Epidural Labor Analgesia is Associated With a Decreased Risk of Postpartum Depression

Ding, Ting; Wang, D.X.; Yuan, Qing; Chen, Q.; Zhu, Sai-Nan

doi:10.1097/01.aoa.0000463825.55384.a8

Cited by 23 publications

(49 citation statements)

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“…Participants in both treatment groups scored medium levels of pain and no between‐group differences were noted. These findings do not correlate with a previous report of low levels of pain among women treated with patient‐controlled epidural analgesia during delivery of live births [20]. The difference in pain levels between live births and induced abortions might be explained by the negative feelings often experienced by women undergoing induced abortion.…”

Section: Discussioncontrasting

confidence: 99%

Physical symptoms and emotional responses among women undergoing induced abortion protocols during the second trimester

Freeman

Porat

Rojansky

et al. 2016

International Journal of Gynecology & Obstetrics

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Section: Discussioncontrasting

confidence: 99%

Physical symptoms and emotional responses among women undergoing induced abortion protocols during the second trimester

Freeman

Porat

Rojansky

et al. 2016

International Journal of Gynecology & Obstetrics

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“…Labor epidural analgesia reduces the pain of childbirth. Prior studies have suggested that labor epidural analgesia for childbirth may lower the risk of PPD [6,7]. However, other analgesia methods for labor including nitrous oxide and acupuncture have not been associated with decreased rates of PPD [7].…”

Section: Introductionmentioning

confidence: 99%

Labor Epidural Analgesia and Postpartum Depression

Tobin

Wilson

Hebbar

et al. 2016

Arch Depress Anxiety

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Introduction: Epidural labor analgesia may decrease the risk of postpartum depression (PPD). Methods: In a secondary analysis of a prospective study, the association between epidural utilization and PPD was evaluated using a Fisher's exact test. PPD was defined as an Edinburgh Postnatal Depression score of > 10 at 6-8 weeks postpartum. Results: 20% (13/65) of women meet criteria for PDD. 24% (n=12/50) of women who received epidural labor analgesia developed PPD, compared to 6.7% (n=1/15) of women who did not receive epidural labor analgesia (P = 0.27). Conclusions: Labor epidural analgesia did not reduce the risk of postpartum depression. original study, yet to be published, examined the association of blood biological markers and peripartum depression. The original study also prospectively evaluated for antepartum depression at 8-10 weeks and 24-28 weeks gestation. Epidural status at time of delivery was noted. Women were screened for PPD on their routine postpartum visit at 6-8 weeks postpartum using the Edinburgh Postnatal Depression Scale (EDPS) score of > 10. EPDS has been described as the most common screening tool for postpartum depression evaluation [1]. The EDPS is a 10-item questionnaire and is a validated screening tool for depression in pregnant and postpartum women [9]. An EPDS score of > 10 has been used in other studies to identify PPD [2,8]. A variety of EPDS cutoff scores ranging from 9 to 13 have been used for diagnosis. Participant's corresponding demographic information was gathered antepartum including age, BMI, race, parity, gravida, relationship status with the father, income level, education level and history of psychiatric illness. Following delivery, participant's charts were reviewed to identify utilization or non-utilization of epidural labor analgesia as well as gestational age of the baby at delivery. Statistical analyses were performed using Fisher's exact tests to examine the association between labor epidural and PPD at 6-8 weeks postpartum and other dichotomous variables. T-tests or Wilcoxon rank sum tests were used for continuous variables where appropriate. Results Epidural utilization during labor, and PPD status were available for 65 parturients. Demographic characteristics of parturients did not differ between subjects with EDPS score of < 10 compared to those with EDPS score > 10 (Table 1). At 6-8 weeks postpartum, 20% (13/65) of women meet criteria for PPD. Epidural labor analgesia was utilized by the majority of parturients (76.9%; 50/65; Table 1). Parturients who received epidural labor analgesia had a 24% (n=12/50) incidence of PPD compared to a rate of 6.7% (n=1/15) among parturients who did not receive labor analgesia (P = 0.27; Figure 1). Women without PPD had an overall lower BMI compared to Methods This study was a secondary analysis of an IRB approved prospective cohort study conducted at the

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“…The conflicting findings could be related to methodological issues as mentioned, but could also be related to differences in medical procedures in the various clinics. In two of the studies that linked epidural labor analgesia to a decreased risk of postpartum depression, epidural was given upon request [39,40], implying that it was given at an earlier point in time than in our study where it was provided fairly late. Randomized studies of epidural analgesia are challenging, but not impossible.…”

Section: Discussionmentioning

confidence: 91%

“…The lack of association between pain intensity during labor and persistent pain and postpartum depression may therefore partly be caused by a ceiling effect. Nevertheless, the literature is inconclusive when it comes to these associations; some suggest that there is an association [10] and that better pain management during birth could prevent postpartum depression [9,11,39] whilst others do not find any preventive effects of analgesia [12,13]. The conflicting findings could be related to methodological issues as mentioned, but could also be related to differences in medical procedures in the various clinics.…”

Section: Discussionmentioning

confidence: 99%

Are labor pain and birth experience associated with persistent pain and postpartum depression? A longitudinal cohort study

Rosseland

Rème

Simonsen

et al. 2019

Preprint

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Background: Managing labor pain and early postpartum pain has been linked to a reduced risk for postpartum depression and pain. However, the role of labor pain and the overall birth experience in the development of postpartum depression and persistent pain still remains unclear. Methods: The study sample (n=2217) was drawn from the Akershus Birth Cohort, which targeted all pregnant women scheduled to give birth at Akershus University Hospital in Norway between 2008-2010. Data from the hospital’s birth record as well as questionnaire data from gestational week 17 of pregnancy and eight weeks postpartum were used. An additional questionnaire about labor pain and birth experience was answered by 1 244 women within 48 hours after delivery. The Edinburgh Postnatal Depression Scale was used to measure postpartum depression, a single question was used to measure persistent pain eight weeks postpartum, while pain and birth experience were measured by numeric rating scales within 48 hours after delivery. Results: The results showed that neither labor pain nor birth experience were associated with persistent pain eight weeks postpartum, whereas pain before pregnancy (OR 3.70; 95% CI 2.71-5.04) and a history of depression (OR 2.31; 95% CI 1.85-2.88) were statistically significant predictors of persistent pain. A negative birth experience was significantly (OR 1.16; 95% CI 1.04-1.29) associated with postpartum depression, whereas labor pain intensity was not. Again, a history of depression (OR 3.95; 95% CI 2.92-5.34) and pre-pregnancy pain (OR 2.03; 95% CI 1.37-3.01) were important predictors of postpartum depression eight weeks after delivery. Discussion: Whilst the relationship between labor pain intensity and postpartum pain and depression remain unclear, our results do imply the need to screen for previous depression and chronic pain conditions in pregnant women, as well as consider preventive measures in those who screen positive.

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Epidural Labor Analgesia is Associated With a Decreased Risk of Postpartum Depression

Cited by 23 publications

References 0 publications

Physical symptoms and emotional responses among women undergoing induced abortion protocols during the second trimester

Physical symptoms and emotional responses among women undergoing induced abortion protocols during the second trimester

Labor Epidural Analgesia and Postpartum Depression

Are labor pain and birth experience associated with persistent pain and postpartum depression? A longitudinal cohort study

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