Updated July 25, 2014.

A study is circulating that claims that women who have epidurals have lower rates of postpartum depression at six weeks postpartum. This is based on a few different observational studies, including the main one cited from China. In the Chinese study the women had the option of epidural anesthesia or no anesthesia, no other comfort measures were offered.

As I have pointed out before, there is a huge difference both in the epidural or nothing mentality; and in the population who does not get an epidural but wanted one (for a variety of reasons women may not get a desired epidural).

These women are not separated in this discussion.

There is also a lot of talk about persistent postpartum pain, which may or may not be associated with epidural use in labor. I would say that anyone who has persistent pain is more likely to experience depression. This is not a new concept, though not often discussed in terms of the childbearing year.

In this article the authors point out that the postpartum depression group was also less likely to have initiated breastfeeding. They say that other studies show that women who do not breastfeed or initiate breastfeeding have a higher incidence of postpartum depression. There have been other, better quality studies, that have shown women with epidural anesthesia have lower rates of breastfeeding and increased problems with lactation.

I do not want to dismiss this study entirely. I think the discussion of postpartum depression is vital. I think there are a few things that are lacking from the discussion in this article. The first is that traumatic birth, which can include inadequate pain relief, plays a huge part in maternal depression after the birth of her baby.

We really do not like to talk about this topic, particularly from an obstetrical standpoint.

Adequate pain relief is an important topic, but pain relief means a lot of different things to a lot of people. Many women choose, and love, epidural anesthesia. These women have every right to have an epidural and should be treated well and have their concerns about improper coverage addressed. There are also women who do not wish to use an epidural. For these women, having an epidural forced on them, or even when it becomes their choice in the course of labor, may feel like they had wished things had turned out differently. When not addressed this can also be a cause of depression after birth, particularly if the woman experienced a traumatic birth (as she defines it, not her providers).

Women need to be offered a variety of pain relief options, including epidural anesthesia, but also non-drug methods like movement, massage, hydrotherapy, and others methods of pain relief. Childbirth classes can help women be properly prepared with these non-drug methods, even when a woman desires an epidural eventually in labor.

We also need to do a better job of addressing postpartum pain. For many, it seems that unless you are actively giving birth, the medical profession is not often as concerned about your pain as you are concerned. We go from numbing people’s bodies, to allowing them only mild pain killers after birth.

Lastly, this article addresses the fact that 90% of the moms who tested positive for postpartum depression, also had other mental health issues. We do a poor job of addressing mental illness in general, but even worse when it comes to our mothers.

Everyone needs adequate access to the pain relief methods they wish to have access to in birth, access to mental health screenings in pregnancy and postpartum, and better overall communications.

 

_{Katherine L. Wisner, Catherine Susan Stika, Crystal T. Clark. Double Duty. Anesthesia & Analgesia, 2014; 119 (2): 219 DOI: 10.1213/ANE.0000000000000322}