Maternal postpartum health problems can persist well beyond the conventional six-week postpartum care period. No nationwide studies have combined large-scale electronic health records (EHRs) from perinatal and general practice (GP) care linking long-term health problems to birth mode. We aimed to examine how birth mode (spontaneous vaginal, instrumental vaginal, and caesarean section) influences the frequency and hazard of maternal physical and psychological health problems in GP care from six weeks to three years postpartum. In this observational population-based cohort study we linked Dutch perinatal EHRs (2014-2020) to GP EHRs (2015-2023), including women who gave birth to a term singleton. Health problems were retrieved from GP EHR's using International Classification of Primary Care codes and GP notes, the latter analysed with natural language processing. Women were stratified by parity. Cox proportional hazard models estimated crude and adjusted associations between birth mode and postpartum health problems, using spontaneous vaginal birth as the reference. In total, 10 628 primiparous and 11 719 multiparous women were included. Adjusted for confounders, caesarean section and instrumental vaginal birth were linked to significantly increased hazards of dyspareunia. Caesarean section was additionally associated with an elevated anaemia hazard but reduced hazards of urinary incontinence and ureterovaginal prolapse compared to spontaneous vaginal birth. We showed that maternal health problems may persist up to three years postpartum and vary by birth mode. These findings may raise awareness among mothers and care providers of key long-term maternal health problems, underscoring the need for a new paradigm of prolonged postpartum care.

Prenatal stress and anxiety are two of the most common mental health concerns during pregnancy and are public health issues. Therefore, non-pharmacological interventions to prevent and manage stress, anxiety and fear of childbirth are recommended. This systematic review aimed to synthesize non-pharmacological interventions to prevent and manage stress, anxiety and fear of childbirth during pregnancy. It provides an updated and broader synthesis of the available evidence, encompassing diverse populations and intervention approaches. This review followed PRISMA guidance and was conducted using PubMed, PsycINFO, CINAHL and Web of Science from 2014 to 2026. PROSPERO registration was obtained before the beginning of the study (CRD42024611014). While previous systematic reviews and meta-analyses focused on one specific criterion, this review included both online and in-person interventions, individual and group-based formats, and both high-risk and low-risk pregnancies. Risk of bias was assessed using ROB-2 or ROBINS-I. Results were analyzed using a narrative synthesis. Sixty-nine articles were included and classified as mindfulness (26%), psychotherapy (23%), antenatal classes (22%), mind-body interventions (16%), art-therapy interventions (6%), peer-support-based interventions (4%) and attachment-based interventions (3%). This review provides a comprehensive overview of interventions which prevent or manage prenatal stress, anxiety and fear of childbirth. However, heterogeneity across studies made comparisons of effectiveness impossible. Greater standardization is needed in future studies. Specific populations such as coparents and specific medical conditions such as participants with psychiatric comorbidities must be included in future studies. Finally, a reduction in the risk of bias is required to allow findings to inform clinical practice.