Catherine D Tobin*, Sylvia H Wilson, Latha Hebbar, Laura L Roberts, Bethany J Wolf and Constance Guille
Medical University of South Carolina, USA
Received: 02 November, 2016; Accepted: 12 November, 2016; Published: 14 November, 2016
Catherine D Tobin, MD, Assistant Professor, Medical University of South Carolina, 167 Ashley Avenue, MSC 912, Suite 301, Charleston, SC 29425, USA, Tel: 843792 2322; E-mail:
Tobin CD, Wilson SH, Hebbar L, Roberts LL, Wolf BJ, et al. (2016) Labor Epidural Analgesia and Postpartum Depression. Arch Depress Anxiety 2(1): 044-046. DOI: 10.17352/2455-5460.000014
© 2016 Tobin CD, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Introduction: Epidural labor analgesia may decrease the risk of postpartum depression (PPD).
Methods: In a secondary analysis of a prospective study, the association between epidural utilization and PPD was evaluated using a Fisher’s exact test. PPD was defined as an Edinburgh Postnatal Depression score of > 10 at 6-8 weeks postpartum.
Results: 20% (13/65) of women meet criteria for PDD. 24% (n=12/50) of women who received epidural labor analgesia developed PPD, compared to 6.7% (n=1/15) of women who did not receive epidural labor analgesia (P = 0.27).
Conclusions: Labor epidural analgesia did not reduce the risk of postpartum depression
Postpartum depression (PPD) is a common psychiatric disorder affecting 11-20.4% of childbearing women and is a major public health concern . PPD poses significant risks to mothers and their children, including risk of maternal suicide, infanticide, poor infant growth and development, and decreased maternal–newborn attachment. PPD risk reduction strategies are greatly needed and are an important area of current investigation.
Causes of PPD are characterized as multifactorial. While a number of important risk factors for PPD have been identified including anxiety and depression during pregnancy, lack of social support, previous perinatal loss , many of these factors are not modifiable making it difficult to reduce the risk of PPD. However, labor pain is often characterized as severe  and has been associated with post-traumatic stress disorder . Similarly, a link between mood disorders in the postpartum period and pain in childbirth has also been noted . Consequently, it is hypothesized that the immense psychological stress stimulated by labor pain may result in further neuropsychological consequences including PPD development. Therefore, analgesia during childbirth may ameliorate this stress response and reduce PPD rates.
Labor epidural analgesia reduces the pain of childbirth. Prior studies have suggested that labor epidural analgesia for childbirth may lower the risk of PPD [6,7]. However, other analgesia methods for labor including nitrous oxide and acupuncture have not been associated with decreased rates of PPD . As epidural labor analgesia is increasingly accessible, this is an exciting area of investigation, but replication of these findings is needed. The aim of this study was to examine the association of labor epidural analgesia and risk of PPD.
This study was a secondary analysis of an IRB approved prospective cohort study conducted at the Medical University of South Carolina in Charleston, South Carolina, United States. The original study, yet to be published, examined the association of blood biological markers and peripartum depression. The original study also prospectively evaluated for antepartum depression at 8-10 weeks and 24-28 weeks gestation. Epidural status at time of delivery was noted. Women were screened for PPD on their routine postpartum visit at 6-8 weeks postpartum using the Edinburgh Postnatal Depression Scale (EDPS) score of > 10. EPDS has been described as the most common screening tool for postpartum depression evaluation . The EDPS is a 10-item questionnaire and is a validated screening tool for depression in pregnant and postpartum women . An EPDS score of > 10 has been used in other studies to identify PPD [2,8]. A variety of EPDS cut-off scores ranging from 9 to 13 have been used for diagnosis.
Participant’s corresponding demographic information was gathered antepartum including age, BMI, race, parity, gravida, relationship status with the father, income level, education level and history of psychiatric illness. Following delivery, participant’s charts were reviewed to identify utilization or non-utilization of epidural labor analgesia as well as gestational age of the baby at delivery.
Statistical analyses were performed using Fisher’s exact tests to examine the association between labor epidural and PPD at 6-8 weeks postpartum and other dichotomous variables. T-tests or Wilcoxon rank sum tests were used for continuous variables where appropriate.
Epidural utilization during labor, and PPD status were available for 65 parturients. Demographic characteristics of parturients did not differ between subjects with EDPS score of < 10 compared to those with EDPS score > 10 (Table 1). At 6-8 weeks postpartum, 20% (13/65) of women meet criteria for PPD. Epidural labor analgesia was utilized by the majority of parturients (76.9%; 50/65; Table 1). Parturients who received epidural labor analgesia had a 24% (n=12/50) incidence of PPD compared to a rate of 6.7% (n=1/15) among parturients who did not receive labor analgesia (P = 0.27; Figure 1).
- Center for Disease Control and Prevention (2008) Prevalence of self-reported postpartum depression symptoms-17 states, 2004-2005. Morb Mortal Wkly Rep 57: 361-366.
- Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium (2015) Heterogeneity of postpartum depression: a latent class analysis. Lancet Psychiatry 2: 59-67.
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