Our study results did not demonstrate a significant increase in the odds for PPD at 6 weeks among women who intended to deliver with LEA but subsequently delivered without. However, we identified a protective interaction between intended LEA use and actual use on the incidence of PPD. Our data suggest an increased risk when women do not deliver as intended, particularly when not initially intending to deliver with LEA. The relationship between unplanned LEA and PPD may be mediated by a physically difficult delivery rather than or in addition to negative emotions related to unmet expectations or a sense of personal failure; therefore, counseling women after delivery to address any negative perceptions may be useful.

(Anesth Analg. 2018;126:1590–1597) At the Beilinson Campus of the Rabin Medical Center in Petach Tikva, Israel, a proportion of women who intend to deliver with labor epidural analgesia (LEA) are often unable to receive it due to a lack of available nursing staff, labor rooms, or anesthesiologists at the time of request. As there is no study to date that has specifically examined the relationship between birth plan, satisfaction with LEA, and development of postpartum depression (PPD), the authors of the present study examined the impact of delivering without analgesia when such was not the intended plan. They hypothesized that the PPD rate at 6 weeks would be highest among women who intended to deliver with LEA but who actually delivered without.

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AFE is associated with significant maternal morbidity. This study highlights the importance of providing advanced training for the delivery suite staff for cases of maternal cardiovascular collapse secondary to AFE and increasing awareness for this rare and devastating obstetric condition.