Study: Labour pain linked to postpartum depression

Controlled chaos is the best way to describe the atmosphere in the hospital room where my daughter was born. A steady stream of nurses and resident doctors rushed through the halls of the high-risk maternity ward, unusually busy for a February morning. A harried-looking OB-GYN peered over his mask at me with kindness in his eyes. I'd never met him before, but the nurses assured me he was the very best. As if I had any say in the matter.

"You can push soon," he said. "I know you're in pain, but I can't give you anything. You're too far along for an epidural and too close to transition for IV pain killers." From the next room, I heard the bellow of another labouring woman. "Besides," he continued. "The anesthetist is with another patient."

With that, he stood up and hurried out the room. My husband looked hopefully at a nurse, who nodded her head slowly—a silent reassurance that everything would be OK, even without painkillers. I wasn't as convinced, seeing as how I was in the most pain I'd ever felt. An excruciating hour later, Gillian was born.

While the OB/GYN delivered the placenta and stitched me up, he told me I should be proud of my VBAC, adding he doesn’t see very many. I was too sore and tired to care.

Gillian's birth was very different from my son's delivery three years earlier via C-section. The pain I'd felt during early labour with Isaac was managed with a combination of nitrous oxide and morphine. When Isaac's heart beat and my blood pressure dropped, an anesthetist quickly appeared, administering an epidural that took me through my unplanned section. Even my recovery from my C-section was easy, requiring none of the painkillers the hospital sent me home with.

To be honest, I’m not sure how I made it through Gillian’s birth with only a single dose of fentanyl in early labour. While the memory of the physical pain has since disappeared, the emotional pain and shame of my brush with postpartum depression has not. For the first six weeks of her life, I was convinced Gillian was not my baby, that the hospital made a horrible mistake and gave me the wrong one. I avoided her, finding any excuse to leave the house to escape her. I fed her only because I had to. I couldn't feel love for her because.

While there is no single known cause of the tragedy that is postpartum depression, new research in China suggests a link between the pain a woman experiences during childbirth and postpartum depression. The study found that women who had an epidural for a vaginal delivery had a 14 percent rate of depression at six weeks postpartum compared to nearly 35 percent rate of depression for those who did not have the epidural.

“It’s a huge omission that there has been almost nothing in postpartum depression research about pain during labour and delivery and postpartum depression. There is a well-known relationship between acute and chronic pain and depression,” writes Northwestern Medicine perinatal psychiatrist, Katherine Wisner, in the medical journal Anesthesia & Analgesia. “Managing acute postpartum pain supports the new mother’s ability to emotionally attach and care for her infant,” she adds.

The possible link between labour pain and postpartum depression explains why I struggled with mental health challenges after my daughter was born, whereas when my pain was well-managed during my son’s birth.

“Whether it’s vaginal or Caesarean section delivery, pain control postpartum is an issue for all new mothers," Wisner writes. "There is no way to have a delivery without pain. The objective here is to avoid severe pain. Controlling that delivery pain so a woman can comfortably develop as a mother is something that makes a lot of sense.”

How a woman manages her pain during labour is an intensely personal decision, with the pressure that a drug-free labour is somehow “better” than electing to have an epidural. It’s important to note that during both of my experiences I didn’t have a choice in how my pain was managed. Had it been an option, I definitely would have taken an epidural for my VBAC, especially knowing now that my risk of PPD could have been reduced.

“These findings are quite exciting and further research should be done to confirm them, especially in women at increased risk of postpartum depression and in women from other cultures,” Wisner said.

I, for one, am excited about the amazing benefits this research will offer women at risk for postpartum depression.

Follow along as Jennifer Pinarski shares her experiences about giving up her big city job and lifestyle to live in rural Ontario with her husband, while staying home to raise their two young children.

 @JenPinarski.