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Cited by 40Maternal Mental Health During Pregnancy and PostpartumAnesthesia and Pain ManagementMaternal and Perinatal Health Interventions

The relationship between labor pain management, cortisol level and risk of postpartum depression development: a prospective nonrandomized observational monocentric trial

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Oksana V. Ryazanova, Yuri S. Alexandrovich, A. Ioscovich·2018·Romanian Journal of Anaesthesia and Intensive Care
DOI 10.21454/rjaic.7518.252.rznPMC PMC6211609
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Abstract

Postpartum depression (PPD) is the main psychological status disorder and women suffering from postpartum depression often need long-term psychological and socio-economic rehabilitation. The study is dedicated to the evaluation of the role of labor pain management using epidural analgesia in natural delivery on stress level in labor and frequency of postnatal depression. MATERIALS AND METHODS: 210 women were investigated and divided into two groups. In the first group for labor pain management in natural delivery, patient-controlled epidural analgesia was used (bolus - 10.0 - 0.08% ropivacaine hydrochloride, lockout - 30 min, limit - 120 ml/6 h) with a background of continuous-flow infusion of local anesthetic 0.08% ropivacaine hydrocluoride solution. Patients in the second group had no pain relief in delivery. The stress level was evaluated using blood plasma cortisol level in the early stages of labor, 6 hours and 3 days after delivery. The assessment of depression development was carried out step-by-step: Before the delivery, 6 hours after, 3 days and 6 weeks after the delivery. RESULTS: The baby blues frequency 6 hours after the delivery in the group where the pain relief was conducted was 29.91%, with cortisol level below and equal to 2310.91 nmol/l. In the group with no pain relief 6 hours after delivery, baby blues was found in 15.53% of puerperas (p < 0.05) and the cortisol level was 2673.82 nmol/l (p < 0.05). Six weeks after the birth, postpartum depression was diagnosed in 4.67% of women who received epidural analgesia during delivery, in comparison to 6.79% with no pain relief during delivery. However, the difference was not statistically significant (p < 0.05). CONCLUSIONS: The use of epidural analgesia leads to a significant reduction of pain syndrome and stress response during natural delivery, increases the risk of baby blues in the early postnatal period, but slightly influences the frequency of postpartum depression.

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  • Epidural analgesia is associated with substantial reductions in labor pain, improved maternal satisfaction, and attenuation of maternal and neonatal physiologic stress responses associated with childbirth.

    “Epidural analgesia is the most common neuraxial modality and is associated with substantial reductions in labor pain, improved maternal satisfaction, and attenuation of maternal and neonatal physiologic stress responses associated with childbirth.3,21,22”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [21]

    The Results report significantly lower labor-pain scores with epidural analgesia and lower maternal blood cortisol six hours after delivery; the Discussion interprets the cortisol difference as a reduced maternal stress response. The paper does not report improved maternal satisfaction or attenuated neonatal stress responses. The available passages have no page numbers. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Ryazanova, O. V., Alexandrovich, Y. S., & Ioscovich, A.
Affiliations
  • Saint Petersburg State Pediatric Medical University (RU)
  • Hebrew University of Jerusalem (IL)
ORCID
Oksana V. Ryazanova
Venue
Romanian Journal of Anaesthesia and Intensive Care
Publisher
Romanian Society of Anaesthesia and Intensive Care
Published
2018-10-20
Volume
25
Issue
2
Pages
123-130
ISSN
2392-7518 (ISSN-L)
DOI
10.21454/rjaic.7518.252.rzn
PMC
PMC6211609
OpenAlex
W2980771113
Cited by
40
References
11
Citations by year
2026: 3 · 2025: 5 · 2024: 4 · 2023: 5 · 2022: 6 · 2021: 9 · 2020: 7 · 2019: 1
FWCI
3.92
Type
journal article
Language
en
Open access
Locations
  • Romanian Journal of Anaesthesia and Intensive Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
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, patient-controlled epidural analgesia, ropivacaine, cortisol, stress response, natural delivery, baby blues, puerpera

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