Persistent pain after childbirth may predict postpartum depression – even if a woman’s labor and delivery were not particularly painful, new research suggests.
Doctors have long observed that pain related to childbirth was linked to depression afterwards, but had not been about to specify what period of pain was most closely associated with the potentially debilitating mental health condition.
Researchers at Harvard Medical School and Brigham and Women’s Hospital have uncovered that it is the post-birth period that needs special attention.
They advise that doctors need to make sure that women are not sent home to suffer in order to protect their physical and mental health.
Making sure women have better pain management after giving birth – especially via C-section – may reduce their risks of postpartum depression, new study suggests
About one in every nine women in the US experience postpartum depression.
The symptoms of the disorder may come on any time in the first year of a newborn’s life, and may last weeks or even months, though the trajectory is different for everyone.
In some ways, postpartum depression resembles other forms of the mood disorder, with symptoms like deep general sadness and fatigue, but it can also cause women to feel violent toward themselves and their newborns.
The disorder can interfere with the ability of a woman and and her child to bond, leading to poorer health outcomes for both.
Postpartum depression is in part caused by the dramatic hormonal shifts women experience during and following pregnancy, but that’s made worse by the emotional rollercoaster and exhaustion of taking care of a new baby.
Plus, doctors believe other factors, including how much physical pain a woman is in, contribute to whether or not she will develop postpartum depression.
This is particularly true, the authors of the new study found, if a woman has a great deal of pain during her recovery after giving birth.
Complications such as tearing or wounds left by a caesarean section have a greater than expected impact.
Until now it had been thought only pain during childbirth was linked to the condition, but now it appears the dominant factor is the pain new mothers suffer once they leave the delivery room.
Assistant Professor Dr Jie Zhou, who led the study from Brigham and Women’s Hospital and Harvard Medical School, Boston, said: ‘For many years, we have been concerned about how to manage labour pain.
‘But recovery pain after labour and delivery often is overlooked.
‘Our research suggests we need to focus more on helping new mothers manage pain after the baby is born.’
In the new study, Dr Zhou’s research group reviewed pain scores, from the start of labor to being discharged from hospital, for more than 4,300 first-time mothers who gave birth naturally or by C-section.
Scientists compared the results to the scores from mothers’ Edinburgh postnatal depression scale (EPDS), used in postpartum depression screening, one week after delivery.
Results showed strong links between depression and higher postnatal pain scores.
Mothers with postpartum depression demonstrated more pain-related complaints during recovery and often needed additional pain medication.
Those women group were also more likely to have given birth by C-section. That means that doctors had to cut through layers of their abdominal muscle as well as the uterus to get surgically remove the baby.
While safe, these procedures are far more invasive and likely to result in a longer, more painful recovery.
Yet women who had C-sections were more likely to report inadequate pain control after labor.
Though clinical guidance says that post-delivery pain should be manageable with ibuprofen, previous research suggests that about half of American women who get C-sections are also prescribed opioid painkillers.
This practice is risky, as the drugs are powerful and addictive. Yet, the new study found that many C-section patients are still in too much pain, raising risks of depression.
Much more needs to be done to mitigate these, and other, risks of postpartum depression, the study authors wrote.
A number of factors, besides having a c-section and postnatal pain, can contribute to postpartum but researchers found it was more common among women who were overweight or obese.
It was also more prevalent among women who cried during childbirth, who had a history of depression, anxiety or chronic pain and whose babies were smaller and had lower physical health scores minutes after birth.
Dr Zhou said: ‘While ibuprofen and similar pain medications are considered adequate for pain control after childbirth, clearly some women need additional help managing pain.
‘We need to do a better job identifying who is at risk for postpartum pain and ensure they have adequate postpartum care.’
The findings were presented by the American Society of Anesthesiologists in San Francisco.