Association of Childbirth Pain with Postnatal Depressive and Anxiety Disorders in Nulliparous Parturients: A Prospective Study

Abstract

Purpose There is limited knowledge on the relationship between postnatal depression and childbirth pain characteristics associated with childbirth. We investigated whether the characteristics of childbirth pain, as assessed by Short-form-McGill Pain Questionnaire-2 (SF-MPQ-2), were associated with postnatal anxiety and depressive disorders. Patients and Methods Nulliparous parturients who received labor epidural analgesia (LEA) and delivered in our institution were invited to have a Mini-International Neuropsychiatric Interview (MINI) assessment following their 5–9 weeks post-delivery follow-up phone survey of a larger study. Parturients’ demographics, pre-delivery questionnaires on pain and psychological vulnerabilities, LEA data, maternal and neonatal outcomes, postnatal follow-up survey on pain and psychological vulnerabilities, pain and breastfeeding were collected accordingly. The primary outcome was the binary variable (yes/no) of the presence of postnatal depression and/or anxiety disorders based on the post-delivery MINI assessment. Results Among the 107 parturients who participated in the post-delivery MINI assessment, a total of 40 (42.5%) patients were found to have postnatal anxiety and depressive disorders. A greater pre-delivery SF-MPQ-2 neuropathic pain mean subscale score (adjusted odds ratio (OR) 1.32, 95% CI 1.00–1.73, p=0.0482) and greater post-delivery Edinburgh Postnatal Depression Scale (EPDS) at 5–9 weeks post-delivery (adjusted OR 1.30, 95% CI 1.13–1.50, p=0.0002) were independently associated with the presence of postnatal anxiety and/or depressive disorders (receiver operating characteristic (ROC) = 0.7489). Conclusion Patients with greater pre-delivery neuropathic pain and higher EPDS scores at 5–9 weeks post-delivery are more likely to have postnatal depression and/or anxiety disorders, suggesting possible associations between pain and psychological vulnerability in the development of postnatal mental disorders.

Tools for assessing labour pain: a comprehensive review of research literature

“…Thirteen studies 22–24,32,34,52,62,78,84,90,94,96,111 used the abbreviated version of the MPQ: the Short-Form McGill Pain Questionnaire (SF-MPQ). The SF-MPQ includes 15 descriptors of pain, with 11 focusing on the sensory-discriminative quality of the pain and the remaining 4 focusing on the motivational-affective quality, all of which only describe negative affective states (“tiring-exhausting,” “sickening,” “fearful,” and “punishing-cruel”).…”

“…The SF-MPQ also incorporates the VAS, anchored "no pain" and "worst possible pain," as well as a PPI scale with verbal descriptors from zero (no pain) to 5 (excruciating pain). Twelve studies [22][23][24]32,34,52,78,84,90,94,96,111 used the tool in its entirety, and one study 62 excluded the PPI section. Two studies 2,85 used the updated second version (SF-MPQ-2), which includes an additional 7 symptoms relevant to neuropathic qualities of pain, making a total of 22 descriptors, and also changed the 4-point rating scale to a 0 to 10 numerical scale.…”

Relationship between Knowledge Level and Anxiety Facing Childbirth in Primiparous Mothers at Panembahan Senopati Hospital Bantul

“…As a result of the body's response, the uterus becomes increasingly tense so that the flow of blood and oxygen into the uterine muscles is reduced because the arteries become smaller and narrower, which then causes inevitable pain. Therefore, if the expectant mother giving birth is in a comfortable, relaxed state, all the muscle layers in her uterus will work together in harmony (Tan et al, 2021).…”

Women's Experiences of Postnatal Depression in Samoa

“…Depression is an example of a mental health condition defined by Almond (2009) as a mental illness or an emotional state where individuals experience negativity towards themselves and their surroundings (Walsh, 2009). A study conducted in Singapore indicated that postnatal depression (PND), is the most common mental disorder associated with childbirth and is a significant health issue (Tan, et al, 2021).…”