Expectant women with prenatally diagnosed fear of childbirth are at an increased risk of postpartum depression, according to a study of over 500,000 mothers in Finland. Women with a history of depression are at the highest risk of postpartum depression. The fact that fear of childbirth puts women without a history of depression at an approximately three times higher risk of postpartum depression is a new observation which may help health care professionals in recognising postpartum depression. The results were published recently in BMJ Open.
In Finland, postpartum depression was diagnosed in 0.3% of all mothers delivering a singleton birth in 2002–2010. The risk of postpartum depression is highest after the first childbirth. Postpartum depression was diagnosed in 5.3% of women with a history of depression, while approximately one-third of women experiencing postpartum depression had no history of depression. In these women, physician-diagnosed fear of childbirth during pregnancy was discovered to nearly triple the risk of postpartum depression. Other risk factors included Caesarean section, pre-term birth and major congenital anomaly.
Giving birth is a powerful experience both physically and mentally, and a variety of emotions are present. As much as 50–80% of women suffer from baby blues after birth, and some women develop postpartum depression the severity of which may range from minor symptoms to psychotic depression. The consequences of postpartum depression may be severe. For example, postpartum depression may affect the mother's abilities and skills to engage in delicate interaction with the child, and thus impair the development of an attachment relationship – possibly affecting the child's later development and well-being.
Women with a history of depression are known to be at a higher risk of postpartum depression, but it has been difficult to predict the risk of women not belonging to this risk group. According to the researchers, the observed link between fear of childbirth and postpartum depression may help health care professionals in recognising postpartum depression. The study provides strong evidence, as it relies on diagnosis-based data on postpartum depression.
The study was carried out in cooperation between the University of Eastern Finland, Kuopio University Hospital, the Finnish National Institute for Health and Welfare, Copenhagen University Hospital, the Nordic School of Public Health in Gothenburg, Sweden, and Emory University in the USA. The study used data from the Finnish medical birth register, the Finnish congenital malformations register and the Finnish hospital discharge register, which are maintained by the Finnish National Institute for Health and Welfare. The study examined all singleton births in Finland in 2002–2010, a total of 511,422 births.
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BMJ Open 2013;3:e004047 DOI: 10.1136/bmjopen-2013-004047