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, according to a new study.
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 — before, during or after delivery — may be the source of the problem.
According to the researchers behind the new study, it is the first 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 in 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, 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 then compared pain scores to the mothers’ Edinburgh postnatal depression scale (EPDS) scores one week after delivery.
The researchers 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, according to the study’s findings.
Women in the postpartum depression group were more likely to have delivered by C-section, the researchers noted. They also had more reports of inadequate postpartum pain control.
“While ibuprofen and similar pain medications are considered adequate for pain control after childbirth, clearly some women need additional help managing pain,” said Zhou. “We need to do a better job identifying who is at risk for postpartum pain and ensure they have adequate postpartum care.”
The study was presented at the ANESTHESIOLOGY 2018 annual meeting.