Diminished control and unmet expectations: Testing a model of adjustment to unplanned cesarean delivery

Compared to vaginal deliveries, surgical (cesarean) deliveries are associated with more complications, longer recovery, lower satisfaction, and greater risk of postpartum mood disturbances. Despite a steep rise in rates of surgical delivery, there have been few theoretically founded investigations of the mechanisms by which delivery method has an effect on psychosocial outcome. We tested a model of adjustment to unplanned cesarean delivery, focusing on two mediators: diminished control over labor and delivery; and unmet expectations of control over childbirth. Participants were 164 women anticipating a normal vaginal childbirth. Women who delivered by unplanned surgical delivery (24% of the sample) experienced significantly lower childbirth satisfaction than women delivering vaginally. As hypothesized, the association of delivery method with childbirth satisfaction was mediated by diminished control and unmet expectations, even after controlling for other predictors. Differences were not found between delivery groups in postpartum depressed mood. Irrespective of delivery method, perceived control during labor and delivery was strongly associated with childbirth satisfaction and lower depressed mood. Findings suggest that enabling women to exert desired control over childbirth is likely to enhance satisfaction and reduce the likelihood of postpartum mood disturbance. Implications for policies relevant to hospitals, employers, insurance companies, and legal practice are discussed.