The psychological impact of childbirth: Unscheduled cesarean delivery associates with increased risk for acute stress response

Abstract Introduction Cesarean delivery is one of the most common surgical procedures in the United States. Despite their frequency and medical necessity, the acute psychological response associated with unscheduled cesarean delivery is unknown. This study aimed to assess the rates and nature of peritraumatic stress reactions during and shortly after unscheduled cesarean delivery, and whether acute stress predicts later mental health symptoms. Methods A total of 1146 patients receiving routine perinatal care at a single tertiary, urban hospital were assessed for peritraumatic stress reactions during the delivery hospitalization, on average 31 hours postpartum using the patient self‐report Peritraumatic Distress Inventory (PDI). A subgroup ( n = 795; 69.4%) completed an assessment at approximately 1.9 months postpartum. Delivery mode, obstetric complications, prior trauma exposure, and antepartum and postpartum psychiatric symptoms were obtained from questionnaires and medical records. Chi‐square tests, adjusted relative risk estimates, mixed‐effects models, and regression analyses were used to evaluate acute stress by delivery mode, its persistence over time, and associations with postpartum mental health outcomes. Results A total of 10.4% of participants met criteria for clinical acute stress (PDI ≥15). Among women undergoing unscheduled cesarean, 26.6% reported clinical stress, with higher rates observed for cesarean performed during labor (29.3%) and those with greater obstetric morbidity ( ρ = 0.20, p = 0.005). Compared with vaginal delivery, unscheduled cesarean delivery was associated with a fourfold increased risk of acute stress (26.6% vs. 6.3%; relative risk = 4.20; 95% confidence interval [CI], 2.92–6.05). Adjusting for the interval between delivery and PDI completion (hours), demographics, primiparity, obstetric complications, labor induction, prior trauma, and antepartum mental health, unscheduled cesarean remained associated with increased risk. Stress levels among patients undergoing unscheduled cesareans were persistently elevated over time (estimate = 0.39, p = 0.44), while vaginal delivery was associated with a significant symptom reduction (estimate = 0.52, p = 0.03). Acute responses strongly predicted subsequent posttraumatic stress disorder ( β = 0.48, p < 0.001) and depressive ( β = 0.30, p < 0.001) symptoms and maternal–infant bonding ( β = 0.32, p < 0.001) difficulties. Conclusions A substantial proportion of women undergoing unscheduled cesarean delivery experience significant psychological stress during childbirth with enduring morbidities. Screening for acute traumatic stress during postpartum stay is warranted to optimize mental health outcomes.