Operative intervention in delivery is associated with compromised early mother-infant interaction

Objective To investigate the effects of mode and place of delivery on first mother–infant contact and maternal emotional wellbeing.

Design A prospective, longitudinal study.

Participants A sociodemographically representative sample of 203 consecutive primiparous women was recruited, of whom 81% (n=164) were followed up.

Setting Four metropolitan hospitals, including one accredited baby friendly hospital, in Melbourne, Australia, 1997.

Methods During the postnatal hospital stay women were interviewed and medical records were inspected. Participants completed two self-report psychometric measures: the Edinburgh Postnatal Depression Scale (EPDS) and the Profile of Moods States (POMS). Follow up at eight months postpartum comprised completion of a postal questionnaire and repeat administration of the standardised self-report psychometric mood questionnaires.

Results The First Contact Index provides a measure of the first contact between a mother and her baby after the birth. Two-way analysis of variance revealed significant differences in First Contact Index between three modes of delivery groups: spontaneous, instrumentally-assisted, and caesarean section (P<0.001) and four hospital of delivery groups (P<0.001), but there was no significant interaction effect (P=0.55). Significant negative correlations existed between the First Contact Index and both the POMS and EPDS scores at two days postpartum (POMS, r = -0.339, 95% CI -0.46 to -0.22; EPDS, r = -0.279, 95% CI -0.41 to -0.16), even within delivery groups, and these were still present at eight months postpartum (POMS, r = -0.298, 95% CI -0.44 to -0.14, EPDS, r = -0.206, 95% CI -0.36 to -0.03).

Conclusion Instrumental and surgical delivery exert a negative impact on first postnatal contact between a mother and her baby which has persistent adverse maternal emotional correlates. Hospital practices associated with obstetric intervention in delivery also varied and are amenable to change, enabling optimal first mother–baby interaction regardless of mode of delivery.