New U.S. research presented at the Anesthesiology 2018 annual meeting has found that pain after childbirth, rather than pain during labour and delivery, may be linked to a woman's risk of postpartum depression (PPD).
Carried out by researchers at Brigham and Women's Hospital in Boston, the new study looked at 4,327 mothers who were delivering their first child vaginally or by caesarean delivery (C-section) at the hospital.
The researchers compared the mothers' pain scores at different points of the delivery process, from the start of labor to hospital discharge, to their scores on the Edinburgh postnatal depression scale (EPDS) one week after delivery.
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The results showed that PPD was significantly associated with higher postpartum pain scores, with mothers with PPD experiencing more pain-related complaints during recovery, needing more additional pain medication, and more likely to report inadequate postpartum pain control.
Women with PPD were also more likely to have delivered their baby by C-section.
Although previous research has already linked pain from giving birth with an increased risk of PPD, until now it was unclear which part of the delivery process — before, during, or after delivery — is linked to the increased risk. The new study is the first to look at postpartum pain separately from labour and delivery pain and find it to be a significant risk factor for PPD.
Other factors contribute to a PPD risk, too
In addition, the researchers found that a number of other factors also appeared to be linked to a higher risk of PPD including being overweight or obese, suffering from a torn perineum (the area next to the vaginal opening), a history of depression, anxiety or chronic pain, and having smaller babies with lower Apgar scores, a scoring system used to assess the physical health of newborns one minute and five minutes after birth.
"For many years, we have been concerned about how to manage labor pain, but recovery pain after labor and delivery often is overlooked," said Jie Zhou, M.D., M.B.A., lead author of the study. "Our research suggests we need to focus more on helping new mothers manage pain after the baby is born."
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"While ibuprofen and similar pain medications are considered adequate for pain control after childbirth, clearly some women need additional help managing pain," Zhou said. "We need to do a better job identifying who is at risk for postpartum pain and ensure they have adequate postpartum care."
PPD affects around one in nine women, according to the Centers for Disease Control and Prevention (CDC). Symptoms include extreme sadness, low energy, anxiety, crying episodes, irritability and changes in sleep or eating patterns, and the condition can lead to lower rates of breastfeeding and poor bonding with the baby.