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Preoperative anxiety affects 66.7% of women undergoing cesarean delivery across global settingsHigh Rates of Anxiety Found in Women Before Cesarean Births

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Key Takeaway
Note that 66.7% of women undergoing cesarean delivery experience preoperative anxiety, regardless of surgical urgency.

This meta-analysis synthesizes data from 3,928 women to evaluate the prevalence and risk factors of preoperative anxiety in patients undergoing cesarean delivery. The study reports a pooled prevalence of 66.7% (95% CI: 58.3-74.5%). Significant geographical and economic variations were observed, with prevalence ranging from 25.0% in Malaysia to 98.0% in Turkey. Specifically, prevalence was significantly higher in upper-middle-income countries (70.8%) compared to high-income countries (41.0%) (p < 0.001).

Several risk factors were identified, including higher education (OR = 1.67; 95% CI: 1.25-2.22) and primiparity (OR = 1.62; 95% CI: 1.03-2.57). No significant difference was found between elective and emergency cesarean deliveries (p = 0.670). A declining temporal trend in prevalence was noted (beta = -0.068 per year; p = 0.003).

The authors note high heterogeneity (I = 96.7%) in the pooled prevalence estimates. Given the high prevalence of anxiety in nearly two-thirds of patients, the findings suggest a need for universal screening and tailored interventions. Because the underlying studies were observational, these results indicate associations rather than direct causation.

How this fits prior evidence

This meta-analysis addresses a gap in understanding the prevalence of preoperative anxiety in obstetric populations. While previous coverage has identified various interventions for anxiety, such as exercise for children or incarcerated individuals, and pharmacological/psychotherapeutic pathways for anxiety disorders, this study specifically quantifies the high burden of anxiety in women undergoing cesarean delivery. It confirms that anxiety is a prevalent condition in this surgical population, regardless of whether the procedure is elective or emergency.

A large review of global data found that a high number of women experience anxiety before undergoing a cesarean delivery. The study looked at nearly 4,000 women and found that about 66.7% of them reported feeling anxious before their surgery. This high rate suggests that anxiety is a common experience for many women in this situation.

Certain factors were linked to a higher risk of feeling anxious. For example, women who were having their first baby or those with higher levels of education showed a higher risk of anxiety. Interestingly, the study found no difference in anxiety levels between elective and emergency cesarean surgeries. While the data showed a slight downward trend in anxiety over time, the overall numbers remain high.

Because this study used observational data, it shows a link between these factors and anxiety rather than a direct cause. The results also showed a lot of variation between different countries and income levels. These findings suggest that many women may need support and screening for anxiety before surgery, regardless of how quickly the procedure needs to happen.

What this means for you:
About 67% of women experience anxiety before a cesarean, with higher risks for first-time mothers.

Common questions

How common is anxiety before a cesarean delivery?

The study found a pooled prevalence of 66.7% for preoperative anxiety among women undergoing cesarean delivery. This means that about two-thirds of women in the study reported feeling anxious before their surgery.

Does an emergency surgery increase anxiety levels?

The study found no significant difference in anxiety levels between elective and emergency cesarean deliveries. The data showed that the urgency of the surgery did not change the reported levels of anxiety.

Who is at a higher risk for anxiety before surgery?

The study identified that primiparity (being a first-time mother) and having a higher level of education were both linked to an increased risk of preoperative anxiety.

Study Details

Study typeMeta analysis
EvidenceLevel 1
Follow-up216.0 mo
PublishedSep 2026
View Original Abstract ↓
INTRODUCTION: Preoperative anxiety is a significant psychological concern among women undergoing cesarean delivery, with potential implications for maternal and neonatal outcomes. This systematic review and meta-analysis aimed to (1) quantify the global prevalence of preoperative anxiety in women undergoing cesarean sections, (2) identify key risk factors, and (3) assess geographical variations in anxiety patterns. MATERIALS AND METHODS: Following PRISMA guidelines, we systematically searched PubMed, Scopus, Web of Science, and Cochrane Library without time restrictions, including studies published in English or Persian, up to April 2025. Observational studies reporting prevalence and/or risk factors of preoperative anxiety in women (≥18 years) undergoing cesarean delivery were included. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale, and heterogeneity was evaluated via the I and Q statistic. Random-effects meta-analyses with Freeman-Tukey transformation were conducted for pooled prevalence estimates, with subgroup analyses by geography, income level, and assessment tools. Meta-regression explored temporal trends and moderators. RESULTS: Of 950 identified records, 24 studies (n = 3928) were included. The pooled prevalence of preoperative anxiety was 66.7% (95% CI: 58.3-74.5%), with high heterogeneity (I = 96.7%). Prevalence varied significantly by country (25.0% in Malaysia to 98.0% in Turkey), WHO region (p < 0.001), and income level (70.8% in upper-middle-income vs. 41.0% in high-income countries; p < 0.001). Risk factors included higher education (OR = 1.67, 95% CI: 1.25-2.22) and primiparity (OR = 1.62, 95% CI: 1.03-2.57). No difference was observed between elective and emergency cesarean deliveries (p = 0.670). Meta-regression revealed a temporal decline in prevalence (β = -0.068 per year, p = 0.003). CONCLUSION: This meta-analysis suggests that nearly two-thirds of women experience preoperative anxiety before cesarean delivery, with higher burden in upper-middle-income countries and among educated or first-time mothers. The lack of difference by surgical urgency underscores the need for universal anxiety screening and tailored interventions. Geographical disparities and declining temporal trends highlight the importance of context-specific strategies and further research into underlying mechanisms.
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