Controlling childbirth pain tied to reduced depression risk

Controlling pain during childbirth and post delivery may reduce the risk of postpartum depression, writes Katherine Wisner, MD, a Northwestern Medicine perinatal psychiatrist.

Wisner's editorial is based on a new Chinese study that found women who had pain control with epidural anaesthesia during a vaginal delivery had a much lower risk for post-partum depression than women who didn't have the epidural.

''Maximizing pain control in labour and delivery with your obstetrician and anaesthesia team might help reduce the risk of postpartum depression,'' Wisner says.

The study findings are among the few to examine the relationship between pain during labour and post-partum depression.

''It's a huge omission that there has been almost nothing in postpartum depression research about pain during labour and delivery and postpartum depression,'' Wisner says. ''There is a well-known relationship between acute and chronic pain and depression.''

Wisner is director of Northwestern University's Asher Center for the Study and Treatment of Depressive Disorders. She also is a professor of psychiatry and behavioural sciences and obstetrics and gynecology at Northwestern University Feinberg School of Medicine and a psychiatrist at Northwestern Memorial Hospital.

The Chinese study found that women who had an epidural for pain relief during labour for a vaginal delivery had a 14 per cent rate of depression at six weeks post-partum compared to nearly 35 per cent rate of depression for those who did not have the pain relief. An epidural was the only means of pain control available to the women.

The study also found that breast-feeding was more common in the group who had an epidural for pain compared to those who did not (70 per cent versus 50 per cent.)

''These findings are quite exciting and further research should be done to confirm them, especially in women at increased risk of post-partum depression and in women from other cultures,'' Wisner says.

The incidence of severe acute postpartum pain is approximately 11 per cent, Wisner reports in the article. The incidence of chronic pain varies by study but ranges from 1 to 10 per cent for vaginal delivery and 6 to 18 per cent after a caesarean.

Biological and emotional factors contribute to post-partum depression, which affects 14.5 per cent of women who give birth. A woman who has chronic pain one to two months after delivery should be screened for depression, noted Wisner, also the Norman and Helen Asher Professor at Feinberg.

Managing acute post-partum pain supports the new mother's ability to emotionally attach and care for her infant, Wisner points out.

''Pain control gets the mother off to a good beginning rather than starting off defeated and exhausted,'' Wisner said. ''Whether it's vaginal or caesarean section delivery, pain control postpartum is an issue for all new mothers. There is no way to have a delivery without pain. The objective here is to avoid severe pain. Controlling that delivery pain so a woman can comfortably develop as a mother is something that makes a lot of sense.''

Northwestern coauthors on the editorial include Catherine Stika, M.D., and Crystal Clark, MD.