UCSF

Childbirth is a necessary stressor. It prepares the infant for extrauterine life, and prepares the mother for lactation and safe return to the non-pregnant state. However, added stressors can have repercussions. This study aims to describe added stressors (including prenatal maternal socio-demographic and psychological factors) affecting mode of delivery (MOD), and the effect of MOD on mother-infant health at one month postpartum.

Approximately 150 first-time, English-speaking, expectant mothers, at least 18 years of age, recruited from San Francisco, California prenatal clinics, participated in a postpartum intervention sleep study. Women were excluded if they had a sleep or mood disorder, or worked nights. This is a secondary analysis of these data.

Prenatal maternal socio-demographic and risk factors (depression, anxiety, attitudes/adjustment, perceived stress) were evaluated by MOD outcome using analysis of variance (ANOVA), t-tests, Mann Whitney U, and Kruskall-Wallis. Labor induction/augmentation was evaluated by maternal report of non-reassuring fetal status (NRFS) with NRFS as the key outcome, analyzed by Chi-Square and

logistic regression. Lastly, MOD was evaluated for effect on maternal symptoms of depression and anxiety, infant temperament rating, infant sleep, and breastfeeding continuation at one month using ANOVA and Chi-Square statistics.

Prenatal depression and anxiety symptoms were not associated with MOD (normal vaginal, instrument vaginal, cesarean in labor, or scheduled cesarean). Mothers with a prenatal "attitude toward baby" score that was more positive were more likely to have an unplanned cesarean birth. A scheduled cesarean birth was more likely in older women and those with higher pre-pregnancy BMI. Maternal reports of NRFS were associated with induction/augmentation. One month postpartum measures of maternal symptoms, maternal adjustment, infant temperament, and breastfeeding did not differ by MOD. However, according to maternal diary entries, cesarean-born infants slept an average of one hour more during the day than infants born vaginally.

These findings provide preliminary indication that prenatal attitude toward baby plays a role in MOD, induction/augmentation is associated with increased NRFS, and cesarean birth is associated with increased infant sleep at one month. Nurses should develop and test interventions to minimize prenatal and labor factors that unnecessarily add to delivery stress.