Mode of birth and risk of postpartum depression among mothers who gave birth within the last 12 months in Ghana: A mixed-method, cross-sectional study

Background: We examined the association between mode of birth (caesarean section (CS) vs spontaneous vaginal birth (SVB)) and the risk of postpartum depression (PPD) and explored mechanisms of this relationship. Methods: We carried out a mixed-method, cross-sectional study in Ho, Ghana, among postpartum women. We used a binomial log-link generalised linear model to examine the association between birth mode and PPD risk. We applied a potential-outcome framework to test if negative childbirth experience or low self-esteem mediated this association. Additionally, we conducted in-depth interviews (IDIs) with mothers at risk of PPD. Results: Among 399 mothers, CS was associated with a 68% higher prevalence of screen-positive PPD compared with SVB [adjusted prevalence ratio = 1.68 (95% CI; 1.22, 2.32); p = 0.002]. Neither childbirth experience nor self-esteem mediated this association. In the qualitative analysis of 19 IDIs, we identified three themes increasing PPD risk: delayed physical recovery from post-surgical challenges; emotional trauma, unmet expectations, and anxiety about future pregnancies; and experiences of social isolation coupled with financial strain. Conclusion: Screen-positive PPD was common after both SVD and CS, and the association with CS persisted after adjustment for measured confounders. Universal postpartum screening and stepped psychosocial support, with enhanced recovery care for CS, may reduce burden.