Mode of delivery in women with versus without psychiatric vulnerability

Objective: Maternal mental health during pregnancy may influence obstetric outcomes. This study examines associations between psychiatric vulnerability [PV]—defined as current or past psychiatric disorder—and mode of delivery and its indication. Methods: A retrospective cohort study was conducted in a large Dutch maternity hospital. Primiparous women aged ≥ 18 with singleton pregnancies were included between January 2015 and March 2020. Results: In total, 705 women with and 837 women without PV were included. No differences in delivery method were found between these groups. However, women using psychotropic medication had significantly higher odds of undergoing an assisted vaginal delivery [AVD] than a spontaneous vaginal delivery [SVD] (aOR = 2.00). Indications related to maternal mental health for unplanned caesarean section [CS] were exclusively observed in the group with PV (3.4%). No differences were observed in obstetric or fetal indications. Conclusions: Although mode of delivery did not differ between women with and without PV, women using psychotropic medications had higher risks for undergoing an AVD than a SVD. Only in a small proportion of women with PV, maternal mental health constituted an indication for unplanned CS. Further research is warranted to better understand the intersection of PV and psychotropic medication on delivery method.