POSTPARTUM DEPRESSION: Better manage the pain of the mother after childbirth

 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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POSTPARTUM DEPRESSION: Does the sex of the baby have a responsibility?

Baby blues or post-natal depression will affect nearly one in five mothers. And if baby blues is a mild form of depression that occurs after childbirth, if it lasts from a few hours to a few days, postpartum depression -partum is much more severe and prolonged. Characterized by one or more major depressive episodes, within the meaning of the symptoms of depression (DSM), it occurs within 4 to 6 weeks, or even within a year following childbirth. The most common symptoms are difficulty falling asleep, hyperactivity, irritability, anxiety, fatigue and difficulty concentrating. Finally, severe postpartum depression can negatively impact the mother-child relationship.

 

The researchers show here, on a study group of 296 participants, that women who give birth to a boy run between 71 and 79% more risk of suffering from postnatal depression. In addition, women who face birth complications have a 174% increased risk of developing depression.

 

What explanation? Recent research indicates that depression is linked to prolonged inflammation. Factors triggering inflammation could therefore highlight new risk factors for depression. Among these risk factors for inflammation are the male gender of the fetus and birth complications. Thus, giving birth to male children would increase the risks of postnatal depression. CQFD?

 

Recognizing that risk factors are linked to the presence of a male newborn is not straightforward. But it is one factor – admittedly not very specific – that may prompt women's health professionals to seek to identify and support women who are more likely to develop the condition.

 

Another a priori surprising conclusion: women with symptoms of depression, anxiety and stress before birth are always more at risk of developing postpartum depression, but birth complications have little impact on the risk. In practice, these mothers generally receive more support after birth due to their pre-existing mental health problems. This finding also suggests that interventions aimed at supporting young mothers may help prevent the development of depression.

 

Postpartum depression is therefore preventable with appropriate support. Moreover, on a more physiological level, many known risk factors for depressive symptoms are associated with the activation of inflammatory pathways, it is also an opportunity to identify new risk factors according to their inflammatory effects. .

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