Unplanned C-Sections Linked to Higher Postpartum PTSD Risk

People who experienced unplanned cesarean and failed operative vaginal deliveries (OVDs) were at higher risk of developing mental health conditions within the 6 months following childbirth, according to a study presented at the 2025 Pregnancy Meeting of the Society for Maternal-Fetal Medicine.

Those who had an unplanned cesarean without an OVD had 15% higher odds of developing a postpartum mental health condition than those who had a spontaneous vaginal delivery (SVD). Meanwhile, the odds were 20% higher if a cesarean occurred after a failed OVD.

“Given the strong association, doctors should closely screen for mental health during the postpartum period for patients who experience these types of deliveries,” said Samantha L. Kruger, MA, MD, a resident at Stanford University in Stanford, California, who led the study.

Researchers analyzed 829,917 single live births over a span of 14 years using a commercial database of healthcare claims. Exposures included SVD, successful OVD, unplanned cesarean delivery with no attempt to operate, and cesarean delivery after a failed OVD. 

Depression was the most common mental health condition across all delivery methods, followed by anxiety, posttraumatic stress disorder, and other serious psychiatric conditions. Rates of these mental health conditions were the highest among both types of cesareans.

“While PTSD is often associated with extreme traumas like war or violence, the findings in this study highlight that childbirth, especially when it involves unexpected events like an unplanned C-section or failed operative vaginal delivery, can also lead to significant psychological distress,” Kruger said.

Hazel Keedle, PhD, a senior lecturer of midwifery at the School of Nursing and Midwifery at Western Sydney University in Sydney, Australia, said that the mental health struggles people experience postpartum often go unrecognized.

“We kind of see women straight after they’ve had the baby and then maybe for a day or two and then they’re gone,” Keedle said. “We don’t really get to see that longer journey of what they’re like once they’re home.”

Keedle, who also works as a private midwife and has conducted several studies on birth trauma, said she has observed a notable difference in behavior from people and their partners based on the environment cultivated for birth. However, environment alone does not influence mental health outcomes following birth, she said.

“The model of care is really important as well,” Keedle said. “Having that continuity of care — the same provider throughout was really important and decreased the birth trauma rate. I also think clinicians need to get confident on how to support women in active labor as well.”

Kruger said conducting mental health screenings after childbirth are important as physicians can assess and support mothers experiencing mental health challenges.

“Clear communication, offering reassurance, and ensuring the parents feel supported and informed throughout the process could help reduce the trauma,” Kruger said.