Does pain relief during delivery decrease the risk of postnatal depression?
Abstract
Background. To test the hypothesis that sufficient pain relief during delivery decreases the risk of postnatal depression. Methods. As part of a prospective follow‐up study of the risk factors for postnatal depression and its impact on the mother–infant interaction and child development, 185 parturients filled in the Edinburgh Postnatal Depression Scale (EPDS), first during the first postpartum week and again (n = 162) 4 months later. The incidence and the risk of high EPDS scores was calculated according to the mode of delivery and the mode of pain relief during vaginal delivery, also after adjusting for the length of labor. Results. Mothers who received epidural/paracervical blockade during their delivery spent less time in the delivery room than mothers in the nitrous oxide/acupuncture group (p = 0.033) or mothers with no pain relief (p = 0.026) and had shorter length of labor than mothers without pain relief (p = 0.04). The adjusted risk of depressive scores at the first postnatal week was decreased in the epidural/paracervical group when compared with no analgesia group (OR: 0.25, 95% CI: 0.09–0.72). This difference was not shown at 4 months postpartum. Elective or emergency cesarean section did not increase the risk of high EPDS scores at the first week or at 4 months postpartum. Conclusion. The mode of pain relief during vaginal delivery seems to be associated with the incidence of postpartum depression, especially immediately after delivery.
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Across delivery modes, the relationship between neuraxial anesthesia and postpartum depression is best characterized as neutral at the population level, with potential protective effects in select clinical contexts.
“Across delivery modes, the relationship between neuraxial anesthesia and postpartum depression (PPD) appears complex but is best characterized as neutral at the population level, with potential protective effects in select clinical contexts has been described as either protective or neutral at various amounts of time postpartum across many studies.37–51”
Across observational studies, cohort analyses, systematic reviews, and meta-analyses, neuraxial anesthesia does not appear to increase the risk of postpartum depression at the population level.
“Across observational studies, cohort analyses, systematic reviews, and meta-analyses, neuraxial anesthesia does not appear to increase the risk of PPD at the population level.”
Postpartum depression assessment timing varies widely across studies, ranging from days postpartum to two years after delivery, leading to variability in reported prevalence.
“Additionally, PPD assessment timing varies widely across studies, ranging from days of postpartum to two years after delivery, leading to variability in reported prevalence.41,42”
Neuraxial anesthesia is not associated with increased risk of postpartum depression and may have neutral or protective effects, particularly compared with general anesthesia for cesarean delivery.
“Collectively, available evidence indicates that neuraxial anesthesia likely does not increase the risk of postpartum depression and may exhibit either neutral or modest protective effects in labor.37–51”
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Fagan, J., Dufour, S., Duet, S., Downs, E., Siddaiah, H., Viswanath, O., Shekoohi, S., & Kaye, A. (2026) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s579920
- Authors
- Hiltunen, P., Raudaskoski, T., Ebeling, H., & Moilanen, I.
- Affiliations
- Päijät-Hämeen Keskussairaala (FI)
- Oulu University Hospital (FI)
- Corresponding author
- Hiltunen, Pauliina
- Venue
- Acta Obstetricia et Gynecologica Scandinavica
- Publisher
- Wiley
- Published
- 2004-02-16
- Volume
- 83
- Issue
- 3
- Pages
- 257-261
- ISSN
- 0001-6349 (ISSN-L)
- 1600-0412
- OpenAlex
- W1965387916
- Cited by
- 121
- References
- 0
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 5 · 2023: 6 · 2022: 13 · 2021: 6 · 2020: 12 · 2019: 7 · 2018: 11 · 2017: 12 · 2016: 4 · 2015: 7 · 2014: 5 · 2013: 3 · 2012: 2
- FWCI
- 1.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Obstetricia Et Gynecologica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Lastentautien Tutkimussäätiö
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- postpartum depression, labor analgesia, epidural analgesia, paracervical block, nitrous oxide, acupuncture, vaginal delivery, cesarean section, length of labor, Edinburgh Postnatal Depression Scale, risk factors for postpartum depression
- MeSH terms
- Adult, Female, Humans, Pain, Pain Measurement, Pregnancy, Probability, Prognosis, Prospective Studies, Surveys and Questionnaires, Sensitivity and Specificity, Incidence, Confidence Intervals, Odds Ratio, Analgesia, Obstetrical, Patient Satisfaction, Risk Assessment, Depression, Postpartum, Delivery, Obstetric
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