Are labor pain and birth experience associated with persistent pain and postpartum depression? A prospective cohort study (original) (raw)
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2015
In 2007 the International Association for the Study of Pain (IASP) launched the campaign “Real Women, Real Pain”; 2007e2008 was declared as the “Global Year Against Pain” inWomen. By then it was recognized that 90% of women experience severe/unbearable labor pain, and that one very real consequence to labor pain was psychological: “Long-term emotional stress with potential adverse consequences on maternal mental health and family relationships” [1]. One year later Eisenach and his colleagues published their seminal data on the association between acute pain and postpartum depression [2]. Eisenach conducted a multicentre study across North America andWestern Europe, recruiting 1288 women after vaginal and cesarean delivery (CD). The reported combined incidence of acute pain 36 h after deliverywas 10.6%, and persistent pain at 8 weeks was 9.8%. Multivariable regression revealed a threefold increased risk of postpartum depression (PPD) in the presence of acute pain. Rates of persistent...
PAIN, 2008
Cesarean delivery rates continue to increase, and surgery is associated with chronic pain, often coexisting with depression. Also, acute pain in the days after surgery is a strong predictor of chronic pain. Here we tested if mode of delivery or acute pain played a role in persistent pain and depression after childbirth. In this multicenter, prospective, longitudinal cohort study, 1288 women hospitalized for cesarean or vaginal delivery were enrolled. Data were obtained from patient interviews and medical record review within 36 hours postpartum, then via telephone interviews 8 weeks later to assess persistent pain and postpartum depressive symptoms. The impact of delivery mode on acute postpartum pain, persistent pain and depressive symptoms and their interrelationships were assessed using regression analysis with propensity adjustment. The prevalence of severe acute pain within 36 hours postpartum was 10.9%, while persistent pain and depression at 8 weeks postpartum were 9.8% and 11.2%, respectively. Severity of acute postpartum pain, but not mode of delivery, was independently related to the risk of persistent postpartum pain and depression. Women with severe acute postpartum pain had a 2.5-fold increased risk of persistent pain and a 3.0-fold increased risk of postpartum depression compared to those with mild postpartum pain. In summary, cesarean delivery does not increase the risk of persistent pain and postpartum depression. In contrast, the severity of the acute pain response to childbirth predicts persistent morbidity, suggesting the need to more carefully address pain treatment in the days following childbirth.
Sexual & Reproductive Healthcare, 2018
This definitive and cross-sectional study was conducted to determine the relation between mothers' types of labor, birth interventions, birth experiences and postpartum depression. Methods: A total of 1010 mothers who gave birth in four different provinces of Turkey were chosen to participate in the study via purposive sampling method Results: The Edinburgh Postpartum Depression Scale score was determined to be 13 and over in 36.4% of the women. In this study, it was determined that the Edinburgh Postpartum Depression Scale scores for women in the 18-24 age group who had a vaginal birth, did not have health insurance, experienced health problems during pregnancy and were not trained about type of labor during pregnancy were statistically higher. There was no significant correlation between the birth experiences and postpartum depression. The linear regression model showed that there was a statistically significant correlation between enema and amniotomy interventions practised during the birth and the Edinburgh Postpartum Depression Scale scores. Conclusion: In conclusion, it is thought that preparing the mothers for birth with birth preparation training in the antenatal period and imposing the necessary regulations in the delivery room for the mothers to have a positive birth experience are important in reducing postpartum depression risk. [3]. The results of 143 studies were evaluated in the study conducted by Halbreich and Karkun (2006), and the PPD prevalence was found to be 0-60% [4]. The PPD averages of the countries were reported as 16.1% in Hong Kong, 12.8% in the United Kingdom,
Effect of Painless Labor on Postpartum Depression
Journal of Obstetrics, Gynecology and Cancer Research
Epidural labor analgesia is associated with a decreased risk of postpartum depression: a prospective cohort study [2] Predictors of postpartum depression: Prospective study of 264 women followed during pregnancy and postpartum [3] Perinatal depression: Prevalence, screening accuracy, and screening outcomes [4] Psychiatric symptoms following attempted natural childbirth [5] The myth of painless childbirth (the John J. Bonica lecture) [6] The nature and consequences of childbirth pain [7] Labour pain as a model of acute pain [8] Childbirth pain and postpartum depression [9] Association between the intensity of childbirth pain and the intensity of postpartum blues [10] Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression [11] The fear-avoidance model of musculoskeletal pain: current state of scientific evidence [12] Methods to identify postnatal depression in primary care: an integrated evidence synthesis and value of information analysis [13] Clinically significant changes in pain along the visual analog scale [14] Depressed mood, anxiety, and the use of labor analgesia [15] Factors associated with postpartum depressive symptomatology in Brazil: the Birth in Brazil national research study, 2011/2012 [16] The Connections of Pregnancy-, Delivery-, and Infant-Related Risk Factors and Negative Life Events on Postpartum Depression and Their Role in First and Recurrent Depression [17] Pain Management During Labor Part 2: Techniques for Labor Analgesia [18] A negative birth experience: prevalence and risk factors in a national sample [19] Birth place preferences and women's expectations and experiences regarding duration and pain of labor [20] Depressive symptoms and symptoms of posttraumatic stress disorder in women after childbirth [21] Pain relief during childbirth: Efficacy and safety of prolonging labour-analgesia with morphine directly into the lumbar cerebro-spinal-fluid (CSF) [22] Neoadjuvant chemotherapy for locally advanced ... [23] Labor Epidural Analgesia and Postpartum Depression [24] Childbirth and the development of acute trauma symptoms: incidence and contributing factors
Romanian Journal of Anaesthesia and Intensive Care, 2018
Postpartum depression (PPD) is the main psychological status disorder and women suffering from postpartum depression often need long-term psychological and socioeconomic rehabilitation. The study is dedicated to the evaluation of the role of labor pain management using epidural analgesia in natural delivery on stress level in labor and frequency of postnatal depression. Materials and methods: 210 women were investigated and divided into two groups. In the first group for labor pain management in natural delivery, patient-controlled epidural analgesia was used (bolus-10.0-0.08% ropivacaine hydrochloride, lockout-30 min, limit-120 ml/6 h) with a background of continuousflow infusion of local anesthetic 0.08% ropivacaine hydrocluoride solution. Patients in the second group had no pain relief in delivery. The stress level was evaluated using blood plasma cortisol level in the early stages of labor, 6 hours and 3 days after delivery. The assessment of depression development was carried out step-by-step: Before the delivery, 6 hours after, 3 days and 6 weeks after the delivery. Results: The baby blues frequency 6 hours after the delivery in the group where the pain relief was conducted was 29.91%, with cortisol level below and equal to 2310.91 nmol/l. In the group with no pain relief 6 hours after delivery, baby blues was found in 15.53% of puerperas (p < 0.05) and the cortisol level was 2673.82 nmol/l (p < 0.05). Six weeks after the birth, postpartum depression was diagnosed in 4.67% of women who received epidural analgesia during delivery, in comparison to 6.79% with no pain relief during delivery. However, the difference was not statistically significant (p < 0.05). Conclusions: The use of epidural analgesia leads to a significant reduction of pain syndrome and stress response during natural delivery, increases the risk of baby blues in the early postnatal period, but slightly influences the frequency of postpartum depression.
Birth, 2014
Background: The aim of this prospective study was to investigate the role of labor pain and overall birth experience in the development of posttraumatic stress symptoms in a comprehensive framework. Methods: The study sample (N = 1893) comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort, which targeted all women scheduled to give birth at Akershus University Hospital in Norway. Questionnaires were given at three different stages: from pregnancy weeks 17 to 32, from the maternity ward, and from 8 weeks postpartum. Data were also obtained from the hospital's birth record. Using structural equation modeling, a prospective mediation model was tested. Results: Posttraumatic stress symptoms were significantly related to both labor pain (r = 0.23) and overall birth experience (r = 0.39). A substantial portion (33%) of the effect of labor pain on posttraumatic stress symptoms was mediated by the overall birth experience. Conclusions: Although the results of this study showed that both labor pain and overall birth experience played a role in the development of posttraumatic stress symptoms after childbirth, overall birth experience appeared to be the central factor. The women's birth experience was not only related to posttraumatic stress symptoms directly but also mediated a substantial portion of the effect of labor pain on posttraumatic stress symptoms. Future work should address which areas of birth experience confer protective effects on women to improve clinical care. (BIRTH 41:1 March 2014) Key words: labor pain, longitudinal cohort study, overall birth experience, posttraumatic stress symptoms after childbirth Up to one-third of all women view their labor and delivery as traumatic (1,2). An estimated 2-6 percent of women experience the full constellation of symp-toms of posttraumatic stress disorder (PTSD) relating to childbirth and qualify for a clinical PTSD diagnosis (3).
Journal of Clinical Anesthesia, 2019
The primary aim of the proposed study was to determine the association between postoperative pain and breastfeeding after cesarean delivery during hospital stay. Design: Retrospective cohort study. Setting: Postoperative recovery area and operating room. Patients: Data was obtained on singleton pregnancies undergoing scheduled cesarean deliveries under spinal anesthesia between 2013 and 2016. Interventions: Determine the association between postoperative pain and breastfeeding after cesarean delivery. Measurements: Postoperative pain score, breastfeeding, LATCH score post-partum depression and length of stay values collected. Main results: The dataset consisted of electronic medical records from 5350 patients. We found that the pain score is negatively associated with the LATCH score; higher pain was associated with lower LATCH scores, −0.01 [−0.01,-0.00], p < .0402. Every one-point increase in average pain score was associated with a 21% reduction in the odds of in-hospital exclusive breast-feeding relative to exclusive formula-feeding, OR = 0.79 [0.70-0.90], p < .0002. We observed that the post-partum depression status was associated with the average postoperative pain score, F (1, 5347) = 41.51, p < .0001. We also found a significant positive association between the average pain score and the duration of hospital stay (p < .0001); every one-point increase in the average pain-score was associated with a 7.98 [6.28, 9.68] hour increase in length of stay. Conclusions: Our results demonstrate significant association between the increase in post-cesarean pain scores and deterioration of breastfeeding initiation while also exposing slight reductions in the quality of breastfeeding. Additionally, we found that increases in post-cesarean pain scores also positively associate with postpartum depression and duration of stay, with each increase in pain score resulted in an almost one-day increase in the length of stay.