The influence of birth modus on the emotional state of the mother, bonding, and the newborn’s neurobehavioural state

Dorota Pilch

Abstract


Introduction: Childbirth is an important event, both in a wom‑ an’s, and in her family’s lives, an event which carries a huge emo‑ tional charge and influences the functioning of a triad. Labour is a physiological process which may have health (somatic, psychological, mental) and economic consequences. Irrespective of the reasons why it is performed, caesarean section involves surgical, obstetric and anaesthesiological intervention, as well as the necessity for pharmacological agents. Bonding between parents and their children serves as a basis for optimal psychomotor development, and the first year is impor‑ tant for the rest of life. The aim of the study was to assess the influence of the labour mode on the mother’s emotional state, motherchild bonding, and the infant’s neurobehavioural state.

Material and methods: The plan of this study was approved by the Bioethical Commission of the Pomeranian Medical University in Szczecin (BN‑001/108/08). The research material comprised 200 women and their children. The following instruments were used in this study: an original questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), the Mother‑Child Relationship FIRST score (MCR FIRST score), the Brazelton Scale, also known as the Neonatal Behavioural Assessment Scale (NBAS). The umbilical blood was used to determine the level of cortisol as a stress marker. Statistical analysis was performed using the Shapiro–Wilk test, the χ2 test, the Mann–Whitney U‑test, the Fisher test, and the Spearman rank correlation coefficient. The accepted significance level (p) was equal to 0.05 (the acceptable type I error).

Results: Around 35% of the women took part in prenatal edu‑ cation, and 59% of them declared the intention to participate in postnatal education. The respondents wanted someone close to be with them during delivery (65.5%), although only 35% had such a possibility. Women giving birth naturally were more often accompanied by their partners (p = 0.00005). Less than half of the women (35%) had skin‑to‑skin contact with their babies, and there was a difference between delivery mode (p = 0.01). Attempts at breastfeeding were made by 81.5% of those surveyed. Women after c‑section less often tried to breastfeed their babies than their counterparts after natural delivery (p = 0.003). The levels of cortisol in umbilical blood were significantly higher after natural labour than after caesarean section (p < 0.00001). The assessment of the risk of postnatal depression performed with the EPDS did not demonstrate significant differences between women in particular delivery modes (p = 0.82). The percentage of ‘crying’ children was similar in both modes (12% of naturally born babies and 13% of those born by c‑section); the difference was not statistically significant (p = 1.0). Infant examination with the Brazelton Scale revealed differ‑ ences in babies’ behaviour in 30 parameters of the scale in favour of naturally born children. Children born through caesarean section had rarer contact with their mothers after delivery (p = 0.01).

Conclusions: Naturally born babies obtained higher scores on the NBAS, which is an argument for the promotion of this delivery mode. Naturally born babies had significantly higher cortisol levels and more frequent direct contact with their mothers after delivery, which creates favourable conditions for forming bonds. Delivery mode had no influence on the occurrence of postpar‑ tum depression, according to the EPDS (p = 0.82).


Keywords


delivery mode; postpartum depression; newborn neurobehavioural status; cortisol; bonding

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References


Bielawska‑Batorowicz E.: Psychologiczne aspekty prokreacji. Wyd. Nauk. Śląsk, Katowice 2005.

Banasiak‑Parzych B.: Depresja poporodowa. Przyczyny, skutki, zapobieganie. Wyd. Koldruk, Warszawa 2007.

Anestezjologia w położnictwie i medycynie perinatalnej. Zasady i praktyka. Eds: K.M. Kuczkowski, L. Drobnik. Wyd. Med‑Media, Warszawa 2009.

Łoś Z.: Rozwój psychiczny człowieka w ciągu całego życia. Wyd. Uniw. Wrocław., Wrocław 2010.

Cohen S., Woods W.: The role of epidural morphine in the post cesarean patient: efficacy and effects on bonding. Anesthesiology. 1983, 58, 500–504.

Patel R., Murphy D., Peters T.: Operative delivery and postnatal depression: a cohort study. Br Med J. 2005, 330, 879–882.

Charles C.: Cesarskie cięcie. In: Prowadzenie porodu. Eds: V. Chapman, C. Charles. Wyd. Lek. PZWL, Warszawa 2011.

Kuczyńska A.: Sposób na bliski związek. Zachowania wiążące w procesie kształtowania się i utrzymywania więzi w bliskich związkach. Wyd. Instytutu Psychologii PAN, Warszawa 1998.

Löbner I.: Warum sind die Frauen heute unsicherer im Umgang mit Geburt und erstem Kind? Die Hebamme. 2008, 21, 45–49.

Maciarz A.: Macierzyństwo w kontekście zmian społecznych. Wyd. Akadem. Żak, Warszawa 2004.

Tietz A., Zietlow A., Reck C.: Maternal bonding in mothers with postpartum anxiety disorder: the crucial role of subclinical depressive symptoms and maternal avoidance behaviour. Arch Womens Ment Health. Springer‑Verlag,

Wien 2014.

Mack S.: Hormone bei Geburt – aktueller Wissensstand. Die Hebamme. 2010, 23, 243–247.

Bowlby J.: Przywiązanie. Wyd. Nauk. PWN, Warszawa 2007.

Brazelton T.B.: Touchpoints: Your child’s emotional and behavioral development. A Merloyd Lawrence Book.

Psychologiczne portrety człowieka. Praktyczna psychologia rozwojowa. Ed. A. Brzezińska. Gdańskie Wyd. Psychologiczne, Gdańsk 2005.

Lütje W.: Welche Faktoren beeinflussen die Zufriedenheit und das Erleben in der Geburtshilfe? Die Hebamme. 2007, 20, 44–51.

Schaper A., Rooney B., Kay N., Silva P.: Use of the Edinburgh Postnatal Depression Scale to identify postpartum depression in a clinical setting. J Reprod Med. 1994, 8 (39), 620–624.

Czub T.: Wiek niemowlęcy. Jak rozpoznać ryzyko i jak pomagać? In: Psychologiczne portrety człowieka. Praktyczna psychologia rozwojowa. Ed. A. Brzezińska. Gdańskie Wyd. Psychologiczne, Gdańsk 2005.

Langer M.: Psychische Aspekte der Sectio caesarea. Gynaekol Geburtsh Rundsch. 1992, 32, Suppl. 1, 70–71.

Oberndörfer K.: Angst im Zusammenhang mit Schwangerschaft und Geburt. Die Hebamme. 2005, 18, 75–78.

Huber G., Seelbach‑Goebel B.: Re‑Sectio versus Spontangeburt nach Sectio: Unterschiede im Erleben von Geburt und Bonding. Die Hebamme. 2006, 19, 227–230.

Skoczylas P., Bińczycka­‍‑Anholcer M.: Poród drogami natury po przebytym cięciu cesarskim – istotny problem społeczny. Prz Ginek Położ. 2005, 5 (3), 161–166.

Korte J., Siegmund R.: Beeinflusst der Geburtsmodus die Entwicklung der Tagesrhytmik von Neugeborenen? Die Hebamme. 2004, 17, 161–163.

Ribero A.F.: At last dyad becomes triad? An evolution of the concept of father and his participation during birth of child. Servir. 2005, 53 (4), 190–194.

Rowe‑Murray H., Fisher J.: Operative intervention in delivery is associated with compromised early mother‑infant interaction. Br J Obstet Gynaecol. 2001, 108 (10), 1068–1075.

Jenkner G.: Das Konzept der integrativen, ganzheitlichen Wochenbettpflege. Die Schwester, der Pfleger. Bibliomed Verlag, Melsungen 2003, 10, 362–366.

Erlandsson K.: Skin‑to‑skin care with the father cesarean birth and its effect on newborn crying and prefeeding behavior. Birth. 2007, 34 (2), 105–114.

David M.: Sectio auf Wunsch? – Eine kritische Analyse der steigenden Sectiorate aus frauenärztlicher Sicht. Die Hebamme. 2006, 19, 231–235.

Hochhausen A.: Die Wunschsectio aus ethischer Sicht. Die Hebamme. 2010, 23, 183–187.

Muß K.: Karmienie piersią – poradnictwo i promocja. MedPharm Polska, Warszawa 2008.

Suchocki S., Piec P., Łuszczyńska A.: Cięcie cesarskie na życzenie – trudny problem medyczny, etyczny i prawny. Ginek Położ. 2007, 1 (3), 55–62.

Wőrlein F., Reulbach U., Goecke T.: Erhöhte Rate an Depressionen nach Wunschsectio? Die Hebamme. 2006, 19, 250–252.

Niederhofer H.: Welche Langzeitauswirkungen hat die pränatale Mutter‑Kind‑Bindung? Die Hebamme. 2006, 19, 29–33.

Rowe‑Murray H., Fisher J.: Baby Friendly Hospital Practices: Cesarean section is a persistent barrier to early initiation of breastfeeding. Birth. 2002, 29 (2), 124–131.

Lang C.: Bonding. Bindung főrdern in der Geburtshilfe. Elsevier, Urban & Fischer Verlag, Műnchen 2009.

Moehler E.: Maternal depressive symptoms in the postnatal period are associated with long‑term impairment of mother‑child bonding. Arch Womens Ment Health. 2006, 9 (5), 273–278.

Rocha S.M.: Mother‑child bonding: comparative study of mothers after normal delivery and cesarean section. Rev Bras Enferm. 2003, 56 (2), 125–129.




DOI: https://doi.org/10.21164/pomjlifesci.137

Copyright (c) 2015 Dorota Pilch

License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/