229 - Does paternal presence impact the relationship between pre-existing maternal mental illness and delivery mode?

Poster Number: 229
Publication Number: 229.1255

Background: Maternal mental illness has been associated with adverse birth outcomes & potential fear of vaginal delivery due to past trauma. Our previous work demonstrated a link between maternal mental illness & increased odds of cesarean delivery (C/S), accounting for social determinants of health. Fathers may provide maternal support during the peripartum period, thus increasing breastfeeding & reducing maternal stress. Yet, little is known regarding delivery mode & paternal presence in the context of maternal mental illness.

Objective: To determine if maternal mental illness is associated with higher rates of primary C/S among those with & without paternal presence.

Design/Methods: This is a cross sectional study (2016-2020) of maternal (≥18 yrs) survey responses merged with birth certificate data of singleton live births. Mothers without a previous C/S were classified into those with mental illness (self-reported anxiety, depression, bipolar, schizophrenia or other) or without. Maternal characteristics included demographics, adverse life events [ALE ≥3 of 14 stressors such as homelessness or incarceration], lifestyle behaviors & pregnancy history. Among those with & without paternal presence (defined as paternal survey completion prior to discharge from birth hospitalization), logistic regression assessed associations of maternal mental illness & primary C/S controlling for race, education, insurance, exercise, prenatal care, ALE, high risk pregnancy (defined as comorbidities or extremes of age), substance use & nativity.

Results: 1134 mothers without a previous C/S were analyzed of which 150 had self-reported mental illness. Mothers with mental illness had higher rates of primary C/S (consistent with our past results), social stressors, substance use & lower rates of marriage (Table 1). Primary C/S was associated with higher social stressors (Table 2). Among fathers who were not present, maternal mental illness did not increase odds of C/S (OR 1.47, CI 0.70-3.09). In contrast, of mothers with paternal presence, those with mental illness exhibited higher odds of C/S (OR 2.40, CI 1.05-5.51).

Conclusion(s): Paternal presence increased odds a mother with mental illness had a primary C/S. This association did not persist when fathers were absent. We speculate paternal presence may have empowered mothers with mental illness to advocate for C/S potentially mitigating trauma associated with vaginal delivery. Clinicians should target counseling mothers with mental illness & their partners regarding risks of C/S.