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Table 1 Summary characteristics of included studies

From: Women’s psychosocial outcomes following an emergency caesarean section: A systematic literature review

Author/YearAimStudy DesignStudy LocationParticipantsTime frameStudy PeriodMeasurePsychosocial OutcomesRelevant Key FindingsMMAT QARa
Adams, 2012To assess the association between mode of delivery (MoD) and maternal postpartum emotional distress.Prospective CohortNorway55, 81417 & 30 weeks gestation and 6 months postpartum1998–2008Short form of the Hopkins Symptom Checklist-25 (SCL-8)Emotional DistressMoD was not associated with the presence of emotional distress postpartum.*****
Adewuya, 2006To estimate the prevalence PTSD after childbirth and to examine associated factors.Cross-sectionalNigeria8766 weeks postpartum2004MINI International Neuropsychiatric Interview, Index of marital satisfaction, Medical Outcomes Study Social Support Survey, Life events scale, Labour agentry scalePTSDInstrumental delivery and Emergency Caesarean Section (EmCS) were associated with PTSD, while elective caesarean section (ElCS) sections showed no significant effect.*****
Ahluwalia, 2012To assess the relationship between MoD and breastfeeding.Prospective longitudinalUnited States3026Before birth and 10 times during the year after birth.2005–2006Study specificBreastfeedingMedian breastfeeding duration was 20.6 weeks for EmCS. Breastfeeding duration among women who initiated breastfeeding show that the prevalence of breastfeeding at any time through 60 weeks after delivery was lowest for those who had induced VD or EmCS than among those in the other two groups (spontaneous VD or planned CS). 
Beck, 2008To explore the impact of birth trauma on mothers’ breast feeding experiences.QualitativeNew Zealand, US, Australia, UK, Canada52UnspecifiedUnspecifiedStudy specificInfant feedingWomen repeatedly explained that their decision to breastfeed was driven by their need to make amends to the infants for the traumatic way they had arrived into the world, for example, by EmCS.*****
Baas, 2017To understand the relationship between client-related factors and the experience of midwifery care during childbirth to improve care.Prospective longitudinalNetherlands237720 and 34 weeks pregnant and 6 weeks postpartum2009–2011Study specific and Labour Agency ScaleExperience of careMoD effected experiences of care. Women who had an unplanned CS were more likely to indicate that they had received “less than good” midwifery care during childbirth.****
Baston, 2008To examine what factors relate to women’s appraisal of their birth three years later.Prospective CohortEngland and Netherlands20483 years postpartum2003–2004Study specificSatisfaction of experienceEmCS was a factor contributing to a negative appraisal of birth in England and the Netherlands.****
Bergant, 1998To study the subjective psychological and physical stressful experience of childbirth burden.Cross-sectionalAustria12505 days postpartum1993–1994EPDS, Trait-Anxiety Inventory, Burden of childbirthBurden of childbirthWomen who experienced emergency surgical intervention (EmCS and vacuum extraction) demonstrated higher childbirth burden scores.****
Bryanton, 2008To determine factors that predict women’s perceptions of the childbirth experience and to examine whether these vary with the type of birth a woman experiences.Prospective cohortCanada65212–47 h postpartum2004–2005Questionnaire Measuring Attitudes About Labour and DeliveryPerceptions of birthWomen who had a planned CS birth scored significantly lower on birth perception than those who had an EmCS or a VD.****
Burcher, 2016To elicit women’s narratives of their unplanned CS births to identify potentially alterable factors that contribute to CS regret.QualitativeUnited States142–6 weeks postpartumUnspecifiedStudy specificRegret and dissatisfactionFour key themes emerged from patients’ unplanned CS narratives: poor communication, fear of the operating room, distrust of the medical team, and loss of control.*****
Carquillat, 2016To compare subjective childbirth experience according to different delivery methods.Cross-sectionalSwitzerland and France2914–6 weeks postpartum2014–2015Questionnaire for Assessing Childbirth ExperienceChildbirth ExperienceWomen who had an EmCS were at highest risk of experiencing childbirth in a negative way.****
Chen, 2002To compare women who had a VD with those who had a CS in depression, perceived stress, social support, and self-esteem.Cross-sectionalTaiwan3576-weeks postpartum1999The Beck Depression Inventory, The Perceived Stress Scale, The Interpersonal SupportEvaluation List (ISEL) Short Form, Coopersmith’s Self-Esteem InventoryDepression, perceived stress, social support, self-esteemThere was no association found in this study between the type of CS (planned or emergency) and psychosocial measures.*****
Creedy, 2000To determine the incidence of acute trauma symptoms and PTSD in women as a result of their labour and birth experiences, and to identify factors that contributed to the women’s psychological distress.Prospective LongitudinalAustralia4994–6 weeks postpartum1997–1998Posttraumatic Stress Symptoms interviewPTSDThe experience of an EmCS was correlated with the development of trauma symptoms.****
Durick, 2000To examine if unplanned CS would be related to less optimal outcomes and that this relationship would be mediated by mother’s appraisal of the delivery and would attenuate over time.Longitudinal cohortUnited States5704 and 12 months postpartumUnspecifiedThe Eysenck Personality Inventory Form, The Centre for Epidemiologic Studies Depression Scale, Rosenberg’s (1965) self-esteem scaleMother-infant interactions, Neuroticism, Depression, Self-esteem, appraisal of the birth experience.The psychological experiences associated with delivery by unplanned CS, by planned CS, or VD are distinct, and unplanned CS deliveries are appraised most negatively.****
Eckerdal, 2017To explore the association between MoD and postpartum depression.Longitudinal cohortSweeden3888118th gestational week, the 32nd week of pregnancy, at 6 weeks, 6months postpartum2009–2014EPDSPostpartum depressionA higher prevalence of depressive symptoms at 6 weeks postpartum was noted among women who delivered by EmCS, whereas no significant association with MoD was found regarding PPD at six months postpartum.*****
Enabudoso, 2011To assess the prevalence of satisfaction, and associated factors, among women who had recently delivered by CS.Cross-sectionalNigeria2112–5 days postpartum2010Study sepcificSatisfactionSatisfaction with CS was significantly higher among women who had ElCS as compared with EmCS.***
Fenaroli, 2016To explore the influence of cognitive and emotional variables on labour and delivery outcomes and examine how individual characteristics, couple adjustment, and medical factors influence the childbirth experience.Longitudinal cohortItaly121Between 32 and 37 weeks of pregnancy and 30–40 days postpartum2010–2012Wijma Delivery Expectancy Questionnaire, EPDS, Dyadic Adjustment ScaleChildbirth expectations, depressionThere was no relationship found between MoD and perceived emotional experience.****
Fenwick, 2009To explore women’s experiences of CS.QualitativeEngland21Between 7 and 32 weeks postpartum1999–2000 ExperiencesFeelings of failure were present whether or not the CS was planned or an emergency, and these feelings had an impact on their status passage to motherhood for several reasons. The surgery resulted in the loss of women’s familiar, normal, healthy body. From their perspective, their body had let them down, denying them a normal birth.*****
Forti-Buratti, 2017To compare the mother-to-infant bond of mothers who gave birth by elective C-section versus EmCS.Prospective cohortSpain11648–72 h and 10–12 weeks after deliveryNot specifiedMother-to-Infant Bonding Scale, responses to separationMother-infant bondingNo significant differences between the two CS in bonding, newborn response to separation or type of feeding were observed at any time points.****
Furuta, 2016To identify factors associated with birth-related post-traumatic stress symptoms during the early postnatal period.Prospective cohortEngland18246–8 weeks postpartum2010Impact of Event ScalePTSDEmCS was a high risk factor for post-traumatic stress symptoms.*****
Gamble, 2005To examine the relationship between MoD and symptoms of psychological trauma at 4–6 weeks postpartumProspective cohortAustralia40072 h and 4–6 weeks postpartum2001–2002Mini-International Neuropsychiatric Interview-Post-Traumatic Stress Disorder(MINI-PTSD)PTSDWomen who had an EmCS or operative VD were more likely to meet the diagnostic criteria for PTSD than women who had an ElCS section or spontaneous VD.****
Gaillard, 2014To identify socio-demographic, psychosocial and obstetrical risk factors of postpartum depression.Prospective cohortFrance31232–41 weeks gestation, and6–8 weeks postpartum2007–2009EPDS (French version)DepressionWomen with PND did not differ from the others in MoD (spontaneous vaginal, assisted vaginal, EmCS or ECS).****
Gibbins, 2001To explore, describe and understand the expectations during pregnancy and subsequent experiences of childbirth in women.QualitativeEngland82 weeks post birthUnspecifiedStudy specificExperiencesWomen expressed positive feelings about their labours, even though all women felt that labour was different to what they had expected.*****
Goker, 2012To determine the effect of MoD on the risk of postpartum depression.Cross-sectionalTurkey3186 weeks postpartumUnspecifiedEPDSDepressionDelivering by spontaneous VD, ECS, or EmCS had no effect on EPDS scores.***
Graham, 1999To assess the degree and nature of women’s involvement in the decision to deliver by CS section, and women’s satisfaction with this involvement.QualitativeScotland1663–4 days and 6–12 weeks postpartum1995–1996Study specificSatisfaction and decision makingWomen undergoing ElCS section generally received adequate information; however, with EmCS, half of the women had not received enough information during pregnancy. A significant proportion of women experienced negative feelings, particularly with EmCS (30%).****
Guittier, 2014To determine important elements associated with first delivery experience according to the MoD.QualitativeSwitzerland244–6 weeks postpartum2012Study specificExperiencesThe MoD directly impacted on key delivery experience determinants as perceived control, emotions, and the first moments with the newborn.****
Handelzalts, 2017To compare the impacts on childbirth experience of `planned’ delivery (elective CS and vaginal delivery) versus `unplanned’ delivery (vacuum extraction or EmCS).Cross-sectionalIsrael469Up to 72 h postpartum2014–2015Subjective Childbirth Experience Questionnaire and Personal Information QuestionnaireExperienceUnexpected MoD (EmCS) results in a more negative birth experience than a planned MoD.*****
Herishanu-Gilutz, 2009To examine the significance of the subjective experience of mothers who gave birth by an EmCS.QualitativeFinland104–6 monthsUnspecifiedStudy specificExperiencesThemes were identified related to the traumatic experience of the operation, e.g. sense of loss of control regarding the decision to operate, feeling of fear and anger toward the caretaking staff.*****
Hobbs, 2016To examine MoD and breastfeeding initiation, duration, and difficulties reported by mothers at 4 months postpartum.Prospective CohortCanada302134–36 weeks gestation and 12–14 months postpartum2008UnspecifiedInfant feedingWomen who delivered by EmCS had a higher proportion of breastfeeding difficulties (41%), and used more resources before (67%) and after (58%) leaving the hospital, when compared to VD (29, 40, and 52%, respectively) or planned CS (33, 49, and 41%, respectively).****
Iwata, 2015To identify factors for predicting post-partum depressive symptoms after childbirth in Japanese women.Prospective CohortJapan4791 day before hospital discharge, 1, 2, 4, and 6 months post-partum.2012–2013EPDS, The Postnatal Accumulated Fatigue Scale, The Postpartum Maternal Confidence Scale, The Childcare Value ScaleDepressionSix variables reliably predicted the risk of postpartum depression including EmCS.*****
Jansen, 2007To investigate fatigue and HRQoL in women after VD, ElCS, and EmCs.Prospective cohortNetherlands14112–24 h after VD and 24-48 h after CS and 1,3, weeks postpartum2003–2004The Multidimensional Fatigue Inventory, EuroQoL 5D, Short-Form 36HRQoLPatients after VD had higher mean physical HRQoL scores than after CS. The average period to reach full physical recovery was 3 weeks after VD, 6 weeks after elective CS, and 6 weeks after EmCS.*****
Karlström, 2017To compare self-reported birth outcomes for women undergoing birth through spontaneous onset of labour between those who actually had a vaginal birth and those who eventually had an EmCS.Prospective LongitudinalSweden870Mid pregnancy (18–19 weeks), late pregnancy (32–34 weeks), 2 months and 1 year postpartum/UnspecifiedStudy specificBirth fear and experienceBirth experience were more among women having an EmCS.****
Karlstrom, 2007To investigate women’s experience of postoperative pain and pain relief after CS and factors associated with pain assessment and the birth experience.Cross-sectionalSweden602–9 days postpartum2004 and 2005The Visual Analog Scale, and study specificExperiencesThe risk of a negative birth experience was 80% higher for women undergoing an EmCS compared with elective CS.***
Loto, 2010To examine the association between the MoD, self-esteem, and parenting self-efficacy both at delivery and at 6 weeks postpartum.Prospective cohortNigeria115Prior to hospital discharge and 6 weeks postpartum2007–2008Rosenberg self-esteem scale and parent–child relationship questionnaireSelf-esteemFactors that were significantly associated with low self-esteem include being single and having EmCS.***
Loto, 2009To assess the level of self-esteem of newly delivered mothers who had CS andevaluate the sociodemographic and obstetrics correlates of low self-esteem in them.Cross-sectionalNigeria109 2007–2008Rosenberg self-esteem scaleSelf-esteemEmCS closely correlated with low self-esteem in women who had CS.****
Lurie, 2013To evaluate sexual behaviour longitudinally in the postpartum period by MoD.Prospective cohortIsrael826, 12, and 24 weeks postpartum2010–2011Female Sexual Function IndexSexual FunctionSexual function did not differ significantly by MoD at 6, 12, or 24 weeks postpartum.****
Maclean, 2000To examine women’s distress in response to one of four obstetric procedures: spontaneous VD; induced VD; instrumental VD; or, EmCS.Cross-sectionalEngland406 weeks postpartum1996–1997Impact of Event Scale, Hospital Anxiety and Depression ScaleExperience, wellbeing, distressWomen who gave birth assisted by instrumental delivery reported the childbirth event as distinctly more distressing than the women in the other three obstetric groups (VD; induced VD; EmCS).****
Modarres, 2012To estimate the prevalence of childbirth-related post-traumatic stress symptoms and its obstetric and perinatal risk factors.Cross-sectionalIran4006–8 weeks after birth2009Post-traumatic Symptom Scale-InterviewPTSDEmCS was a significant contributing factor to PTSD after childbirth.****
Noyman-Veksler, 2015To investigate the protective role of sense of coherence (SOC) and perceived social support in the effect of EmCS/ELCS on postnatal psychological symptoms and impairment in mother–infant bonding.Prospective LongitudinalIsrael1426 and 12 weeks postpartumUnspecifiedPost-partum bonding questionnaire, Post-traumatic diagnostic scale, Edinburgh post-natal depression questionnaire, Sense of coherence, Social support questionnaireDepression, bonding, PTSD, social supportNo effect was found of the MoD on bonding with the infant. An EmCS predicted an increase in PTSD symptoms in Time 2, but only among women with low levels of Time-1 social support.****
O’Reilly, 2014To establish a greater understanding of the emotional and cognitive mechanisms associated with CS.Cross-sectionalFrance201At least 6–8 weeks postpartum2011–2012Labour Agentry Scale, Maternal Self Report Inventory, Unconditional Self-AcceptanceQuestionnaireSense of control during the delivery, maternal self-esteem self-acceptanceSense of control during labour and delivery was significantly higher for women who had a spontaneous VD when compared to those who had undergone an instrumental VD, a planned, or an EmCS.*****
Patel, 2005To assess the association between elective CS section and PD compared with planned VD and whether EmCS or assisted VD is associated with PD compared with spontaneous vaginal delivery.Prospective cohortUK10,9348 weeks postpartum1991–1992EPDSDepressionNo increased risk of PD was found between MoD.*****
Porter, 2007To explore the factors that women identified as distressing so as to understand their responses to standard questions on satisfaction.Mixed methodsScotland1661Up to 22 years postpartum2002Study specificDistressMany women had never had an operation before and the fact that their CS was classified as an “emergency” frightened them.****
Redshaw, 2010To gain a better understanding of CS by investigating women’s recent experiences and reflections on their care.QualitativeEngland29603 months postpartum2006Study specificExperiences with careFear and confrontation with the unexpected were themes identified from women who had an EmCS.*****
Rowlands, 2012To examine the physical and psychological outcomes of women in the first three months after birth, and whether these varied by MoD.Cross-sectionalEngland53323 months postpartum2010Study specificPTSD and general psychological outcomesWomen having unplanned CS section births were marginally more likely to report PTSD-type symptoms, however, there was no association between PTSD type symptoms and planned CS section births.****
Ryding, 1998To describe women’s thoughts and feelings during the process of a delivery that ended in an EmCS, to ascertain if an EmCS might fulfil the stressor criterion PTSD according to DMS IV.QualitativeSweden532 days after birthUnspecifiedStudy specificPTSD and Experiences55% of women experienced intense fear for their own life or that of their baby. 8% felt very badly treated by the staff. Almost all women had adequate knowledge of the reasons for the EmCS.*****
Ryding, Wijma 1998To compare the psychological reactions of women after EmCS, ElC, instrumental VD, and normal VD.Prospective cohortSweden3262 days and 1 month postpartum1992–1993Wijma Delivery Expectancy Experience Questionnaire the Impact of Event Self-Rating ScaleI, 35-item version of the Symptoms Check ListExperiences and traumaThe EmCS group reported the most negative delivery experience at both times, followed by the lVD group. At a few days postpartum the EmCS group experienced more general mental distress than the VD group, but not when compared with the ElCS or the instrumental VD groups. At 1 month postpartum the EmCS group showed more symptoms of post-traumatic stress than the ECS and instrumental VD groups, but not when compared to the VD group.****
Ryding, 2000To investigate the possibility to categorize women’s experiences of EmCS based on the patterns displayed in their narration of the event, and to describe typical features of those categories.QualitativeSweden25A few days and 1–2 months postpartum.UnspecifiedStudy specificExperiencesThe narratives of the 25 women were categorized as follows: Pattern 1 - confidence whatever happens (n 5); Pattern 2 - positive expectations turning into disappointment (n 7); Pattern 3 - fears that come true (n 9); and Pattern 4 - confusion and amnesia (n 4).*
Safarinejad, 2009To quantify the relationship between MoD and subsequent incidence of sexual dysfunction and impairment of quality of life (QOL) both in women and their husbands.Prospective cohortIran912Every month post deliveryup to 12 months.2006–2007Female Sexual Function Index (FSFI), and International Index of Erectile Function (IIEF),Sexual Function, QoLWomen with VD and EmCS had statistically significant lower Female Sexual Function Index (FSFI) scores as compared with planned CS Section women*****
Saisto, 2001To examine the extent to which personality characteristics, depression, fear andanxiety about pregnancy and delivery, and socio-economic background, predict disappointment with delivery and the risk of puerperal depression.Prospective LongitudinalFinland211Once after the 30thweek of pregnancy, and 2–3 months after deliveryUnspecifiedBeck’s Depression Inventory, the NEO-PI Scale for neuroticism, a partnership satisfaction scale, a Pregnancy Anxiety Scale, a revised version of a fear-of-childbirth questionnaireDisappointment with delivery and satisfactionStrongest predictors of disappointment with delivery were labour pain and EmCS.*****
Sarah, 2017To investigate the relationship between type of delivery and postpartum depression.Cross-sectionalIranUnspecifedUnspecified2013Beck depression inventoryDepressionThe prevalence of postpartum depression is 33.4%, respectively, of which 13.8% related to EmCS, 7.2% of vaginal deliveries, and 8% of elective CS.**
Shorten, 2014To explore women’s values and expectations during their process of decision making about the next birth.QualitativeAustralia18736–38 weeks pregnant and 6–8 weeks postpartumUnspecifiedStudy specificDecisions after prior CSWomen described long labours ending in CS did not want to go through it again, and especially did not want to repeat the “emergency” scenario. Many described a sense of loss after the previous CS experience and expressed a personal need to remedy this feeling through a better experience in the next birth. “After an emergency CS I felt I had failed, I felt cheated of the childbirth experience I had wanted”.*****
Soderquist, 2002To study whether or not a more stressful delivery was positively related to traumatic stress after childbirth.Cross-sectionalSweden1550Unspecified1994–1995Traumatic event scaleTraumatic stressTraumatic stress symptoms and having a PTSD symptom profile were both significantly related to the experience of an EmCS or an instrumental VD.****
Somera, 2010To explore women’s experience of an EmCS birth to gain a better understanding of their thoughts, and feelings throughout the birth process.QualitativeCanadian91–5 days after birth and 11–27 days after birthNot specifiedOpen-ended questionsExperienceSeven themes were identified describing the women’s experience: (1) It was for the best, (2) I did not have control, (3) Everything was going to be okay, (4) I was so disappointed, (5) I was so scared, (6) I could not believe it and (7) I was excited.*****
Spaich, 2013To investigate the extent to which satisfaction with childbirth depends on the MoD, and evaluated factors determining postpartum satisfaction.Prospective cohortGermany335Unspecified2010–2011Salmon’s Item ListExperienceThere were no women in the subgroup with EmCS who score indicating an overall negative birth experience. The subjective experience of birth was described as ‘good/very good’ in 89% of the women who underwent EmCS.****
Storksen, 2013To assess the relation between fear of childbirth and previous birth experiences.Prospective cohortNorway1657Weeks 17 and 32 pregnant2009–2011Wijma Delivery Expectancy QuestionnaireFearEmCS and vacuum extraction were associated with fear of childbirth in subsequent pregnancies.*****
Tham, 2007To examine the associations between new mother’s sense of coherence (SOC) and obstetric and demographic variables a few days postpartum, and post-traumatic stress symptoms 3 months’ postpartum in relation to women who had undergone an emergency CS section.Prospective cohortSweden1222 days and 3 month postpartumNot specifiedSense of Coherence Scale (SOC-13), Impact of Event Scale (IES-15).PTSD25% of the women reported symptoms of post-traumatic stress to a moderate degree (indicating a need for follow-up), and 9% had a high degree of symptoms (indicating possible PTSD).****
Tham, 2010To describe women with and without symptoms of post-traumatic stress following EmCS, and how they perceived the support received in connection with the birth of their child.QualitativeSweden846–7 months postpartumNot specifiedQuestions seeking the women’sexperienced social and emotional support from the staffand from their familiesExperience and supportThe midwives’ action, the content and organisation of care, the women’s emotions, and the role of the family were main categories that seemed to influence the interviewees’ perceptions of support in connection with childbirth. Women with PTSS further mentioned nervous or non-interested midwives, intense fear and feelings of shame during delivery, lack of postnatal follow-up, long-term postpartumfatigue and inadequate help from husbands as influencing factors. Women without symptoms reported involvement in the EmCS decision and a feeling of relief.****
Trivino-Juarez, 2017To conduct a longitudinal study to analyse differences in HRQoL at the sixth week and sixth month postpartum, with mode of birth as the main independent variable.Prospective LongitudinalSpain5476 weeks and 6 months postpartum2013–2014EPDS, SF-36HRQoLWomen who had vaginal, forceps or vacuum-extraction births at the sixth week postpartum reported better physical functioning than women who had elective or EmCS. At the sixth month postpartum, a significantly higher proportion of women in the forceps group (34%) than in the EmCS group (15%) reported being less satisfied with their sexual relations than before pregnancy.****
Tully, 2013To examine women’s experiences of and explanations for undergoing cesarean delivery.QualitativeEngland115Not specified2006–2009Study specificExperiencesAll mothers described labour prior to their unscheduled caesareans as wasted effort.*****
Ukpong, 2006To investigate postpartum emotional distress including depression women who had a CS by comparing them at 6–8 weeks following childbirth with 47 matched controls who had normal vaginal delivery.Cross-sectionalNigeria946–8 weeks postpartumUnspecifiedGeneral Health Questionnaire (GHQ-30), Beck Depression inventoryDepression, general healthThere was no relationship between the depression scores and being scheduled for either ElCS or EmCS.****
Vossbeck-Elsebusch, 2014To replicate earlier findings regarding the prediction of PTSD levels following childbirth by known prenatal, perinatal and postnatal predictors.Prospective cohortGermany2241–6 monthsUnspecifiedPosttraumatic DiagnosticScale (PDS), University of California, Los Angeles Social SupportInventory (UCLA-SSI-d), Peritraumatic DissociativeExperience Questionnaire (PDEQ), PosttraumaticCognitions Inventory (PTCI), Responsesto Intrusions Questionnaire (RIQ), German version of the PerseverativeThinking Questionnaire (PTQ)PTSDThe mean PDS (Posttraumatic Diagnostic Scale) score for women who had an EmCS were significantly higher than the PDS score for women who had a normal VD.*****
Wijma, 2002To examine whether the women’s psychological condition during pregnancy correlates with their psychological well-being after EmCS.Prospective cohortSweden1981Gestation week 32, a few days, and one monthUnspecifiedWijma Delivery Expectancy/ Experience Questionnaire, Spielberger Trait Anxiety Inventory, Stress Coping Inventory, Impact of Event Scale, Symptom ChecklistFearSurgical complications including EmCs correlated with postpartum fear of childbirth negatively a few days after the operation, but positively one month later.****
Wiklund, 2009To examine changes in personality from late pregnancy to early motherhood in primiparas having vaginal or CS.Prospective cohortSweden31437–39 gestational weeks in pregnancy and 9 months after delivery.2003–2006Karolinska Personality ScalesPersonalityWomen who had an EmCS scored higher on the subscale measuring Psychasthenia (low degree of mental energy and stress susceptible) 9 months after birth compared to those who had a spontaneous VD.****
Wiklund, 2007To examine the expectations and experiences in women undergoing a CS on maternal request and compare these with women undergoing CS with breech presentation as the indication and women who intended to have VD acting as a control group and to study whether assisted delivery and EmCS in the control group affected the birth experience.Prospective cohortSweden496Prior to delivery and 3 months postpartum2003–2005Wijma Delivery Expectancy/Experience QuestionnaireExperiencesWomen planning a VD but experiencing an EmCS or an assisted VD had more negative birth experiences than the other groups.****
Xie, 2011To examine whether or not CS delivery is associated with increased risk of postpartum depression.Cross-sectionalChina5342 weeks postpartum2007Chinese version of the EPDS (EPDS), Social Support Rating Scale,DepressionPPD rate was higher in the group who had elective CS delivery than inthe group who had EmCS.****
Yang, 2011To examine whether MoD are associated with postnatal depression.Prospective cohortTaiwan10,535Unspecified2003–2006Data collected from the National Health Insurance Research DatabaseDepressionRisk of acquiring PPD was lower in mothers with a normal VD or an instrumental VD compared to mothers with an EmCS. The women who elected to have a CS section was higher risk than an EmCS.****
Zanardo, 2016To assess feelings towards newborn infants in mother swho delivered by elective (ElCD) or emergency EmCS.Cross-sectionalItaly573Not specified2014–2015Mother-to-Infant Bonding Scale (MIBS)Mother-infant bondingEmCS negatively affected mother bonding and opening emotions, and originated inmother feeling sadness and disappointment for the unplanned delivery.**
  1. aMixed Methods Appraisal Tool Quality Assessment Rating