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Persistence of anxiety symptoms after elective caesarean delivery

  • Anna B. Janssen (a1), Katrina A. Savory (a2), Samantha M. Garay (a3), Lorna Sumption (a3), William Watkins (a4), Isabel Garcia-Martin (a3), Nicola A. Savory (a5), Anouk Ridgway (a5), Anthony R. Isles (a6), Richard Penketh (a7), Ian R. Jones (a6) and Rosalind M. John (a8)...



In the UK, 11.8% of expectant mothers undergo an elective caesarean section (ELCS) representing 92 000 births per annum. It is not known to what extent this procedure has an impact on mental well-being in the longer term.


To determine the prevalence and postpartum progression of anxiety and depression symptoms in women undergoing ELCS in Wales.


Prevalence of depression and anxiety were determined in women at University Hospital Wales (2015–16; n = 308) through completion of the Edinburgh Postnatal Depression Scale (EPDS; ≥13) and State-Trait Anxiety Inventory (STAI; ≥40) questionnaires 1 day prior to ELCS, and three postpartum time points for 1 year. Maternal characteristics were determined from questionnaires and, where possible, confirmed from National Health Service maternity records.


Using these criteria the prevalence of reported depression symptoms was 14.3% (95% CI 10.9–18.3) 1 day prior to ELCS, 8.0% (95% CI 4.2–12.5) within 1 week, 8.7% (95% CI 4.2–13.8) at 10 weeks and 12.4% (95% CI 6.4–18.4) 1 year postpartum. Prevalence of reported anxiety symptoms was 27.3% (95% CI 22.5–32.4), 21.7% (95% CI 15.8–28.0), 25.3% (95% CI 18.5–32.7) and 35.1% (95% CI 26.3–44.2) at these same stages. Prenatal anxiety was not resolved after ELCS more than 1 year after delivery.


Women undergoing ELCS experience prolonged anxiety postpartum that merits focused clinical attention.

Declaration of interest


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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence: Rosalind M. John, Biomedicine Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK. Email:


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Persistence of anxiety symptoms after elective caesarean delivery

  • Anna B. Janssen (a1), Katrina A. Savory (a2), Samantha M. Garay (a3), Lorna Sumption (a3), William Watkins (a4), Isabel Garcia-Martin (a3), Nicola A. Savory (a5), Anouk Ridgway (a5), Anthony R. Isles (a6), Richard Penketh (a7), Ian R. Jones (a6) and Rosalind M. John (a8)...
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