Quest Journals
Journal of Medical and Dental Science Research
Volume 8~ Issue 4 (2021) pp: 43-48
ISSN(Online) : 2394-076X ISSN (Print):2394-0751
www.questjournals.org
*Corresponding Author: Hashemi Zeinab 43 | Page
Research Paper
Relationship between demographic characteristics, stress and
anxiety before and after cesarean section in pregnant women
Hashemi Zeinab
(Department of Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran )
Background and Aim: Stress and anxiety can have adverse effects for the mother and baby. Proper prevention
requires identifying the predisposing factors for these disorders. Due to the lack of information on stress and
anxiety related factors in Iran, this study aimed to determine the relationship between demographic
characteristics with stress and anxiety before and after cesarean section in pregnant women referring to Besat
Hospital in Sanandaj.
Materials and Methods: This descriptive correlational and cross-sectional study on 180 pregnant women
undergoing elective cesarean section was performed in 2018. Samples were selected by convenience sampling
from referring women to Besat Hospital in Sanandaj. Data were collected using a two-part demographic and
midwifery questionnaire and Dass 21 stress and anxiety questionnaire. Data were analyzed using SPSS
software version 16, descriptive and analytical statistics.
Results: The results showed that there was a significant relationship between age, educational level, income
level, history of surgery and cesarean section, marital satisfaction and gender satisfaction of infant with stress
and anxiety before and after cesarean section (p <0.05).
Conclusion: Factors affecting the level of stress and anxiety in this study can help screening pregnant women at
risk of stress and anxiety, assisting physicians, health care providers, and treatment staff. It is also
recommended to design supportive and preventive programs for pregnant women.
Key word: Demographic characteristics, Stress, Anxiety, Cesarean section
Received 29 Mar, 2021; Revised: 10 Apr, 2021; Accepted 12 Apr, 2021 © The author(s) 2021.
www.questjournals.org Published with open access at
I. INTRODUCTION
Cesarean section means the exit of one or more newborns, or rarely, a dead fetus through the incision
in the mother’s abdominal wall and the uterus (1). Caesarean section is one of the most common gynecological
surgeries around the world (2). However, it may cause mental and physical complications in the mother.
Physical complications associated with cesarean section include intra- and postoperative bleeding, surgical site
infections, intra-abdominal adhesions, deep vein thrombosis (DVT) and pulmonary embolism (3), hysterectomy
due to uncontrollable bleeding, brain hazards, increased risk of wound opening, maternal death(4).
Anxiety and stress are also considered psychological complications affecting mothers undergoing
cesarean section (5). Stress is a reaction of a person to external pressures or inappropriate conditions and
anxiety is one of its common side effects (6). Anxiety is a very unpleasant sensation and appears in the form of
severe fear or distress or suspicion for an unknown factor (7). Stress and anxiety caused by surgery by
stimulating the sympathetic, parasympathetic and endocrine systems make the body abnormal and cause
symptoms such as high blood pressure, palpitations, shortness of breath, tremors, palm sweating, and flare-ups.
Decreased saliva, dry mouth, high blood sugar, increased gastric and intestinal motility and urinary incontinence
(8).
10-30% of hospitalized patients experience stress even without the need for surgery, but this figure
reaches 60-80% in patients in need of surgery (9). Stress affects not only pregnant women but also the fetus
(10). Maternal stress reduces blood supply to the placenta and fetus through epinephrine secretion and uterine
contractility. Epinephrine also reduces the ability of fetal brain cells that are responsible probe for hypoxia by
increasing maternal and fetal blood glucose, and thus, fetal brain cells are damaged (11). Stress can increase
postpartum hemorrhage by inhibiting the release of oxytocin (12).
The prevalence of preoperative anxiety varies from 11% to 80%. Age, gender, culture, level of the
individual’s awareness of surgery, history of previous surgery, type and duration of surgery, and individual
characteristics in stressful situations are some factors that can affect the level of anxiety suffered by patients (7).