Background: Depression and anxiety symptoms can impact childbirth. The aim of this study was to examine the association between peripartum depression and anxiety symptoms with unplanned cesarean or operative vaginal births. Methods: This single-center observational study categorized women into two groups based on the presence (or absence) of depression symptoms in the last 7 days. We collected birth records, demographic data, clinical characteristics, Hospital Anxiety and Depression Scale (HADS) scores, and visual analog scale (VAS) score for pain. Results: A total of 201 women participated in the study, with 37 (18.4%) experiencing depression symptoms, and 164 (81.6%) without such symptoms. Women with peripartum depression symptoms were more likely to require an unplanned medical intervention (unplanned cesarean or operative vaginal birth) compared to those without such symptoms (54.1% vs. 28.0%; p = 0.002). Similarly, women with peripartum anxiety symptoms were also more likely to require an unplanned medical intervention (43.0% vs. 25.2%; p = 0.008). Binary logistic regression analysis demonstrated that experiencing peripartum depression symptoms independently increased the probability of undergoing an unplanned cesarean or operative birth. Conclusions: Women experiencing symptoms of peripartum depression near the time of birth are at a higher risk of having an unplanned cesarean or operative vaginal birth.