Objectives: To assess the association between elective caesarean section and p ostnatal depression compared with planned vaginal delivery and whether emergency caesarean section or assisted vaginal delivery is associated with postnatal dep ression compared with spontaneous vaginal delivery. Design: Prospective populati on based cohort study. Setting: ALSPAC (the Avon longitudinal study of parents a nd children). Participants: 14 663 women recruited antenatally with a due date b etween 1 April 1991 and 31 December 1992. Main outcome measure: Edinburgh postna tal depression scale score ≥13 at eight weeks postnatal on self completed quest ionnaire. Results: Albeit with wide confidence intervals, there was no evidence that elective caesarean section altered the odds of postnatal depression compared with plann ed vaginal delivery (adjusted odds ratio 1.06, 95%confidence interval 0.66 to 1 .70, P = 0.80). Among planned vaginal deliveries there was similarly little evid ence of a difference between women who have emergency caesarean section or assis ted vaginal delivery and those who have spontaneous vaginal delivery (1.17, 0.77 to 1.79, P = 0.46, and 0.89, 0.68 to 1.18, P = 0.42, respectively). Conclusions : There is no reason for women at risk of postnatal depression to be managed dif ferently with regard to mode of delivery. Elective caesarean section does not pr otect against postnatal depression. Women who plan vaginal delivery and require emergency caesarean section or assisted vaginal delivery can be reassured that t here is no reason to believe that they are at increased risk of postnatal depression.
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