Postpartum depression linked to mother's pain after childbirth

While childbirth pain has been linked to postpartum depression, the culprit may be the pain experienced by the mother following childbirth, rather than during the labor and delivery process, suggests new research presented at the ANESTHESIOLOGY 2018 annual meeting.

Previous research has demonstrated the pain associated with giving birth may increase the risk of postpartum depression but has not specified which part of the labor process (e.g., before, during or after delivery) may be the source of the problem. This is the first study to differentiate postpartum pain from labor and delivery pain and identify it as a significant risk factor for postpartum depression.

"For many years, we have been concerned about how to manage labor pain, but recovery pain after labor and delivery often is overlooked," said Jie Zhou, M.D., M.B.A., lead author of the study and assistant professor of anesthesia at Brigham and Women's Hospital and Harvard Medical School, Boston. "Our research suggests we need to focus more on helping new mothers manage pain after the baby is born."

Symptoms of postpartum depression—including extreme sadness, low energy, anxiety, crying episodes, irritability and changes in sleep or eating patterns—affect about 1 in 9 women, according to the Centers for Disease Control and Prevention (CDC). Postpartum depression can lead to lower rates of breastfeeding and poor bonding with the baby.

In the study, Dr. Zhou's research group 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.

Dr. Zhou found postpartum depression 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.

A number of factors can contribute to postpartum depression. Researchers determined postpartum depression 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."