The Relationship Between Women’s Intention to Request a Labor Epidural Analgesia, Actually Delivering With Labor Epidural Analgesia, and Postpartum Depression at 6 Weeks: A Prospective Observational Study

Orbach‐Zinger, Sharon; Landau, Ruth; Harousch, Avi Ben; Ovad, Oren; Caspi, Liron; Kornilov, Evgeniya; Ioscovich, Alexander; Bracco, Danielle; Davis, Atara; Fireman, Shlomo; Hoshen, Moshe; Eidelman, Leonid A.

doi:10.1213/ane.0000000000002501

Cited by 63 publications

(75 citation statements)

References 22 publications

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“…Our findings complement those from Orbach-Zinger and colleagues [8], who found that unmatched intention effects with respect to use of labor analgesia are significantly associated with six-week depression risk. The current study focused on the pain experience of women planning and receiving their intended labor analgesia approach.…”

Section: Discussionsupporting

confidence: 88%

“…Moderator-mediator models can be used to investigate indirect associations between pain and depression. Characterizing these indirect associations is important, because identifying explanatory factors/conditions under which primary relationships change may clarify conflicting results in published literature on the relationship between parturitional pain, analgesia, and depression symptoms [1][2][3]8]. Moderator-mediator analyses assess how the relationship between perinatal pain and depression changes (increases or decreases) for patient subgroups ("moderation" analysis).…”

Section: Introductionmentioning

confidence: 99%

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Obstetric pain correlates with postpartum depression symptoms: a pilot prospective observational study

Lim

LaSorda

Farrell

et al. 2020

BMC Pregnancy Childbirth

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Background: Data linking labor pain and postpartum depression are emerging. Robust, prospective evaluations of this relationship while factoring other important variables are lacking. We assessed perinatal pain and other factors predicting postpartum depression (PPD) symptoms. Methods: Third trimester women, stratified by a priori plan to receive or avoid labor epidural analgesia, were longitudinally followed from the prenatal period through labor and delivery, until 6 weeks and 3 months postpartum. Electronic pain data was collected hourly during labor in real time, capturing pain unpleasantness, intensity, pain management satisfaction, and expectations. Prenatal and postpartum data included anxiety, depression, the Brief Pain Inventory (BPI), pain catastrophizing, resiliency, and perceived social support and stress. The primary outcome was Edinburgh Postnatal Depression Score (EPDS) as a marker of PPD symptoms. The primary pain variable of interest was labor pain emotional valence (unpleasantness burden, area under the curve for entire labor duration). Single and multivariable linear regressions examined perinatal pain variables in relation to EPDS. Results: Of 72 subjects included, 55 planned/received labor epidural analgesia and 17 planned avoidance/avoided it. In the planned epidural group, the emotional valence of labor pain independently predicted six-week EPDS (labor pain unpleasantness burden, R 2 = 0.42, P = 0.002). In addition to labor pain, prenatal and postpartum pain variables from the BPI independently predicted six-week EPDS. Three-month depression scores were linked to labor and acute pain (6 weeks postpartum), but not to chronic (3 months postpartum) pain variables. Intrapartum pain management satisfaction and expectations were largely met or exceeded and did not differ between analgesia groups. Conclusion: For susceptible women, pain at all perinatal time points-prenatal, labor, and postpartum-appear to be independently linked to depression scores at 6 weeks postpartum. The relationships are true, even though satisfaction and expectations regarding labor pain management were met or exceeded. These data support the concept that labor and acute postpartum pain influences both acute and long-term PPD symptoms, although additional data are needed to assess how analgesia preference interacts with these relationships.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Obstetric pain correlates with postpartum depression symptoms: a pilot prospective observational study

Lim

LaSorda

Farrell

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…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%

“…Some studies suggest there is an association between labor pain and postpartum depression, suggesting that managing labor pain and early postpartum pain decreases the risk for depression [8][9][10]. A recent study even suggest that effective labor pain management with epidural analgesia was associated with reduced postpartum depression symptoms [11].…”

Section: Introductionmentioning

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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“…Ding Ting et al reported 4 months after delivery, there was a lower incidence rate of PPD in parturients who received epidural and paracervical blockade during vaginal delivery [16]. In contrast, another study examining PPD rates among 1326 women did not demonstrate a difference between women with intrapartum epidural and those without [17]. Besides the conflicting results in the literature, the subjects of previous studies on PPD are almost aiming at nulliparous women rather than pluripara; therefore, further study is warranted.…”

Section: Introductionmentioning

confidence: 97%

Epidural Labor Analgesia Is Associated with a Decreased Risk of the Edinburgh Postnatal Depression Scale in Trial of Labor after Cesarean: A Multicenter, Prospective Cohort Study

Sun

Xiao

Zou

et al. 2020

BioMed Research International

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Postpartum depression is a disabling mental disorder commonly seen in parturients under trial of labor after cesarean, which causes serious harm to the parturients. The etiology is unclear. We hypothesized that epidural labor analgesia can reduce the incidence rate of postpartum depression. Enrolled multiparas were divided into the epidural labor analgesia group (n = 263) or nonanalgesia group (n = 160) according to their own request. Edinburgh Postnatal Depression Scale was used to assess their mental status at 48 hours and 42 days after delivery. Relative perinatal variables were collected and further analyzed using univariate analysis and multivariate logistic regression analysis to assess the relation of epidural analgesia with the occurrence of postpartum depression under trial of labor after cesarean. The Edinburgh Postnatal Depression Scale score 48 hours ≥ 10 in the no epidural analgesia group was 26.42% while the epidural analgesia group was 8.49% (OR, 0.209; 95% CI, 0.096–0.429; P<0.001). The Edinburgh Postnatal Depression Scale score 42 day ≥ 10 in the no epidural analgesia group was 25.16% while the epidural analgesia group was 6.59% (OR, 0.235; 95% CI, 0.113–0.469; P<0.001). The incidence of postpartum depression was significantly lower in the epidural labor analgesia group at 48 hours and 42 days. There was also a significant relation between the Edinburgh Postnatal Depression Scale scores at 48 hours and 42 days after delivery. Epidural analgesia, discomfort within 42 days, and self-rating anxiety scale are independent predictors of postpartum depression for trial of labor after cesarean in 42 days. Epidural labor analgesia is associated with a decreased risk of postpartum depression. Further study with a large sample size and more centers is needed to evaluate the impact of epidural analgesia on the occurrence of postpartum depression. Chinese Clinical Trial Register, ChiCTR-ONC-17010654.

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The Relationship Between Women’s Intention to Request a Labor Epidural Analgesia, Actually Delivering With Labor Epidural Analgesia, and Postpartum Depression at 6 Weeks: A Prospective Observational Study

Cited by 63 publications

References 22 publications

Obstetric pain correlates with postpartum depression symptoms: a pilot prospective observational study

Obstetric pain correlates with postpartum depression symptoms: a pilot prospective observational study

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

Epidural Labor Analgesia Is Associated with a Decreased Risk of the Edinburgh Postnatal Depression Scale in Trial of Labor after Cesarean: A Multicenter, Prospective Cohort Study

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