An Examination of Mode of Birth, Maternal Postpartum Mental Health, and Childhood Behavioural Problems

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Cesarean section (C-section) deliveries account for 21% of all deliveries worldwide (Betran, Ye, Moller, Souza, & Zhang, 2021). They are frequently considered a medical necessity in labour dystocia, placenta previa, and malpresentation (Caughey, Cahill, Guise, & Rouse, 2014). However, delivery via C-section has been associated with an increased risk of internalizing (anxiousness, depressiveness, withdrawal) and externalizing (aggression, hyperactivity) behavioural problems among children (Rutayisire et al., 2018; Sirvinskiene, Zemaitiene, Jusiene, & Markuniene, 2016). Research evaluating the link between C-section and child behaviour is inconclusive and limited. Delivery via an emergency C-section is the strongest factor linked to a negative perception of the birth experience (Waldenstrom & Schytt, 2009). A negative perception of the birth experience is strongly associated with postpartum post-traumatic stress disorder (PTSD) (Dekel, Ein-Dor, et al., 2019; Soderquist, Wijma, & Wijma, 2002; Verreault et al., 2012), which may be comorbid with postpartum depression (PPD) (Soderquist, Wijma, & Wijma, 2006). Therefore, it is hypothesized that the relationship between C-section and child behaviour depends on the type of C-section, and postpartum PTSD and PPD mediate this association. This manuscript-based dissertation is comprised of five papers. The first and second manuscripts include a review protocol and systematic review outlining the procedures and current evidence regarding the association between C-section delivery and child externalizing and internalizing behavioural problems. The third manuscript presents results regarding the association between C-section delivery and maternal PPD and the role of maternal PTSD in mediating this association. The fourth manuscript presents the study findings on the association between C-section delivery and child behavioural problems and the role of maternal postpartum PTSD and PPD as mediating factors. The final manuscript reviews the current landscape of maternal postpartum mental health screening in Canada and suggests improvements for screening. The dissertation concludes with implications for nursing practice, policy, education, and research.
cesarean section, postpartum depression, post-traumatic stress disorder, child behaviour
Grisbrook, M.-A. (2024). An examination of mode of birth, maternal postpartum mental health, and childhood behavioural problems (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from