Implications of Perceived Control for Recovery from Childbirth for Unplanned Cesarean, Planned Cesarean, and Vaginal Deliveries

ABSTRACT: This study examines relationships between perceptions of control, postpartum depression, and physiological symptoms in women who gave birth vaginally or by cesarean. Extrapolating from a cognitive framework, it was hypothesized that women who gave birth by cesarean would exhibit lower levels of perceived control and higher levels of depression and physiological symptoms as compared with women who gave birth vaginally. Results were supportive of the hypotheses, suggesting that it may be helpful to explore ways of assisting women to experience greater control over their childbirth. Future research should assess the desire for and the value placed on perceptions of control in childbirth. KEY WORDS: Childbirth, control, caesarean, postpartum depression. INTRODUCTION Medical technology has had a profound impact on childbirth practices in the United States. Increasingly, birth has become medicalized as we look to doctors and technology for answers in our quest for the "perfect birth" (Wertz & Wertz, 1989). Women have gradually given over to doctors the medical control of birth (Wertz & Wertz), a process that traditionally was managed solely by women (the laboring woman, a midwife, and a team of other women for social support). One of the ways in which birth has been impacted by medical technology can be seen in the rates of cesarean deliveries in the United States. Recent reports by the National Center for Health Statistics (Martin et al., 2003) found that cesarean rates in the year 2002 were the highest ever reported in the United States (26.1% of all births). These numbers indicate that although the majority of births that occur in the United States are vaginal births, the number of non-vaginal births is still sufficiently high to warrant a closer examination of contributing variables and implications for cesarean births. In fact, some medical professionals have come to view cesarean birth as non-complicated birth, perhaps as a consequence of what Shearer (1989) has named the "normalizing effect" of such high cesarean rates in this country. What used to occur only in extremely rare and acute emergency situations has now become more normal and less extraordinary as the rates have increased. Cesarean delivery, a unique childbirth method as it is a major abdominal surgery requiring lengthier physiological recovery time than vaginal delivery (Hillan, 1992; Tulman & Fawcett, 1988) may also involve more negative psychological effects that require extended periods of recovery (Edwards, Porter, & Stein, 1994; Mutryn, 1993; Tulman & Fawcett, 1991). A trend toward decreased satisfaction with the birth experience (Oakley, 1983) and lower levels of interaction between newborns and cesarean-delivered mothers (Hwang, 1987; Pederson et al, 1981; Trowell, 1982) is cause enough to generate concern over the facilitation of women's recovery from cesarean childbirth. Some sources even liken the recovery from cesarean childbirth to recovery from PostTraumatic Stress Disorder (e.g., Ryding, Wijma, & Wijma, 1998). However severe the aftermath, it is clear that attention should be given to the recovery process experienced by women who have had a cesarean birth, especially given that findings apply to over a quarter of all births in the U.S. Perceived Control An aspect related to childbirth in general, and cesarean childbirth in particular, is the concept of perceived control. Psychological research has shown that "a sense of control is a robust predictor of physical and mental well-being" (Skinner, 1996, p. 549). The perception of control has been shown to reduce stress associated with noxious situations (Glass & Singer, 1972), to aid in coping with major life stressors (Thompson et al., 1993), and to play an important role in various other arenas of health psychology. Perceived control has been found to be a fundamental part of the process of psychological recovery from surgery (Matthews & Ridgeway, 1981; Orbell et al, 1998; Ridgeway & Matthews, 1982). …