Risk of postpartum depression in women with cesarean delivery after previous vaginal birth: a retrospective observational study.

BACKGROUND

This study aimed to compare the rates of postpartum depression (PPD) between women with a history of vaginal birth who delivered by cesarean section in their current pregnancy (CDAPVB) and those who delivered vaginally (VB), and to explore whether CDAPVB may be linked to a higher risk of PPD.

METHODS

This retrospective study was conducted among women who gave birth at the Gynecology and Obstetrics Clinic of Ankara Etlik City Hospital between September 2024 and February 2025 and who had experienced at least one prior vaginal delivery. Participants were stratified by current delivery type as CDAPVB or VB. Comparisons were made between the study groups with respect to Edinburgh Postnatal Depression Scale (EPDS) scores, demographic factors, prevalence of PPD, and adequacy of antenatal care. Furthermore, logistic regression analysis was conducted to identify independent predictors of PPD.

RESULTS

A total of 120 CDAPVB cases and 120 VB cases were observed in the study. EPDS scores were significantly higher in CDAPVB patients (p = 0.006). Overall, high risk for PPD was observed in 26.7% of CDAPVB patients and 10.0% of VB patients (p < 0.001). The adequacy of antenatal care was significantly lower among CDAPVB patients (36.7% vs. 55.8%; p = 0.003). In the CDAPVB group, subanalyses showed no significant difference in the rate of probable PPD for elective (28.1%) versus emergency cesarean Sect.  (25.0%) (p = 0.699). Using Firth’s penalized logistic regression in a multivariable analysis, CDAPVB (aOR = 4.049, p < 0.001) and interpregnancy interval (aOR = 0.926, p = 0.006) were found to be independent risk factors for PPD.

CONCLUSION

This study shows that women in the CDAPVB group had significantly higher EPDS scores, and that women with CDAPVB were more likely to have PPD, with CDAPVB as an independent risk factor. In addition, a shorter interpregnancy interval was found to be independently associated with an increased risk of PPD. No significant difference was found between elective and emergency cesarean sections. These observations highlight the psychological significance of delivery type, particularly when it differs from prior experiences, and underscore the importance of prenatal and postpartum care. Future prospective studies are required to validate these observations.