A recent report suggests that epidural labor analgesia is associated with a decreased risk of postpartum depression (PPD). This prospective study included 214 pregnant women from Beijing, China who were preparing for a vaginal delivery. Epidural labor analgesia was performed in 107 of 214 patients based on their request. Depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at 3 days and 6 weeks after delivery. A score of 10 or higher on the scale at 6 weeks was used as an indication of postpartum depression.

Postpartum depression occurred in 14.0% (15 of 107) of women who received epidural labor analgesia and in 34.6% (37 of 107) of those who did not (P < 0.001).

In addition, women who attended childbirth classes during pregnancy were also at decreased risk for PPD (OR 0.30, 95% CI, 0.12-0.79, P = 0.015).

The lowest risk for PPD was observed in women who continued breastfeeding after delivery (OR 0.02, 95% CI, 0.00-0.07, P < 0.001).

While many previous studies have examined the association between mode of delivery and risk of postpartum depression, few have examined the impact of pain management on risk of depression after delivery, which is somewhat surprising given the abundant literature supporting an association between pain and depression in non-puerperal populations. In an accompanying editorial, Katherine Wisner reviews other studies which have examined the relationship between peripartum pain and risk for postpartum depression.

In a multicenter, prospective, longitudinal cohort study (n = 1288),  women with severe pain acutely had a 2.5-fold increased risk of persistent pain and a 3-fold increased risk for postpartum depression compared with women with mild postpartum pain. Another study conducted in Finland (Hiltunen et al, 2004) observed that the risk of PPD was significantly lower among women who received epidural analgesia compared to women with no analgesia (odds ratio [OR] = 0.25, 95% confidence interval [CI], 0.09–0.72).

It is understandable that chronic pain after delivery would increase the risk of postpartum depression. It is interesting to note that acute management of pain in the form of epidural analgesia may also have long-term benefits.  On this finding, Wisher comments:

The initiation of the postbirth period with maximal comfort sets in motion adaptive maternal behaviors and a positive emotional milieu for new motherhood. 

She goes on to recommend that,

Clinicians should be aware that women who do not receive optimal pain management are at increased risk for depression and screening is recommended; conversely, women with postpartum depression should be evaluated for acute and chronic perinatal pain.

Ruta Nonacs, MD PhD

 

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.

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.

Wisner KL, Stika CS, Clark CT.  Double duty: does epidural labor analgesia reduce both pain and postpartum depression?  Anesth Analg. 2014 Aug;119(2):219-21.