Labor Epidural Prevents Post-Partum Depression
depression

Labor Epidural Prevents Post-Partum Depression

Date: September 25th, 2014

Postpartum depression affects women after childbirth. It has all the signs and symptoms of clinical depression and can manifest in many ways. Its common symptoms are impaired mood, insomnia or excessive sleepiness, mental slowing down or agitation, weight gain or weight loss, feeling of worthlessness and guilt, reduced self-esteem, difficulty concentrating and, in extreme cases, suicidal attempts. It affects between 10 and 15% of mothers within the first year of giving birth.

It is not fully understood what causes post-partum depression. Risk factors include a history of previous psychiatric illness, unstable mood during pregnancy, marriage problems, lack of social support and stressful events. Labor itself is a painful and stressful event for most women, and recently several studies confirmed a link between the intensity of labor pain and post-partum depression.

A 2007 study demonstrated observed the link between the intensity of labor pain and “postpartum blues”, mood disorders that happen early after childbirth (1). Another study published a year later showed the association of severe pain after childbirth and post-partum depression. It didn’t matter if women had vaginal birth or cesarean section (2).

The question is: will better pain control during childbirth reduce the incidence of post-partum depression. In a 2004 study from Scandinavia the risk of post-partum depression among mothers who received epidural or paracervical blocks during their delivery was four times lower than among those whose pain was not treated. Of note, their labors were also shorter, which is another argument against the accepted opinion that epidural prolongs labor. Elective or emergency cesarean section did not increase the risk of depression (3).

Another study published in August this year added to the evidence that treating labor pain reduces the risk of post-partum depression (4). The study included 214 women, of whom 107 – exactly half – received epidural analgesia for their labors. Six weeks after delivery 52 women were diagnosed with post-partum depression: 15 among those who received epidural and 37 in those who did not. Detailed analysis of all risk factors the use of labor epidural was the strongest predictor of reduced chances of post-partum depression.

As emphasized in the pages of this site, labor pain is one of the most intense and distressing types of pain available for human experience. Intense pain is mentally debilitating and is accompanied by severe physiological response that can be harmful both to the mother and the baby. Intense pain can also lead to the development of prolonged and/or chronic pain. The facts presented in this article clearly demonstrate that untreated labor pain may lead to the development of post-partum depression, while labor epidural reduces its risks.

References.

Boudou M, Teissèdre F, Walburg V, Chabrol H. [Association between the intensity of childbirth pain and the intensity of postpartum blues]. Encephale. 2007;33:805–10 (link)

Eisenach JC, Pan PH, Smiley R, Lavand’homme P, Landau R, Houle TT. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain. 2008;140:87–94 (link)

Hiltunen P, Raudaskoski T, Ebeling H, Moilanen I. Does pain relief during delivery decrease the risk of postnatal depression? Acta Obstet Gynecol Scand. 2004;83:257–61. (link)

Ding T, Wang DX, Qu Y, Chen Q, Zhu SN. Epidural labor analgesia is associated with a decreased risk of postpartum depression: a prospective cohort study. Anesth Analg. 2014 Aug;119(2):383-92 (link)

Image from: http://www.freedigitalphotos.net/images/Gestures_g185-Young_Woman_Depressed_p108897.html

Dr. Eugene Smetannikov is a practicing anesthesiologist with the interest in obstetric anesthesia. He is the author of the most comprehensive book on the subject, The Truth About Labor Epidural

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