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Table 2 Associations of identified psychosocial outcomes and EmCS

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

Key psychosocial outcomesNumber of studiesAssociation between EmCS and psychosocial outcomesInconclusive associations between EmCS and psychosocial outcomesQualitative summary
Postpartum depression (PPD)12 +Studies reported inconsistent findings. The majority of studies reported no significant association (n = 7) between EmCS and PPD whereas the remaining studies reported a relationship between EmCS and increased symptoms of PPD (n = 5).
Post-traumatic stress disorder (PTSD)11+ All studies (n = 11) reported consistent findings that EmCS was a contributing factor to increasing post-traumatic stress symptoms and PTSD after childbirth.
Health related quality of life2 Consistent findings were found across studies (n = 2) that women who had an EmCS had poorer physical functioning compared to other MoDs.
Mother infant bonding3 Studies reported inconsistent findings. In n = 1 study EmCS appeared to have a negative association with mothers bonding and opening emotions with their baby. In contrast, no significant affect was found in terms of MoD on mother-infant bonding in the remaining studies (n = 2).
Infant feeding3 Consistent findings were found across studies in that EmCS impacted negatively in varying ways on infant feeding (n = 3). Women who have an EmCS were more likely to have had an unsuccessful first breastfeeding attempt, were less likely to breastfed their baby within the first 24 h and upon leaving the hospital, and to breastfeed for a shorter duration of time compared to other MoDs.
Sexual function3 +/−Studies were inconsistent in their findings (n = 3) in terms of satisfaction with sexual relations after birth and sexual function postpartum.
Experiences21+/− In terms of quantitative research (n = 9), the majority of studies found that EmCS was more likely to result in a negative birth experience (n = 6), n = 1 study reported MoD had no influence on mother experiences and n = 2 studies reported that EmCS was related to positive experiences in comparison to other MoDs. In terms of the qualitative studies (n = 12) women described a wide variety of emotions as salient aspects to their EmCS experience however, a number of dominating negative experiences were consistent across all studies
Satisfaction4 Consistent findings were reported across all studies (n = 4) with women who had an EmCS more likely to appraise their deliveries less favourably than those who delivered via other MoDs.
Self-esteem3 Consistent findings were reported across all studies (n = 3). Women who had an EmCS were more likely to report feelings of emotional vulnerability after delivery including feelings of failure, regret, and lower self-esteem.
Distress3 Findings were inconsistent in terms of distress after EmCS. No significant association between MoD and distress were reported in a study (n = 1), another study reported other MoD causing more distress than EmCS (n = 1), the final study reported a relationship between EmCS and distress.
Fear2 Inconsistent findings were reported. With n = 1 study reporting EmCS was associated with increased fear of childbirth in subsequent pregnancies and n = 1 study reporting a correlation with fear of childbirth a few days after the operation, however this decreased one month later.
Other
 Childbirth Burden1+ Women who experienced emergency surgical intervention (i.e EmCS) were more likely to demonstrate higher childbirth burden scores than any other MoD (n = 1).
 Feelings of control1 Women who had a spontaneous VD reflected having a significantly higher sense of control during their labour and childbirth relative to with an instrumental VD, a planned CS, or an EmCS (n = 1).
  1. + indicates that some (or all) evidence supports a positive association
  2. - indicates that some (or all) evidence supports a negative association