Emergent Cesarean Delivery and Immediate Postpartum Depression Symptoms and Social Work Consultation Rates

Birth trauma, which may result following emergent cesarean delivery (CD), is a risk factor for postpartum depression (PPD). We hypothesized that PPD symptoms and social work (SW) consultation rates would be higher in emergent term CDs compared to vaginal deliveries (VD). Cohort study of patients delivering at term ( >37 weeks) at a single institution from 2017-2020. Patients were divided into three groups: emergent CD (ECD), non-emergent CD (NCD), and VD. Inpatient PPD symptoms (PHQ-9) and SW consultation rates were compared between groups. Fisher exact tests were performed to compare social work consultation rates across groups. Multivariable logistic regression used to assess factors associated with screen positive PPD (PHQ-9 >8) and rates of SW consultation. 25,507 patients delivered within the study window and 242 were in the ECD group. Rates of screen positive PPD (PHQ-9≥8) were higher in both CD groups compared to VD (2.4% in ECD, 2.5% in NCD, 1.6% in VD, P=0.0001). NCD had the highest rates of screen positive PPD, which remained significant on multivariable regression, adjusting for nulliparity, non-white race and advanced maternal age (age≥35) (OR 1.59, 95% CI[1.28-1.98]). SW consultation rates were highest in the ECD group (55.0% ECD, 47.4% NCD, 40.4% VD, P< 0.0001). SW consultation rates remained significant for ECD and NCD adjusting for AMA and non-white race (ECD OR 1.3 95% CI[1.25-1.40] and NCD OR 1.75 95% CI[1.31-2.34]). Inpatient PPD symptoms are higher in ECD and NCD groups compared to VD, supporting our hypothesis. Inpatient SW consultation is critical for patient education and referral to services. These results suggest that patients undergoing ECD have the highest rate of inpatient SW consultation. Future studies will follow up with PPD diagnostics (not just symptom screening) 4-6 weeks postpartum in the ECD and NCD groups, to determine whether inpatient SW consultation was effective in connecting those at highest risk to care.