Mode of Delivery and Request for Caesarean Section in Birthing People With Mental Disorders: A Register-Based Total Population Study.

OBJECTIVE

To determine risks of caesarean section (CS) and instrumental deliveries, including CS on individual request, in birthing people with mental disorders, overall and according to indications (i.e., Robson group).

DESIGN

Register-based total population study.

SETTING

Record-linkage of administrative and health data registers.

POPULATION: A total of 178,069 people with a delivery during 2014-2020 in Stockholm County.

METHODS

Mental disorders in birthing people were identified from health care registers as at least one recorded diagnosis according to ICD-10, and categorised as non-psychotic mood and anxiety disorders, severe, psychotic neurodevelopmental, and other mental disorders. Binary and multinomial regression analyses were used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95% CI), overall and stratified by Robson group.

MAIN OUTCOME MEASURES: Overall mode of delivery (non-instrumental vaginal, instrumental vaginal, elective and emergency CS) and CS on individual request (yes/no).

RESULTS

In total, 143 483 individuals were included in the analysis. Among them, 10.06% had elective caesarean section (CS), 10.89% non-elective CS, 5.61% instrumental delivery, and 5.70% CS on maternal request. The adjusted odds ratio of elective CS (aOR 1.54, 95% CI 1.49-1.60), emergency CS (aOR 1.24, 95% CI 1.20-1.28), and CS on request (aOR 2.05, 95% CI 1.96-2.14) was increased among birthing people with mental disorders. The associations were of similar magnitudes regardless of the type of mental disorder, but particularly pronounced among nulliparous birthing people with full-term, single, cephalic delivery (Robson group 1-2).

CONCLUSIONS

Mental disorders in birthing people are associated with an increased risk of caesarean section, both overall and on birthing person request. There may be unmet needs for obstetric care in birthing people with mental disorders.