Administration of epidural labor analgesia is not associated with a decreased risk of postpartum depression in an urban Canadian population of mothers: a secondary analysis of prospective cohort data
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BACKGROUND: Postpartum depression (PPD) is a common complication of pregnancy, affecting approximately 13% of mothers internationally. Previous research has examined whether epidural analgesia used for pain control during labor and birth is associated with a lower risk of PPD, but reports conflicting results and may have suffered from methodological shortcomings. Our study aimed to prospectively assess whether epidural analgesia is associated with a lower risk of PPD (at either 6 weeks or 6 months postpartum) after attempting to adequately adjust for selection bias and confounding variables. METHODS: We conducted a secondary analysis of a prospective cohort of urban Canadian mothers who were recruited at birth in Calgary, Canada, in 2010, for a primary study on predictors of PPD. Mothers with full-term, singleton infants who did not require neonatal intensive care unit admission of >24 hours were included, and filled out questionnaires at birth, 6 weeks and 6 months postpartum including demographics, birth data, maternal and infant physical health, lifestyle, breastfeeding and maternal mental health. Descriptive statistics were calculated for participant characteristics and to identify potential confounder variables. Multivariable logistic regression analysis was conducted to assess whether epidural analgesia is associated with PPD after controlling for available confounding variables. RESULTS: Our study included 206 mothers who had vaginal deliveries and were free of depression at delivery. We found an incidence of PPD of 13.3% (n=27) and no statistically significant association between epidural use and PPD, regardless of adjustment for potential confounding variables (unadjusted odds ratio [OR] 0.86, 95% confidence interval [CI] 0.69-1.22; adjusted OR (for body mass index 1.04, 95% CI 0.40-2.77). CONCLUSION: We did not observe a significant association between epidural use and PPD. While the CIs are wide, we do not believe that this masks a clinically relevant association, and as such, the risks and benefits of epidural analgesia communicated to women during labor and delivery should not be modified.
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Many studies demonstrate a neutral association between neuraxial anesthesia and postpartum depression.
“Many studies demonstrate a neutral association”
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 [49]
The Discussion and Conclusion report no observed association between epidural labor analgesia and postpartum depression, consistent with Hiltunen et al. But the Introduction describes prior studies as having inconsistent results, including studies reporting lower odds of postpartum depression. This source does not support the broader claim that many studies demonstrate a neutral association for neuraxial anesthesia generally. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSeveral recent studies demonstrate no independent association between epidural use and postpartum depression after adjustment for psychosocial confounding variables.
“However, several recent studies demonstrate no independent association between epidural use and PPD after adjustment for psychosocial confounding variables.45–51”
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 [49]
The Results report no statistically significant association between epidural use and postpartum depression after adjustment. However, BMI was the only confounder retained in the final model; income and parity were removed, so this study does not establish the claim specifically after adjustment for psychosocial confounders. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSome current evidence, including meta-analysis and prospective studies, does not support a direct relationship between neuraxial anesthesia and protection against postpartum depression.
“Importantly, some current evidence, including meta-analysis and prospective studies, does not support a direct relationship between neuraxial anesthesia and protection against postpartum depression.46–49”
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Cites
Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis
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MethodJardri, R., Pelta, J., Maron, M., Thomas, P., Delion, P., Codaccioni, X., & Goudemand, M. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.03.009 · Cited by 95 · cited 2× · see citing works
“21,22 It differentiates between non-pathological postpartum “blues” symptoms and those of PPD, more effectively than other depression measures.”
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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
- Nahirney, M., Metcalfe, A., & Chaput, K.
- Affiliations
- University of Calgary (CA)
- Corresponding author
- Chaput, Katie
- ORCID
- Metcalfe, Amy
- Venue
- Local and Regional Anesthesia
- Publisher
- Informa UK Limited
- Published
- 2017-10
- Volume
- Volume 10
- Pages
- 99-104
- ISSN
- 1178-7112 (ISSN-L)
- PMC
- PMC5673041
- OpenAlex
- W2766059015
- Cited by
- 32
- References
- 2
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 2 · 2022: 6 · 2021: 7 · 2020: 7 · 2019: 2 · 2018: 2
- FWCI
- 2.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Local and Regional Anesthesia (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Funders
- Children's Health Research Institute
- Women and Children's Health Research Institute
- Health Research Board
- University of Alberta
- 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
- epidural analgesia, postpartum depression, labor analgesia, maternal mental health, vaginal delivery, confounding adjustment, body mass index, risk-benefit communication
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