Epidural anaesthesia may do more than relieve pain during labour; in some women it may decrease the likelihood of postpartum depression, suggests a preliminary study presented at ANESTHESIOLOGY 2016, the Annual Meeting of the American Society of Anesthesiologists (ASA).
“Labour pain matters more than just for the birth experience,” said Grace Lim, MD, Magee Women’s Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. “It may be psychologically harmful for some women and play a significant role in the development of postpartum depression.”
“We found that certain women who experience good pain relief from epidural analgesia are less likely to exhibit depressive symptoms in the postpartum period,” she said.
The researchers controlled for factors already known to increase the risk for postpartum depression, including pre-existing depression and anxiety, as well as post-delivery pain caused by tissue trauma during childbirth. After accounting for these factors, the study found that in some women, labour pain was still a significant risk factor for postpartum depression symptoms. And, therefore, alleviating this pain might help reduce the risk for postpartum depression.
For the study, the researchers reviewed the medical records of 201 women who used epidural analgesia and had their pain assessed using a 0 to 10 scale during labour. They calculated the percent improvement in pain (PIP) throughout labour after the implementation of epidural analgesia. Depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS) 6 weeks after childbirth.
The researchers found that the higher the PIP scores, the lower the EPDS scores.
“Although we found an association between women who experience less pain during labour and lower risk for postpartum depression, we do not know if effective pain control with epidural analgesia will assure avoidance of the condition,” said Dr. Lim. “Postpartum depression can develop from a number of things including hormonal changes, psychological adjustment to motherhood, social support, and a history of psychiatric disorders.”
Labour pain may be more problematic for some women than others, the authors noted. Additional research is needed to identify which women are more likely to experience severe labour pain and who would benefit the most from effective labour pain-control strategies to help reduce the risk and effect of pain on postpartum recovery.