Ibuprofen and similar analgesics are considered suitable treatments for postpartum pain control, however some women clearly need additional help with pain management. This study by a team from Brigham and Women's Hospital and Harvard (Boston), presented at the 2018 Anesthesiology® Annual Meeting, indeed shows a strong link between postpartum depression and maternal pain after childbirth. Results that call for better pain management during the recovery period.
Postpartum depression affects approximately 1 in 9 women. Symptoms include extreme sadness, lack of energy, anxiety, crying spells, irritability, and changes in eating and sleeping habits. Postpartum depression can ultimately lead to reduced breastfeeding rates and less strong relationship with the baby.
The team looked at pain scores, from onset of labor through discharge, of 4,327 mothers who delivered a single child either vaginally or by caesarean section at Brigham and Women's Hospital in 2017. The researchers compared pain scores to Postnatal Depression Scale scores. The analysis thus reveals that:
- postpartum depression is significantly associated with higher postnatal pain scores;
- mothers with postpartum depression report more pain complaints during recovery and often request additional pain medication;
- finally, women suffering from postpartum depression are more likely to have given birth by caesarean section;
- are more likely to not have adequate pain control.
Other factors associated with postpartum depression are also identified: these depressed patients are more likely,
- to be overweight or obese,
- to suffer from a torn perineum,
- have a history of depression, anxiety or chronic pain;
- to have a smaller baby and/or a baby with a lower Apgar score.
Thus, birth pain would be more strongly involved in the development of postpartum depression than the process of labor and delivery. While previous studies have shown that pain associated with childbirth can increase the risk of postpartum depression, they did not identify precisely the stage of the process at the origin of the problem. This study is the first to differentiate postpartum pain from pain related to labor and childbirth and to identify it as a significant risk factor for depression.
Efforts have always been on optimal pain management during labor, less on pain experienced during recovery, concludes lead author Dr. Jie Zhou, professor of anesthesia at Harvard.
“ We need to focus more on supporting the mother to help her manage the pain better after the baby is born .”
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