Does Route of Delivery Affect Quality of Life?

Varying risks and benefits are associated with cesarean deliveries as compared to vaginal deliveries, including the impact on the mother’s health and the infant’s health. Ultimately, the goal is to deliver the baby the safest way possible for both mother and baby, but does the mode of delivery significantly impact the health-related quality of life in the immediate postpartum period through the first year after childbirth?

To better understand the ramifications of route of delivery, Dr Daniel G. Kiefer of Lehigh Valley Health Network in the Allentown, Pennsylvania, and colleagues conducted a prospective observational cohort study of 169 hospitalized postpartum patients. About 60% (101) of the patients had vaginal deliveries; the remaining participants had cesarean deliveries.

The researchers collected baseline demographic data, medical history, social support information, and perinatal factors for all participants. The Euroqol 5D questionnaire [http://www.euroqol.org/] was utilized to ascertain health-related quality-of-life factors, including performance of usual activities, pain, and anxiety. A visual analog scale (VAS) was also used to assess overall health status. Data were also collected at the postpartum visit (at 6 to 8 weeks), at 6 months, and at 12 months after delivery.

Patients who underwent cesarean delivery were more likely to have medical/perinatal problems than the counterparts who underwent a vaginal delivery. Women who had cesarean births also were more likely to deliver earlier that those who had vaginal deliveries, but there were no apparent differences in social support. Similarly, women who had cesarean deliveries did not rate their overall health before delivery differently than their counterparts.

Following delivery and on enrollment in the study, the women who underwent cesarean birth reported problems associated with their health-related quality of life. For instance, compared with patients who had vaginal deliveries, women who underwent cesarean birth reported decreased mobility, decreased ability to self-care, and a decreased ability to perform usual activities. They also had lower VAS scores as compared to their counterparts (69 vs 76, respectively). These differences disappeared by the postpartum visit, and they were not evident at the 6-month or 12-month follow-up. The researchers did not find any differences for pain or anxiety among the 2 delivery methods. 

In presenting their findings at the 59th Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists, the researchers concluded, “Differences in health-related quality of life related to route of delivery appear to be confined to the immediate post-partum period.”
 
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Kiefer DG, Lee L, Figueroa R. Evaluating the impact of route of delivery on health-related quality of life. ACOG Annual Meeting. Poster 84. April 30, 2011.