Physical, chemical and psychological effect of COVID-19 pandemic upon health care providers.

Maternal psychiatric conditions are among the most common complications after childbirth. Approximately 85% of women experience some mood disturbance postpartum, and one in five will have more enduring symptoms that may result in a diagnosis of depression, anxiety, posttraumatic stress, or other serious mental health conditions such as bipolar disorder. Although many risk factors for postpartum psychiatric conditions have been identified, evidence on the role of mode of delivery is contradictory and limited. Prior studies have found that unplanned delivery interventions can result in patient traumatization, particularly with unplanned cesarean deliveries. However, evidence is lacking on the psychiatric sequelae of operative vaginal delivery (OVD) attempts. Vacuum- and forceps-assisted deliveries are an important component of labor management because they can expedite delivery for maternal or fetal indications while avoiding a second-stage cesarean delivery and its associated morbidities. Operative vaginal deliveries account for 3.4% (2.4–2.6% vacuum-assisted deliveries, 0.4–0.5% forceps-assisted deliveries) of all deliveries in the United States (2000–2018). An OVD attempt may be traumatic for birthing individuals, particularly when the goal is to expedite delivery in an emergency situation and the OVD attempt is unsuccessful. Prior studies have come to discordant conclusions on mental health outcomes with OVD. Robust, contemporary data evaluating the mental health consequences of all modes of delivery (including successful and unsuccessful OVD attempts) are needed. Therefore, we aimed to evaluate the association between mode of delivery and incident postpartum psychiatric diagnoses. We hypothesized that cesarean deliveries with and without OVD attempts, but not successful OVDs, would be associated with increased rates of postpartum psychiatric conditions compared with spontaneous vaginal birth.