Childbirth experience and its relationship with postpartum depression and anxiety: a cross-sectional study from Gaza.

backgroundThe quality of childbirth experience has a profound effect on maternal mental health. Negative experiences during labour, including poor communication, lack of informed consent, and obstetric maltreatment, can increase the risk of postpartum depression (PPD) and postpartum anxiety (PPA). This study explores women’s perspectives on the childbirth experience in Gaza and its associations with PPD and PPA.

aimsTo explore women’s perspectives on the childbirth experience and its relationship with the development of postpartum depression and anxiety. The study included women who gave birth at Gaza hospitals between 2017 and 2021.

methodsThis cross-sectional study surveyed 722 women who gave birth between January 2017 and December 2021 in Gaza’s public and private hospitals. Data were collected via a self-administered online questionnaire shared via social media and working groups. The tool included five sections: sociodemographics, childbirth experience (pain score, satisfaction, communication, procedures maltreatment practices, and postpartum mental health, which were assessed via the PHQ-2 and GAD-2 screening tools).

resultsThe mean participant age was 27.7 years (SD ± 5.37). Most births occurred in governmental hospitals (70.3%), with normal vaginal delivery being most common (74.4%). While 87.1% had regular antenatal care, 49% reported inadequate information on labour, and 29.6% received no explanation regarding vaginal exams. A majority (68.6%) were unaware of episiotomy before the procedure, and 66.9% underwent unconsented episiotomies, often without local anaesthesia (30.6%). Obstetric maltreatment was an unfamiliar term for 41.5% of the women. Inadequate analgesia was the most reported form (63.4%). Compared with those not exposed (n = 422, 58.4%) (p = 0.001), women exposed to any form of maltreatment (n = 300, 41.5%) were at increased risk for PPD or PPA. Among those who were exposed to maltreatment, 78.7% (n = 236) reported PPD and PPA. Instrumental vaginal delivery (AOR = 3.25; p = 0.00, 95% CI = 2.04–4.24) and elective caesarean section (AOR = 2.01; p = 0.001, 95% CI = 1.84–5.17) significantly increased the risk of PPD. Similarly, PPA was more prevalent among women who had elective CS (AOR = 9.16; p = 0.001, 95% CI = 6.32–17.24) and IVDs (AOR = 3.71; p = 0.001, 95% CI = 2.17–5.68). Women who reported being aware of obstetric maltreatment were less likely to develop PPD (AOR = 0.46; p = 0.04, 95% CI = 0.21–0.87) and PPA (AOR = 0.36; p = 0.01, 95% CI = 0.17–0.76).

conclusionPPD and PPA were associated with negative childbirth experiences, particularly maltreatment and lack of informed care. Promoting respectful maternity care and improving patient education may reduce these mental health risks.