A systematic review of challenges, impacts and burdens of cesarean section on the mental health and well-being of pregnant mothers, and family in Nigeria

Cesarean section (CS) rates are increasing globally, yet in low-resource settings such as Nigeria, limited integration of maternal mental health services may heighten psychological vulnerability. This systematic review synthesises evidence on the psychological impacts of CS on mothers and families in Nigeria. A systematic search was conducted across four databases (PubMed, Scopus, African Journals Online, and CINAHL), and grey literature sources were searched for relevant articles following PRISMA guidelines. Two independent reviewers completed screening, data extraction, and quality appraisal using the Mixed Methods Appraisal Tool. Narrative synthesis was applied to reporting the results. Ten studies were included. The evidence demonstrated that CS was consistently associated with elevated psychological morbidity, including postpartum depression, anxiety symptoms, and post-traumatic stress disorder (PTSD). Emergency CS was a strong predictor of PTSD, with a reported higher likelihood. Evidence highlighted fear, loss of control, and feelings of inadequacy following CS. Sociocultural stigma framing CS as a sign of weakness or culturally constructed belief of spiritual failure amplified psychological distress. Only a minority of affected women accessed mental health care. Spousal distress and family-level psychological burden were also reported, indicating broader household impact. Protective factors included spousal support, respectful maternity care, religious coping, and peer support. CS imposes a substantial multilayered psychological burden on Nigerian mothers and their families, yet the health system lacks integrated mental health support. Routine screening, family-centered counselling, and community stigma reduction are urgently required. Policy must mandate postpartum mental health screening, institutionalize respectful maternity care, and scale low-cost psychosocial interventions for CS families.