2017 Volume 31 Issue 2 Pages 140-152
Objectives
The objectives of this study were: 1) to investigate the relationship between satisfaction with the birth experience and early postnatal depression among women who had had a cesarean delivery; and 2) to determine factors that influence maternal satisfaction with the birth experience.
Participants and Methods
We conducted a survey at 22 obstetrical institutions in A and B prefectures. The research participants were 362 postpartum women who had had a cesarean delivery. The questionnaires were self-administered. Completed questionnaires were returned by post or were left at the participating institutions. The survey items included: the basic attributes of the participating women; maternal satisfaction with the birth experience following cesarean delivery, as assessed by the Scales for Measuring Maternal Satisfaction (SMMS, Japanese version); the status of early postpartum depression, as evaluated by the Edinburgh Postnatal Depression Scale (EPDS); self-esteem, as measured by the Scale for Self-esteem (Japanese version); and maternal attachment, as measured by the Maternal Attachment Questionnaire (MAQ). The relationships between the SMMS score and EPDS score and/or the participants' basic attributes were analyzed using t-tests and one-way analysis of variance. Multiple regression analysis was used to investigate factors influencing maternal satisfaction with the birth experience.
Results
The overall response rate was 83.1% (301 of 362 women). Of those who completed the survey, 130 (44.2%) were primiparae with a first cesarean delivery, 139 (47.3%) were multiparae with two or more cesarean deliveries, and 25 (8.5%) were multiparae with a first cesarean delivery. There were more elective cesarean deliveries (70.4%, n=207) than emergency cesarean deliveries (29.6%, n=87). The mean SMMS score was 169.5. In total, 247 women (84.0%) were satisfied with the cesarean birth experience (the satisfied group; SMMS score ≥147). The mean EPDS score was 6.88. The mean EPDS score of the satisfied group was significantly lower than that of the group who were dissatisfied with the cesarean birth experience (the dissatisfied group; SMMS score ≤146) (p=0.003). A comparison of SMMS score by basic attributes showed no significant difference for all attributes, including cesarean delivery mode (planned or emergency). The MAQ score was the only factor identified as significantly influencing the SMMS score (p<0.001).
Conclusion
Our study suggests that there is a relationship between satisfaction and postnatal depression status among women who experience a cesarean birth. This was deducible from the significant difference in the EPDS scores registered by the two groups, i.e., the satisfied group and the dissatisfied group. We also found that maternal attachment was the only factor contributing to maternal satisfaction with the birth experience. In conclusion, it is important that midwives provide women the opportunity for reviewing the birth experience and continuous support after leaving hospital. In addition, earlier skin-to-skin contact and breastfeeding is recommended in the postpartum care for women experiencing cesarean births. These measures may lead to an improvement in maternal birth experience.
