[The influence of birth modus on the emotional state of the mother, bonding, and the newborn's neurobehavioural state].

INTRODUCTION: Childbirth is an important event, both in a woman's, and in her family's lives, an event which carries a huge emotional charge and influences the functioning of a triad. Labour is a physiological process which may have health (somatic, psychological, mental) and economic consequences. Irrespective of the reasons why it is performed; caesarean section involves surgical, obstetric and anaesthesiological intervention, as well as the necessity for pharmacological agents. Bonding between parents and their children serves as a basis for optimal psychomotor development, and the first year is important for the rest of life. The aim of the study was to assess the influence of the labour mode on the mother's emotional state, mother-child bonding, and the infant's neurobehavioural state.

MATERIAL AND METHODS: The plan of this study was approved by the Bioethical Commission of the Pomeranian Medical University in Szczecin (BN-001/108/08). The research material comprised 200 women and their children. The following instruments were used in this study: an original questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), the Mother-Child Relationship FIRST score (MCR FIRST score), the Brazelton Scale, also known as the Neonatal Behavioural Assessment Scale (NBAS). The umbilical blood was used to determine the level of cortisol as a stress marker. Statistical analysis was performed using the Shapiro-Wilk test, the χ2 test, the Mann-Whitney U-test, the Fisher test, and the Spearman rank correlation coefficient. The accepted significance level (p) was equal to 0.05 (the acceptable type I error).

RESULTS: Around 35% of the women took part in prenatal education, and 59% of them declared the intention to participate in postnatal education. The respondents wanted someone close to be with them during delivery (65.5%), although only 35% had such a possibility. Women giving birth naturally were more often accompanied by their partners (p = 0.00005). Less than half of the women (35%) had skin-to-skin contact with their babies, and there was a difference between delivery mode (p = 0.01). Attempts at breastfeeding were made by 81.5% of those surveyed. Women after c-section less often tried to breastfeed their babies than their counterparts after natural delivery (p = 0.003). The levels of cortisol in umbilical blood were significantly higher after natural labour than after caesarean section (p < 0.00001). The assessment of the risk of postnatal depression performed with the EPDS did not demonstrate significant differences between women in particular delivery modes (p = 0.82). The percentage of'crying' Children was similar in both modes (12% of naturally born babies and 13% of those born by c-section); the difference was not statistically significant (p = 1.0). Infant examination with the Brazelton Scale revealed differences in babies' behaviour in 30 parameters of the scale in favour of naturally born children. Children born through caesarean section had rarer contact with their mothers after delivery (p = 0.01).

CONCLUSIONS: Naturally born babies obtained higher scores on the NBAS, which is an argument for the promotion of this delivery mode. Naturally born babies had significantly higher cortisol levels and more frequent direct contact with their mothers after delivery, which creates favourable conditions for forming bonds. Delivery mode had no influence on the occurrence of postpartum depression, according to the EPDS (p = 0.82).