To evaluate the relationship between mode of delivery and postpartum well-being in women with multiple sclerosis (MS).

This is an analysis of a prospective cohort of 41 cis-women with MS from a single academic center who delivered via CS (n=12) or VD (n=29) between 2018 and 2022. Symptoms were assessed one month after delivery using self-reported questionnaires for sleep [Medical Outcomes Study—Sleep Scale (MOS-SS)], fatigue [Epworth Sleepiness Scale (ESS) and Modified Fatigue Impact Scale (MFIS)], and depression [Edinburgh Postnatal Depression Scale (EPDS)]. Scores were compared using two-sample t-tests for continuous variables; significance level was <0.05.

The main demographic and MS characteristics of the women delivering via CS were similar to those delivering via VD, although more were primiparous (P=0.05). Women with CS reported better sleep adequacy (MOS-SS, P=0.0015), reduced daytime sleepiness (ESS, P=0.017), and decreased fatigue (MFIS, P=0.049, particularly the cognitive fatigue sub-scale, (P=0.032) relative to women with VD. Postpartum depression was not associated with delivery mode.

Surprisingly, women with MS who delivered via CS reported better well-being postpartum relative to those delivering vaginally. Given the significant and added burden of MS and symptom management faced postpartum by women with MS, CS could represent a “forced rest,” paradoxically improving well-being. Further research is necessary to evaluate this and other possible mechanisms underlying this association. Overall, the current findings highlight the need for tailored postpartum care strategies to improve the well-being of these patients.