الفهرس 
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Abstract
SUMMARY
Background:
Childbirth has a major impact on maternal health. Pain, depression, and sexual dysfunction are major postpartum maternal health problems (Cappell J, et al 2020).
Postpartum depression (PPD) is a mood disorder that affects ten to twenty percent of women. It can begin any time during the first year after delivery and may last for several months. Postpartum depression affects not only maternal health but also infant growth and development (Eckerdal P, et al. (2018).
Pain following delivery, including headache, perineal pain, abdominal pain, back pain, and nipple pain , is one of the most common postpartum symptoms and is negatively associated with the quality of life after delivery (Banaei M et al., 2020). The fear of perceived pain during vaginal delivery or after cesarean delivery may influence the choice of delivery method (Enaruna NO and Edomwonyi NP 2019
Sexual function after delivery is an issue for both women and their partners. Childbirth is associated with anatomical changes in the lower genitourinary tract (Jansson MH, et al, 2020). Women often develop sexual complaints after childbirth. Female sexual function after delivery may be also affected by postpartum depression (Hajimirzaie SS et al, 2021). The delivery mode has been associated with sexual dysfunction , and dyspareunia-related problems (Gommesen D et al., 2019). One possible reason for choosing a cesarean delivery may be a fear of sexual dysfunction caused by loss of vaginal muscle tone. Cesarean delivery has often been assumed to protect postpartum sexual function because it avoids trauma to the genital tract. Studies found no association between the delivery mode and sexual function. However, reports on the association between delivery mode and female sexual function are conflicting. (Dawson SJ et al, 2020 - De Souza A et al, 2015)
The study aim:
To compare maternal health in terms of pain levels, depressive symptoms and sexual function at 7 days, 6 weeks, and 6 months postpartum between women who undergo vaginal delivery and those who have caesarean delivery
Study Design: A prospective, observational cohort study.
Place and Duration of Study: Beni-suef university hospital, from June 2021 till November 2021
Study population:The study population includes nulliparous women, ability to read Arabic. Women will be recruited for enrollment when they have delivery at the department.
Inclusion criteria:
1. Age (18-35).
2. Nulliparous (i.e. no previous live births or pregnancies ending in a stillbirth).
3. Delivery of a single alive baby> at term.
4. Able to complete self-administered questionnaire and telephone interviews.
5. Are married and had a sexually active partner.
Exclusion criteria:
1. multipara
2. preterm birth.
3. maternal psychiatric disorders.
4. Mothers of infants hospitalized in neonatal or intensive care.
5. Severe and chronic medical illness such as uncontrolled hypertension, uncontrolled diabetes mellitus.
6. History of self-reported sexual dysfunction.
7. Genito-pelvic pain disorders.
8. Complicated vaginal delivery or caesarean section with intra or post operative complication.
Study procedure:
The patients will be submitted to:
Full history taking including: socio-demographic background, medical history, obstetric and gynecological history.
Structured Interview: A structured interview will be conducted by the investigator to collect information about participant socio-demographic, medical, sexual, and relationship history, as well as mode of delivery, genital trauma) will be gathered from participants’ self-report and also will be obtained from their medical records. The baseline questionnaire and a consent form and a separate sheet for providing contact information.
Follow-up questionnaires will be filled at 7 days, 6 weeks and 6 months postpartum. The Data on labor and birth events were abstracted from hospital medical records to give more precise information about any perineal trauma, and timing of caesarean section in elective.
Results:
The study participants were randomized into 2 groups:
• group (A): 130 Women who gave birth by vaginal delivery.
• group (B): 130 Women who gave birth by caesarean section.
Regarding postpartum depression there is a clinical significance at 7DS as women who gave birth by caesarean section experienced more EPDS compared to women who gave birth by vaginal delivery.
There were no clinical significance between EPD after vaginal delivery and caesarean section at 6ws and 6ms.
Regarding postpartum sexual dysfunction, There is clinical significance at 6ws as there is sexual dysfunction after vaginal delivery and caesarean section but women who gave birth by vaginal delivery experienced more sexual dysfunction than women who gave birth by caesarean section
There is no clinical significant difference at 6ms between sexual dysfunction after vaginal delivery and caesarean section.
Regarding postpartum pain,There is clinical significance as at time of discharge women who gave birth by caesarean section experienced more pain than women who gave birth by vaginal delivery.
There clinical significance as women who gave birth by caesarean section experienced Tiredness more than women who gave birth by vaginal delivery
Conclusion:
Caesarean section (especially emergency CS) is a risk factor for postpartum depression, sexual dysfunction, and the level of pain experienced is a marker of its potential severity. Evaluation of factors associated with postpartum pain, sexual dysfunction, and depressive symptoms can help midwives to counsel women better about their delivery alternatives and can promote improved management of women undergoing both types of delivery experiences.