Maximising Pain Control During Labour May Reduce Risk of Postpartum Depression

Controlling pain during childbirth and post delivery may reduce the risk of postpartum depression, according to an editorial published in the journal Anesthesia & Analgesia.

The editorial is based on a new Chinese study that found women who had pain control with epidural anaesthesia during a vaginal delivery had a much lower risk for postpartum depression than women who didn’t have the epidural.

“Maximising pain control in labour and delivery with your obstetrician and anaesthesia team might help reduce the risk of postpartum depression,” said Katherine Wisner, MD, Northwestern University, Chicago, Illinois.

The study findings are among the few to examine the relationship between pain during labour and postpartum depression.

“It’s a huge omission that there has been almost nothing in postpartum depression research about pain during labour and delivery and postpartum depression,” said Dr. Wisner. “There is a well-known relationship between acute and chronic pain and depression.”

The Chinese study found that women who had an epidural for pain relief during labour for a vaginal delivery had a 14% rate of depression at 6 weeks postpartum compared with nearly 35% rate of depression for those who did not have the pain relief. An epidural was the only means of pain control available to the women.

The study also found that breastfeeding was more common in the group who had an epidural for pain compared with those who did not (70% vs 50%).

“These findings are quite exciting and further research should be done to confirm them, especially in women at increased risk of postpartum depression and in women from other cultures,” said Dr. Wisner.

Biological and emotional factors contribute to postpartum depression, which affects 14.5% of women who give birth. A woman who has chronic pain 1 to 2 months after delivery should be screened for depression, noted Dr. Wisner.

Managing acute postpartum pain supports the new mother’s ability to emotionally attach and care for her infant, Dr. Wisner pointed out.

“Pain control gets the mother off to a good beginning rather than starting off defeated and exhausted,” she said. “Whether it’s vaginal or caesarean section delivery, pain control postpartum is an issue for all new mothers. There is no way to have a delivery without pain. The objective here is to avoid severe pain. Controlling that delivery pain so a woman can comfortably develop as a mother is something that makes a lot of sense.”