Does pain relief during delivery decrease the risk of postnatal depression?
BACKGROUND
To test the hypothesis that sufficient pain relief during delivery decreases the risk of postnatal depression.


METHODS
As part of a prospective follow-up study of the risk factors for postnatal depression and its impact on the mother-infant interaction and child development, 185 parturients filled in the Edinburgh Postnatal Depression Scale (EPDS), first during the first postpartum week and again (n = 162) 4 months later. The incidence and the risk of high EPDS scores was calculated according to the mode of delivery and the mode of pain relief during vaginal delivery, also after adjusting for the length of labor.


RESULTS
Mothers who received epidural/paracervical blockade during their delivery spent less time in the delivery room than mothers in the nitrous oxide/acupuncture group (p = 0.033) or mothers with no pain relief (p = 0.026) and had shorter length of labor than mothers without pain relief (p = 0.04). The adjusted risk of depressive scores at the first postnatal week was decreased in the epidural/paracervical group when compared with no analgesia group (OR: 0.25, 95% CI: 0.09-0.72). This difference was not shown at 4 months postpartum. Elective or emergency cesarean section did not increase the risk of high EPDS scores at the first week or at 4 months postpartum.


CONCLUSIONS
The mode of pain relief during vaginal delivery seems to be associated with the incidence of postpartum depression, especially immediately after delivery.
Department of Pediatrics, Lahti Central Hospital, Finland. pauliina.hiltunen@phks.fi
Pauliina
P
Hiltunen
Tytti
T
Raudaskoski
Hanna
H
Ebeling
Irma
I
Moilanen
D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D019052:Depression, Postpartum / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D017060:Patient Satisfaction; D011247:Pregnancy; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires