Pain following childbirth cause of Postpartum depression
Pain experienced by mother following childbirth may be the culprit behind postpartum depression (PPD), rather than the pain during the labour and delivery process, according to a new study presented at the ANESTHESIOLOGY 2018 annual meeting.
Although previous studies have demonstrated that pain during childbirth may increase the risk for PPD but have not specified which part of the labor process (e.g., before, during or after delivery) may be the source of the problem.
Jie Zhou, assistant professor of anesthesia at Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues conducted first such study to differentiate postpartum pain from labor and delivery pain and identify it as a significant risk factor for postpartum depression.
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"For many years, we have been concerned about how to manage labor pain, but recovery pain after labor and delivery often is overlooked," said Zhou. "Our research suggests we need to focus more on helping new mothers manage pain after the baby is born."
Postpartum depression affects about 1 in 9 women, according to the Centers for Disease Control and Prevention (CDC). Its symptoms include extreme sadness, low energy, anxiety, crying episodes, irritability and changes in sleep or eating patterns. It can lead to poor bonding with the baby and lower rates of breastfeeding.
For the study, the research team reviewed pain scores (from the start of labor to hospital discharge) for 4,327 first-time mothers delivering a single child vaginally or by cesarean delivery (C-section) at Brigham and Women's Hospital between June 1, 2015, and Dec. 31, 2017. They compared pain scores to the mothers' Edinburgh postnatal depression scale (EPDS) scores one week after delivery.
- PPD was significantly associated with higher postpartum pain scores.
- Mothers with postpartum depression demonstrated more pain-related complaints during recovery and often needed additional pain medication.
- Women in the postpartum depression group were more likely to have delivered by C-section. They also had more reports of inadequate postpartum pain control.
- PPD was higher among women who were overweight or obese; who suffered from a torn perineum (the area adjacent to the vaginal opening); who had a history of depression, anxiety or chronic pain; and whose babies were smaller and had lower Apgar scores, a scoring system used to assess the physical health of newborns one minute and five minutes after birth.
"While ibuprofen and similar pain medications are considered adequate for pain control after childbirth, clearly some women need additional help managing pain," said Dr. Zhou. "We need to do a better job identifying who is at risk for postpartum pain and ensure they have adequate postpartum care."