Planned mode of birth after previous caesarean section and women’s use of psychotropic medication in the first year postpartum: a population-based record linkage cohort study

Background: Policy in many high-income settings supports giving pregnant women with previous caesarean section a choice between an elective repeat caesarean section (ERCS) or planning a vaginal birth after previous caesarean (VBAC), provided they have no contraindications to VBAC. Despite the potential for this choice to influence women’s mental health, evidence about the associated effect to counsel women and identify potential targets for intervention is limited. This study investigated the association between planned mode of birth after previous caesarean and women’s subsequent use of psychotropic medications. Methods: A population-based cohort study of 31,131 women with one or more previous caesarean sections who gave birth to a term singleton in Scotland between 2010-2015 with no prior psychotropic medications in the year before birth was conducted using linked Scottish national datasets. Cox regression was used to investigate the association between planned mode of birth and being dispensed psychotropic medications in the first year postpartum adjusted for socio-demographic, medical, pregnancy-related factors and breastfeeding. Results: Planned VBAC (n=10,220) compared to ERCS (n=20,911) was associated with a reduced risk of the mother being dispensed any psychotropic medication (adjusted hazard ratio[aHR] 0.85, 95%CI 0.78-0.92), an antidepressant (aHR 0.83, 95%CI 0.76-0.90), and at least two consecutive antidepressants (aHR 0.83, 95%CI 0.75-0.91) in the first year postpartum. Conclusions: Women giving birth by ERCS were more likely than those having a planned VBAC to be dispensed psychotropic medication including antidepressants in the first year postpartum. Further research is needed to establish the reasons behind this new finding.