Association of obstetric practices with postpartum depressive symptoms: data from the Brazilian National Health Survey, 2019.

This article aims to evaluate the association between mode of delivery, obstetric practices, and reason for cesarean section with depressive symptoms in postpartum women up to one year postpartum. Cross-sectional study using data from the 2019 National Health Survey, including women aged >15 years and up to 12 months postpartum. Variables: mode of delivery, obstetric interventions, reasons for cesarean section, and postpartum depressive symptoms. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9>4 symptoms of mild depression and ≥9 as severe). STATA 15.0 was used for the analyses, with Directed Acyclic Graphs supporting confounding variables. A total of 986 postpartum women were analyzed. The prevalence of severe depressive symptoms was 13.1%. Of the total, 54.8% underwent cesarean section, 65.3% without appropriate indication. There was no association between type of delivery and depression, nor between obstetric practices during vaginal delivery and depression. The odds of mild depression symptoms (PHQ-9>4) were higher when cesarean section was the physician's choice during prenatal care compared with cesarean sections indicated due to complications. Unnecessary cesarean sections may increase maternal psychological vulnerability. The importance of prenatal care focused on preparing women to make their decisions is emphasized.