The Effect of Mode of Delivery On Health-Related Quality-of-Life In Mothers: A Systematic Review And Meta-Analysis

Background: Previous research is inconclusive on the effects of mode of delivery on maternal health-related quality-of-life. We conducted a systematic review and meta-analysis to assess the current evidence for associations between mode of delivery and postpartum health-related quality-of-life. Methods: Electronic databases MEDLINE ALL (OVID), Web of Science, The Cochrane Library, CINAHL and EMBASE (OVID) were searched for English written articles investigating the relationship between mode of delivery and quality-of-life published form inception to 15th October 2020. Two reviewers independently screened titles and abstracts, assessed full texts, and extracted data. Meta-analysis was conducted where possible. Results: Twenty-one studies, including 19,879 women, met the inclusion criteria. A meta-analysis of 18 studies found HRQoL scores were significantly higher for women after vaginal delivery in comparison to caesarean (emergency and elective combined) (Effect Size (ES) 0.17, 95% CI 0.01-0.25, n=7665) with highest scores after assisted vaginal delivery (ES 0.21, 95% CI 0.13-0.30, n=2547). Physical functioning (ES 11.18, 95% CI=2.29-20.06, n=1746), physical role (ES 13.10, 95% CI=1.16-25.05, n=1471), vitality (ES 6.31, 95% CI=1.14-10.29, n=1746) and social functioning (ES 5.69, 95% CI=1.26-10.11, n=1746) were significantly higher after vaginal delivery compared to caesarean. There was no significant difference in bodily pain, emotion role, mental health and general health scores were higher after vaginal delivery compared to caesarean. Conclusions: Health-related quality-of-life scores were higher for women after vaginal delivery in comparison to caesarean section. Consequently, women should be encouraged to deliver vaginally where possible. The findings of this research should be available to the relevant population to help support informed choice