Unplanned cesarean delivery linked to higher risk of postpartum depression

Nicola F. Tavella, MPH, Research Director for Maternal Fetal Medicine in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.

At the SMFM 2025 Pregnancy Meeting, Nicola F. Tavella, MPH, research director for Maternal Fetal Medicine in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, presented groundbreaking research on the relationship between postpartum depression and unplanned cesarean delivery. With postpartum depression affecting 10% to 15% of postpartum individuals, understanding its contributing factors is critical to improving maternal mental health outcomes. Tavella’s study analyzed a large national pregnancy dataset to explore how intrapartum experiences influence both postpartum depression development and patient engagement in postpartum care, particularly attendance at the 6-week follow-up visit. In this Q&A, Tavella discusses the study's key findings and their implications for clinical practice.

Contemporary OB/GYN: Can you elaborate on the potential psychosocial and physical stressors of an unplanned cesarean delivery that might contribute to the increased odds of postpartum depression (PPD)?

Nicola F. Tavella, MPH: A major source of biopsychosocial stress in obstetrics is the change in delivery planning, due to various clinical factors that may arise to complicate a planned vaginal birth. For those pregnant patients who intend, and desire to give birth vaginally, emergent need for cesarean delivery presents multifactorial stress; aside from undergoing an urgent unplanned surgical procedure, there is also the patient’s real-time adjustment away from their prior delivery plan. We hypothesized that this multifactorial stress puts these patients at greater risk for developing postpartum depression.

Contemporary OB/GYN: Your study found that individuals who had an unplanned cesarean delivery were more likely to attend their 6-week postpartum visit. What factors do you think might drive this increased health care engagement despite the higher risk of PPD?

Tavella: While we cannot infer too much from this finding, since we did not have much detail regarding uptake of postpartum care, this finding may suggest that having an unplanned cesarean delivery confers a greater sense of intrapartum urgency and vulnerability, such that those patients make more concerted effort to attend their 6-week post-partum clinical visit.

Contemporary OB/GYN: Given the significant differences in maternal age, education, and household income among delivery groups, how did you account for these variables in your analysis, and what role do you think socioeconomic factors play in the relationship between method of delivery and PPD?

Tavella: The regression models we used to examine associations between unplanned cesarean delivery and post-partum depression adjusted for the covariates are significantly different between groups, such as maternal age and household income. We did this precisely because these factors likely confound the relationship between mode of delivery and post-partum depression. Specifically, we know that patients of different ages, racial and ethnic identities, and socioeconomic resources have different birthing experiences and face different treatment from their clinical providers. These differences likely predispose certain patients groups to a greater likelihood of unplanned cesarean, as well as post-partum depression.

Contemporary OB/GYN: Based on your findings, what recommendations would you make to health care providers to better support patients who undergo unplanned cesarean deliveries in terms of mental health screening and postpartum care?

Tavella: These findings suggest that the birthing process—already incredibly complicated—can expose pregnant people to adverse psychosocial stress via urgent changes in delivery planning, leading to cesarean delivery. These patients’ psychosocial health following such a delivery may improve if they are connected to mental health support in the post-partum period. Obstetric institutions should consider comprehensive policies to link these patients with such support.