 82 | 6, 12, and 24 weeks postpartum | 2010–2011 | Female Sexual Function Index | Sexual Function | Sexual function did not differ significantly by MoD at 6, 12, or 24 weeks postpartum. | **** |
| Maclean, 2000 | To examine women’s distress in response to one of four obstetric procedures: spontaneous VD; induced VD; instrumental VD; or, EmCS. | Cross-sectional | England | 40 | 6 weeks postpartum | 1996–1997 | Impact of Event Scale, Hospital Anxiety and Depression Scale | Experience, wellbeing, distress | Women who gave birth assisted by instrumental delivery reported the childbirth event as distinctly more distressing than the women in the other three obstetric groups (VD; induced VD; EmCS). | **** |
| Modarres, 2012 | To estimate the prevalence of childbirth-related post-traumatic stress symptoms and its obstetric and perinatal risk factors. | Cross-sectional | Iran | 400 | 6–8 weeks after birth | 2009 | Post-traumatic Symptom Scale-Interview | PTSD | EmCS was a significant contributing factor to PTSD after childbirth. | **** |
| Noyman-Veksler, 2015 | To investigate the protective role of sense of coherence (SOC) and perceived social support in the effect of EmCS/ELCS on postnatal psychological symptoms and impairment in mother–infant bonding. | Prospective Longitudinal | Israel | 142 | 6 and 12 weeks postpartum | Unspecified | Post-partum bonding questionnaire, Post-traumatic diagnostic scale, Edinburgh post-natal depression questionnaire, Sense of coherence, Social support questionnaire | Depression, bonding, PTSD, social support | No effect was found of the MoD on bonding with the infant. An EmCS predicted an increase in PTSD symptoms in Time 2, but only among women with low levels of Time-1 social support. | **** |
| O’Reilly, 2014 | To establish a greater understanding of the emotional and cognitive mechanisms associated with CS. | Cross-sectional | France | 201 | At least 6–8 weeks postpartum | 2011–2012 | Labour Agentry Scale, Maternal Self Report Inventory, Unconditional Self-AcceptanceQuestionnaire | Sense of control during the delivery, maternal self-esteem self-acceptance | Sense of control during labour and delivery was significantly higher for women who had a spontaneous VD when compared to those who had undergone an instrumental VD, a planned, or an EmCS. | ***** |
| Patel, 2005 | To assess the association between elective CS section and PD compared with planned VD and whether EmCS or assisted VD is associated with PD compared with spontaneous vaginal delivery. | Prospective cohort | UK | 10,934 | 8 weeks postpartum | 1991–1992 | EPDS | Depression | No increased risk of PD was found between MoD. | ***** |
| Porter, 2007 | To explore the factors that women identified as distressing so as to understand their responses to standard questions on satisfaction. | Mixed methods | Scotland | 1661 | Up to 22 years postpartum | 2002 | Study specific | Distress | Many women had never had an operation before and the fact that their CS was classified as an “emergency” frightened them. | **** |
| Redshaw, 2010 | To gain a better understanding of CS by investigating women’s recent experiences and reflections on their care. | Qualitative | England | 2960 | 3 months postpartum | 2006 | Study specific | Experiences with care | Fear and confrontation with the unexpected were themes identified from women who had an EmCS. | ***** |
| Rowlands, 2012 | To examine the physical and psychological outcomes of women in the first three months after birth, and whether these varied by MoD. | Cross-sectional | England | 5332 | 3 months postpartum | 2010 | Study specific | PTSD and general psychological outcomes | Women having unplanned CS section births were marginally more likely to report PTSD-type symptoms, however, there was no association between PTSD type symptoms and planned CS section births. | **** |
| Ryding, 1998 | To describe women’s thoughts and feelings during the process of a delivery that ended in an EmCS, to ascertain if an EmCS might fulfil the stressor criterion PTSD according to DMS IV. | Qualitative | Sweden | 53 | 2 days after birth | Unspecified | Study specific | PTSD and Experiences | 55% of women experienced intense fear for their own life or that of their baby. 8% felt very badly treated by the staff. Almost all women had adequate knowledge of the reasons for the EmCS. | ***** |
| Ryding, Wijma 1998 | To compare the psychological reactions of women after EmCS, ElC, instrumental VD, and normal VD. | Prospective cohort | Sweden | 326 | 2 days and 1 month postpartum | 1992–1993 | Wijma Delivery Expectancy Experience Questionnaire the Impact of Event Self-Rating ScaleI, 35-item version of the Symptoms Check List | Experiences and trauma | The EmCS group reported the most negative delivery experience at both times, followed by the lVD group. At a few days postpartum the EmCS group experienced more general mental distress than the VD group, but not when compared with the ElCS or the instrumental VD groups. At 1 month postpartum the EmCS group showed more symptoms of post-traumatic stress than the ECS and instrumental VD groups, but not when compared to the VD group. | **** |
| Ryding, 2000 | To investigate the possibility to categorize women’s experiences of EmCS based on the patterns displayed in their narration of the event, and to describe typical features of those categories. | Qualitative | Sweden | 25 | A few days and 1–2 months postpartum. | Unspecified | Study specific | Experiences | The narratives of the 25 women were categorized as follows: Pattern 1 - confidence whatever happens (n 5); Pattern 2 - positive expectations turning into disappointment (n 7); Pattern 3 - fears that come true (n 9); and Pattern 4 - confusion and amnesia (n 4). | * |
| Safarinejad, 2009 | To quantify the relationship between MoD and subsequent incidence of sexual dysfunction and impairment of quality of life (QOL) both in women and their husbands. | Prospective cohort | Iran | 912 | Every month post deliveryup to 12 months. | 2006–2007 | Female Sexual Function Index (FSFI), and International Index of Erectile Function (IIEF), | Sexual Function, QoL | Women with VD and EmCS had statistically significant lower Female Sexual Function Index (FSFI) scores as compared with planned CS Section women | ***** |
| Saisto, 2001 | To examine the extent to which personality characteristics, depression, fear andanxiety about pregnancy and delivery, and socio-economic background, predict disappointment with delivery and the risk of puerperal depression. | Prospective Longitudinal | Finland | 211 | Once after the 30thweek of pregnancy, and 2–3 months after delivery | Unspecified | Beck’s Depression Inventory, the NEO-PI Scale for neuroticism, a partnership satisfaction scale, a Pregnancy Anxiety Scale, a revised version of a fear-of-childbirth questionnaire | Disappointment with delivery and satisfaction | Strongest predictors of disappointment with delivery were labour pain and EmCS. | ***** |
| Sarah, 2017 | To investigate the relationship between type of delivery and postpartum depression. | Cross-sectional | Iran | Unspecifed | Unspecified | 2013 | Beck depression inventory | Depression | The prevalence of postpartum depression is 33.4%, respectively, of which 13.8% related to EmCS, 7.2% of vaginal deliveries, and 8% of elective CS. | ** |
| Shorten, 2014 | To explore women’s values and expectations during their process of decision making about the next birth. | Qualitative | Australia | 187 | 36–38 weeks pregnant and 6–8 weeks postpartum | Unspecified | Study specific | Decisions after prior CS | Women described long labours ending in CS did not want to go through it again, and especially did not want to repeat the “emergency” scenario. Many described a sense of loss after the previous CS experience and expressed a personal need to remedy this feeling through a better experience in the next birth. “After an emergency CS I felt I had failed, I felt cheated of the childbirth experience I had wanted”. | ***** |
| Soderquist, 2002 | To study whether or not a more stressful delivery was positively related to traumatic stress after childbirth. | Cross-sectional | Sweden | 1550 | Unspecified | 1994–1995 | Traumatic event scale | Traumatic stress | Traumatic stress symptoms and having a PTSD symptom profile were both significantly related to the experience of an EmCS or an instrumental VD. | **** |
| Somera, 2010 | To explore women’s experience of an EmCS birth to gain a better understanding of their thoughts, and feelings throughout the birth process. | Qualitative | Canadian | 9 | 1–5 days after birth and 11–27 days after birth | Not specified | Open-ended questions | Experience | Seven themes were identified describing the women’s experience: (1) It was for the best, (2) I did not have control, (3) Everything was going to be okay, (4) I was so disappointed, (5) I was so scared, (6) I could not believe it and (7) I was excited. | ***** |
| Spaich, 2013 | To investigate the extent to which satisfaction with childbirth depends on the MoD, and evaluated factors determining postpartum satisfaction. | Prospective cohort | Germany | 335 | Unspecified | 2010–2011 | Salmon’s Item List | Experience | There were no women in the subgroup with EmCS who score indicating an overall negative birth experience. The subjective experience of birth was described as ‘good/very good’ in 89% of the women who underwent EmCS. | **** |
| Storksen, 2013 | To assess the relation between fear of childbirth and previous birth experiences. | Prospective cohort | Norway | 1657 | Weeks 17 and 32 pregnant | 2009–2011 | Wijma Delivery Expectancy Questionnaire | Fear | EmCS and vacuum extraction were associated with fear of childbirth in subsequent pregnancies. | ***** |
| Tham, 2007 | To examine the associations between new mother’s sense of coherence (SOC) and obstetric and demographic variables a few days postpartum, and post-traumatic stress symptoms 3 months’ postpartum in relation to women who had undergone an emergency CS section. | Prospective cohort | Sweden | 122 | 2 days and 3 month postpartum | Not specified | Sense of Coherence Scale (SOC-13), Impact of Event Scale (IES-15). | PTSD | 25% of the women reported symptoms of post-traumatic stress to a moderate degree (indicating a need for follow-up), and 9% had a high degree of symptoms (indicating possible PTSD). | **** |
| Tham, 2010 | To describe women with and without symptoms of post-traumatic stress following EmCS, and how they perceived the support received in connection with the birth of their child. | Qualitative | Sweden | 84 | 6–7 months postpartum | Not specified | Questions seeking the women’sexperienced social and emotional support from the staffand from their families | Experience and support | The midwives’ action, the content and organisation of care, the women’s emotions, and the role of the family were main categories that seemed to influence the interviewees’ perceptions of support in connection with childbirth. Women with PTSS further mentioned nervous or non-interested midwives, intense fear and feelings of shame during delivery, lack of postnatal follow-up, long-term postpartumfatigue and inadequate help from husbands as influencing factors. Women without symptoms reported involvement in the EmCS decision and a feeling of relief. | **** |
| Trivino-Juarez, 2017 | To conduct a longitudinal study to analyse differences in HRQoL at the sixth week and sixth month postpartum, with mode of birth as the main independent variable. | Prospective Longitudinal | Spain | 547 | 6 weeks and 6 months postpartum | 2013–2014 | EPDS, SF-36 | HRQoL | Women who had vaginal, forceps or vacuum-extraction births at the sixth week postpartum reported better physical functioning than women who had elective or EmCS. At the sixth month postpartum, a significantly higher proportion of women in the forceps group (34%) than in the EmCS group (15%) reported being less satisfied with their sexual relations than before pregnancy. | **** |
| Tully, 2013 | To examine women’s experiences of and explanations for undergoing cesarean delivery. | Qualitative | England | 115 | Not specified | 2006–2009 | Study specific | Experiences | All mothers described labour prior to their unscheduled caesareans as wasted effort. | ***** |
| Ukpong, 2006 | To investigate postpartum emotional distress including depression women who had a CS by comparing them at 6–8 weeks following childbirth with 47 matched controls who had normal vaginal delivery. | Cross-sectional | Nigeria | 94 | 6–8 weeks postpartum | Unspecified | General Health Questionnaire (GHQ-30), Beck Depression inventory | Depression, general health | There was no relationship between the depression scores and being scheduled for either ElCS or EmCS. | **** |
| Vossbeck-Elsebusch, 2014 | To replicate earlier findings regarding the prediction of PTSD levels following childbirth by known prenatal, perinatal and postnatal predictors. | Prospective cohort | Germany | 224 | 1–6 months | Unspecified | Posttraumatic DiagnosticScale (PDS), University of California, Los Angeles Social SupportInventory (UCLA-SSI-d), Peritraumatic DissociativeExperience Questionnaire (PDEQ), PosttraumaticCognitions Inventory (PTCI), Responsesto Intrusions Questionnaire (RIQ), German version of the PerseverativeThinking Questionnaire (PTQ) | PTSD | The mean PDS (Posttraumatic Diagnostic Scale) score for women who had an EmCS were significantly higher than the PDS score for women who had a normal VD. | ***** |
| Wijma, 2002 | To examine whether the women’s psychological condition during pregnancy correlates with their psychological well-being after EmCS. | Prospective cohort | Sweden | 1981 | Gestation week 32, a few days, and one month | Unspecified | Wijma Delivery Expectancy/ Experience Questionnaire, Spielberger Trait Anxiety Inventory, Stress Coping Inventory, Impact of Event Scale, Symptom Checklist | Fear | Surgical complications including EmCs correlated with postpartum fear of childbirth negatively a few days after the operation, but positively one month later. | **** |
| Wiklund, 2009 | To examine changes in personality from late pregnancy to early motherhood in primiparas having vaginal or CS. | Prospective cohort | Sweden | 314 | 37–39 gestational weeks in pregnancy and 9 months after delivery. | 2003–2006 | Karolinska Personality Scales | Personality | Women who had an EmCS scored higher on the subscale measuring Psychasthenia (low degree of mental energy and stress susceptible) 9 months after birth compared to those who had a spontaneous VD. | **** |
| Wiklund, 2007 | To examine the expectations and experiences in women undergoing a CS on maternal request and compare these with women undergoing CS with breech presentation as the indication and women who intended to have VD acting as a control group and to study whether assisted delivery and EmCS in the control group affected the birth experience. | Prospective cohort | Sweden | 496 | Prior to delivery and 3 months postpartum | 2003–2005 | Wijma Delivery Expectancy/Experience Questionnaire | Experiences | Women planning a VD but experiencing an EmCS or an assisted VD had more negative birth experiences than the other groups. | **** |
| Xie, 2011 | To examine whether or not CS delivery is associated with increased risk of postpartum depression. | Cross-sectional | China | 534 | 2 weeks postpartum | 2007 | Chinese version of the EPDS (EPDS), Social Support Rating Scale, | Depression | PPD rate was higher in the group who had elective CS delivery than inthe group who had EmCS. | **** |
| Yang, 2011 | To examine whether MoD are associated with postnatal depression. | Prospective cohort | Taiwan | 10,535 | Unspecified | 2003–2006 | Data collected from the National Health Insurance Research Database | Depression | Risk of acquiring PPD was lower in mothers with a normal VD or an instrumental VD compared to mothers with an EmCS. The women who elected to have a CS section was higher risk than an EmCS. | **** |
| Zanardo, 2016 | To assess feelings towards newborn infants in mother swho delivered by elective (ElCD) or emergency EmCS. | Cross-sectional | Italy | 573 | Not specified | 2014–2015 | Mother-to-Infant Bonding Scale (MIBS) | Mother-infant bonding | EmCS negatively affected mother bonding and opening emotions, and originated inmother feeling sadness and disappointment for the unplanned delivery. | ** |
aMixed Methods Appraisal Tool Quality Assessment Rating