Object relations, unconscious defences and fear of childbirth, as reflected in maternal-request caesarean section

Objective: To examine a possible association between maternal-request caesarean section (CS) and two intrapsychic psychoanalytic personality variables: object relations (OR) and unconscious defences.

Background: While maternal-request CS is a growing phenomenon, studies are lacking regarding personality variables that may be associated with it.

Methods: A cross-sectional questionnaire was conducted in one delivery ward. During 2009, 59 primigravida, healthy women were recruited; 28 who had requested and delivered by CS without an obstetrical indication and 31 who opted for a spontaneous vaginal delivery. Due to missing data for some measures, only 27 participants were analysed in each group. All women completed the fear of childbirth (FOC) questionnaire, and the object relations (SCORS) and unconscious defences (DMM) measures of the Thematic Apperception Test (TAT), as well as questionnaires assessing background variables. Multivariate analysis of variance (MANOVA) and a logistic hierarchical multiple regression were performed.

Results: Preliminary MANOVA showed significant differences between groups in age, FOC and use of the defence mechanism projection. Hence, these variables entered as predictors of maternal-request CS to a logistic hierarchical multiple regression model. The model was found to have a good fit [χ²₍₄₎ = 38.19, p < 0.001]. Age, FOC and projection defence were found to be significant factors associated with maternal-request CS.

Conclusion: Maternal-request CS was found to be strongly associated with age and FOC. Except for unconscious defence of projection, intrapsychic variables were not found to be associated with maternal-request CS. Possible implications are discussed.