The goal of this observational retrospective cohort study is to examine the association between mode of delivery and early postpartum depressive symptoms in adult women who delivered at Massachusetts General Hospital. Specifically, the study evaluates whether the urgency of cesarean delivery (elective versus emergency) is associated with differences in Edinburgh Postnatal Depression Scale (EPDS) scores at 6-8 weeks postpartum, compared with elective cesarean delivery and vaginal delivery. The EPDS is a validated 10-item self-report questionnaire with scores ranging from 0 to 30, where higher scores indicate more severe depressive symptoms.

The primary questions are whether EPDS scores differ among women undergoing emergency cesarean delivery, elective cesarean delivery, and vaginal delivery, and whether perioperative and obstetric factors are associated with postpartum depressive symptoms.

This study involves retrospective analysis of de-identified electronic health record data. Participants will not undergo any study-specific interventions.

Inclusion Criteria:

Underwent cesarean delivery (elective or emergency) or vaginal delivery during the study period

Age 18 years or older

Completed at least one Edinburgh Postnatal Depression Scale (EPDS) assessment at 6-8 weeks postpartum

Have complete perioperative data available

Exclusion Criteria:

Missing 6-8 week postpartum EPDS scores

Pregnancy with fetal demise, severe obstetric complications, or atypical maternal conditions

History of severe psychiatric disorders (e.g., schizophrenia, bipolar disorder), when identifiable

Incomplete perioperative medical records

adult patients (≥18 years old) who underwent cesarean delivery or vaginal delivery