A multi-level meta-analysis of the relationship between decision-making during birth and postpartum mental health
Introduction There is accumulating evidence of ineffective decision-making between birthing individuals and healthcare providers during childbirth. While research syntheses have demonstrated that negative birth experiences are associated with postpartum mental health, primary quantitative studies li...
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Taylor & Francis Group
2025-12-01
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| Series: | Health Psychology and Behavioral Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/21642850.2025.2456032 |
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| author | Louisa Arnold Marie Völkel Jenny Rosendahl Michael Rost |
| author_facet | Louisa Arnold Marie Völkel Jenny Rosendahl Michael Rost |
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| description | Introduction There is accumulating evidence of ineffective decision-making between birthing individuals and healthcare providers during childbirth. While research syntheses have demonstrated that negative birth experiences are associated with postpartum mental health, primary quantitative studies linking specific decision-making measures and mental health outcomes have not been synthesised. The present study aims to fill this gap in order to provide hands-on evidence on how to further improve perinatal care.Methods A systematic literature search using Bolean logic was conducted. A final set of 34 publications from 14 different countries could be included in our meta-analysis. Measures of intrapartum decision-making were consolidated into four key domains: information, respect, control, and involvement. We conducted multi-level meta-analyses to assess the overall relationship of intra-partum decision-making and mental-health outcomes, as well as the specific correlations associated with each decision-making domain.Results Our analysisrevealed that less effective intrapartum decision-making is associated with more postpartum overall mental health problems (r = -.25), depression (r = -.19), and posttraumatic stress disorder (r = -.29). More precisely, while all domains of intrapartum decision-making (information: r = -.22, involvement: r = -.23, respect: r = -.28, control: r = -.25) were associated with postpartum overall psychopathology, only information (r = -.18), respect (r = -.25), and control (r = -.12) were associated with depression, and only involvement (r = -.31), respect (r = -.32), and control (r = -.25) were associated with posttraumatic stress disorder. A higher percentange of planned cesarean sections in a sample and longer time lags between birth and post-effect measurement were identified as moderating variables.Conclusions Ineffective decision-making is a significant contributing factor to the development of adverse postpartum mental health problems outcomes. Implications for practice concern establishing numerous antenatal care contacts as a standard to enhance birth preparedness for both birthing individuals and providers. Additionally, measuring the experience of intrapartum decision-making as an indicator of quality of care as a default to monitor, analyse, and improve decision-making and to facilitate accountability systems. |
| format | Article |
| id | doaj-art-ea66fdc1f2004218b62f814dfd5b9025 |
| institution | Kabale University |
| issn | 2164-2850 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Health Psychology and Behavioral Medicine |
| spelling | doaj-art-ea66fdc1f2004218b62f814dfd5b90252025-02-04T08:16:01ZengTaylor & Francis GroupHealth Psychology and Behavioral Medicine2164-28502025-12-0113110.1080/21642850.2025.2456032A multi-level meta-analysis of the relationship between decision-making during birth and postpartum mental healthLouisa Arnold0Marie Völkel1Jenny Rosendahl2Michael Rost3Department for Health Psychology, FernUniversität in Hagen, Hagen, GermanyWilhelm Wundt Institute for Psychology, University of Leipzig, Leipzig, GermanyInstitute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, GermanyInstitute for Biomedical Ethics, University of Basel, Basel, SwitzerlandIntroduction There is accumulating evidence of ineffective decision-making between birthing individuals and healthcare providers during childbirth. While research syntheses have demonstrated that negative birth experiences are associated with postpartum mental health, primary quantitative studies linking specific decision-making measures and mental health outcomes have not been synthesised. The present study aims to fill this gap in order to provide hands-on evidence on how to further improve perinatal care.Methods A systematic literature search using Bolean logic was conducted. A final set of 34 publications from 14 different countries could be included in our meta-analysis. Measures of intrapartum decision-making were consolidated into four key domains: information, respect, control, and involvement. We conducted multi-level meta-analyses to assess the overall relationship of intra-partum decision-making and mental-health outcomes, as well as the specific correlations associated with each decision-making domain.Results Our analysisrevealed that less effective intrapartum decision-making is associated with more postpartum overall mental health problems (r = -.25), depression (r = -.19), and posttraumatic stress disorder (r = -.29). More precisely, while all domains of intrapartum decision-making (information: r = -.22, involvement: r = -.23, respect: r = -.28, control: r = -.25) were associated with postpartum overall psychopathology, only information (r = -.18), respect (r = -.25), and control (r = -.12) were associated with depression, and only involvement (r = -.31), respect (r = -.32), and control (r = -.25) were associated with posttraumatic stress disorder. A higher percentange of planned cesarean sections in a sample and longer time lags between birth and post-effect measurement were identified as moderating variables.Conclusions Ineffective decision-making is a significant contributing factor to the development of adverse postpartum mental health problems outcomes. Implications for practice concern establishing numerous antenatal care contacts as a standard to enhance birth preparedness for both birthing individuals and providers. Additionally, measuring the experience of intrapartum decision-making as an indicator of quality of care as a default to monitor, analyse, and improve decision-making and to facilitate accountability systems.https://www.tandfonline.com/doi/10.1080/21642850.2025.2456032Birthdecision-makingdepressionpost-traumatic stress disordermeta-analysismoderator |
| spellingShingle | Louisa Arnold Marie Völkel Jenny Rosendahl Michael Rost A multi-level meta-analysis of the relationship between decision-making during birth and postpartum mental health Health Psychology and Behavioral Medicine Birth decision-making depression post-traumatic stress disorder meta-analysis moderator |
| title | A multi-level meta-analysis of the relationship between decision-making during birth and postpartum mental health |
| title_full | A multi-level meta-analysis of the relationship between decision-making during birth and postpartum mental health |
| title_fullStr | A multi-level meta-analysis of the relationship between decision-making during birth and postpartum mental health |
| title_full_unstemmed | A multi-level meta-analysis of the relationship between decision-making during birth and postpartum mental health |
| title_short | A multi-level meta-analysis of the relationship between decision-making during birth and postpartum mental health |
| title_sort | multi level meta analysis of the relationship between decision making during birth and postpartum mental health |
| topic | Birth decision-making depression post-traumatic stress disorder meta-analysis moderator |
| url | https://www.tandfonline.com/doi/10.1080/21642850.2025.2456032 |
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