Effect of mode of delivery on postpartum health-related quality of life

This cross-sectional study was conducted between May and August 2022 on healthy singleton pregnant women aged between 18 and 45 years. Data on socio-demographic variables, clinic features, pregnancy and birth characteristics, and neonatal outcomes were collected. Health-related quality of life was assessed by using EQ-5D-5L questionnaire.

RESULTS:

A total of 1,015 healthy pregnant women were included. The EQ-5D-5L index score was higher in those with regular sleep patterns (p<0.001), those who did physical activity (PA) during pregnancy (p<0.001), those who received spousal support (p<0.001), and those with very good and good perceived health (p<0.001). EQ-5D-5L index and EQ-5D-5L-VAS scores were lower in those with unplanned pregnancy, those who preferred cesarean section, those who had cesarean section, those who underwent episiotomy, and those who admitted to the intensive care unit (p<0.001). Emergency cesarean section and elective cesarean section had the lowest and second lowest health-related quality of life mean scores, while normal vaginal deliveries had the highest health-related quality of life mean scores, respectively (p<0.001).

CONCLUSION:

This study showed that health-related quality of life was higher after vaginal delivery than after cesarean section. In addition, spousal support, regular sleep pattern, and PA during pregnancy play an important role in maternal health-related quality of life.

KEYWORDS
Cesarean section; Episiotomy; Delivery, obstetric; Pregnancy; Quality of life

		EQ5D Index Score		EQ-VAS
		Median (min–max)	p-value^* *Mann-Whitney U–test.	Median (min–max)	p-value^* *Mann-Whitney U–test.
Cigarette smoking	Yes	-0.59 (-0.59–1.00)	0.112	80 (75–85)	0.570
Cigarette smoking	No	0.57 (-0.59–1.00)	0.112	75 (35–100)	0.570
Sleep pattern	Regular	0.59 (-0.59–1.00)	<0.001	80 (35–100)	<0.001
Sleep pattern	Irregular	0.03 (-0.59–1.00)	<0.001	70 (40–100)	<0.001
Physical exercise during pregnancy	Regular	0.59 (-0.59–1.00)	<0.001 ^§ §Kruskal-Wallis test. Statistically significant values are denoted in bold.	85 (50–100)	<0.001 ^§ §Kruskal-Wallis test. Statistically significant values are denoted in bold.
	Irregular	0.59 (-0.59–1.00)		80 (40–100)
	None	0.08 (-0.59–1.00)		70 (35–100)
Spousal support during pregnancy and birth	Yes	0.59 (-0.59–1.00)	<0.001	80 (35–100)	<0.001
Spousal support during pregnancy and birth	No	-0.08 (-0.59–1.00)	<0.001	65 (40–90)	<0.001
Perceived status of health	Very Good	0.65 (-0.59–1.00)	<0.001 ^§ §Kruskal-Wallis test. Statistically significant values are denoted in bold.	90 (80–100)	<0.001 ^§ §Kruskal-Wallis test. Statistically significant values are denoted in bold.
	Good	0.59 (-0.59–1.00)		80 (40–100)
	Fair	0.04 (-0.59–1.00)		65 (40–90)
	Poor	-0.59 (-0.59–1.00)		55 (35–85)
	Very Poor	0.52 (-0.59–1.00)		65 (40–100)

		EQ5D Index Score		EQ-VAS
		Median (min–max)	p-value^* *Mann-Whitney U–test.	Median (min–max)	p-value^* *Mann-Whitney U–test.
Intention of pregnancy	Planned	0.58 (-0.59–1.00)	0.004	80 (40–100)	<0.001
Intention of pregnancy	Unplanned	0.04 (-0.59–1.00)	0.004	70 (35–95)	<0.001
Mode of delivery Preferences	Normal vaginal delivery	0.59 (-0.59–1.00)	<0.001	80 (35–100)	<0.001
Mode of delivery Preferences	Cesarean section	0.04 (-0.59–1.00)	<0.001	70 (40–100)	<0.001
Mode of delivery	Normal vaginal delivery	0.88(-0.59–1.00)	<0.001 ^§ §Kruskal-Wallis test. NICU: Neonatal intensive care unit; NVD: normal vaginal delivery. Statistically significant values are denoted in bold.	85 (40–100)	<0.001 ^§ §Kruskal-Wallis test. NICU: Neonatal intensive care unit; NVD: normal vaginal delivery. Statistically significant values are denoted in bold.
	Instrumental NVD	0.30 (0.04–0.85)		80 (55–90)
	Elective cesarean	0.04 (-0.59–0.52)		60 (35–85)
	Emergency cesarean	-0.59 (-0.59–1.00)		60 (40–90)
Episiotomy during birth	Yes	0.59 (-0.59–1.00)	<0.001	85 (50–100)	<0.001
Episiotomy during birth	No	0.10 (-0.59–1.00)	<0.001	70 (35–100)	<0.001
Perineal tear during birth	Yes	0.36 (0.04–0.59)	<0.001	80 (55–90)	0.648
Perineal tear during birth	No	1.00 (-0.59–1.00)	<0.001	75 (35–100)	0.648
Degree of perineal tear	No	1.00 (-0.59–1.00)	<0.001 ^§ §Kruskal-Wallis test. NICU: Neonatal intensive care unit; NVD: normal vaginal delivery. Statistically significant values are denoted in bold.	75 (35–100)	0.890^§ §Kruskal-Wallis test. NICU: Neonatal intensive care unit; NVD: normal vaginal delivery. Statistically significant values are denoted in bold.
	1st	–		–
	2nd	0.35 (0.04–0.59)		80 (55–90)
	3rd	0.54 (0.54–0.54)		80 (80–80)
Need of blood transfusion	Yes	0.59 (-0.59–0.65)	0.976	60 (50–75)	0.001
Need of blood transfusion	No	0.56 (-0.59–1.00)	0.976	80 (35–100)	0.001
Maternal admission to ICU	Yes	0.04 (-0.59–1.00)	0.014	50 (40–70)	<0.001
Maternal admission to ICU	No	0.58 (-0.59–1.00)	0.014	80 (35–100)	<0.001

	Mode of delivery								p-value^* *Kruskal-Wallis test. NVD: normal vaginal delivery; CS: cesarean section. Statistically significant values are denoted in bold.
	NVD		Instrumental NVD		Elective CS		Emergency CS
	Mean	SD	Mean	SD	Mean	SD	Mean	SD
EQ5D-mobility	1.59	0.74	2.82	0.58	4.19	0.68	4.78	0.54	<0.001
EQ5D-self care	1.59	0.74	2.82	0.64	4.20	0.67	4.79	0.53	<0.001
EQ5D-usual activities	1.61	0.77	2.97	0.68	4.20	0.67	4.82	0.52	<0.001
EQ5D-pain/discomfort	1.62	0.78	2.79	0.60	4.20	0.67	4.80	0.53	<0.001
EQ5D-anxiety/depression	1.76	1.08	3.82	0.92	4.19	0.70	4.77	0.66	<0.001

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E-mail: ramb@amb.org.br

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[1] * Corresponding author: leylakaya02@hotmail.com