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Cited by 0Maternal Mental Health During Pregnancy and PostpartumAnesthesia and Pain ManagementMaternal and Perinatal Health Interventions

Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature

Open access
Fagan, Jasmine, Dufour, Sarah, Duet, Seth, Downs, Evan, Siddaiah, Harish, Viswanath, Omar, Shekoohi, Sahar, Kaye, Alan·2026·Neuropsychiatric Disease and Treatment
DOI 10.2147/ndt.s579920PMC PMC13092565
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Abstract

Postpartum depression (PPD) is a prevalent mood disorder affecting 10-20% of women and represents a major contributor to maternal and infant morbidity. Labor pain, delivery mode, and anesthetic technique have been proposed as potential modifiers of postpartum psychological outcomes. Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural techniques is the standard of care for labor analgesia and cesarean delivery, yet its association with PPD remains incompletely defined. This narrative review synthesizes current evidence evaluating the relationship between neuraxial anesthesia and dural puncture epidural (DPE) during vaginal and cesarean delivery and subsequent risk of postpartum depression. 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. Many studies demonstrate a neutral association, while select analyses suggest modest protective effects, particularly among women experiencing severe labor pain or high intrapartum stress. Proposed mechanisms include attenuation of physiologic stress responses, improved pain control, and enhanced maternal satisfaction. These effects, however, are inconsistent across patient populations, and neuraxial anesthesia does not independently prevent PPD. In contrast, general anesthesia for cesarean delivery is consistently associated with higher rates of severe postpartum depression. Overall, postpartum depression is multifactorial condition in which anesthetic technique functions as a modifying rather than determining factor. Optimizing intrapartum pain management, minimizing unnecessary general anesthesia exposure, and implementing systematic postpartum mental health screening are essential components of comprehensive perinatal care.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review synthesizes evidence on neuraxial anesthesia during vaginal and cesarean delivery and postpartum depression (PPD), concluding that neuraxial anesthesia does not appear to increase PPD risk at the population level and may be neutral or modestly protective in some contexts. General anesthesia for cesarean delivery is consistently associated with higher rates of severe PPD.

Key findings

  • Across observational studies, cohort analyses, systematic reviews, and meta-analyses, neuraxial anesthesia was generally not associated with increased PPD risk; some analyses suggested modest protection, particularly with severe labor pain or high intrapartum stress.
  • A meta-analysis of 86,231 participants found a risk ratio of 0.75 for long-term and 0.55 for short-term PPD incidence, while other meta-analyses found neutral associations (e.g., OR 1.02, 95% CI 0.62–1.66; pooled adjusted OR 1.03, 95% CI 0.77–1.37).
  • One meta-analysis reported mixed findings: neuraxial analgesia was protective in a high-PPD-prevalence subgroup (OR 0.61) but appeared to be a risk factor in a low-prevalence subgroup (OR 1.56); a historical cohort found increased odds of PPD with labor epidural analgesia (adjusted OR 1.29, 95% CI reported).
  • General anesthesia for cesarean delivery was associated with increased odds of severe PPD requiring hospitalization (aOR 1.54, 95% CI 1.21–1.95) and suicidal ideation or self-inflicted injury (aOR 1.91, 95% CI 1.12–3.25) compared with neuraxial anesthesia; cesarean delivery overall was associated with approximately 12–33% higher PPD risk, and emergency cesarean delivery with a 20% higher risk.

Methods

  • Narrative review with a targeted literature search of PubMed, Embase, and Google Scholar using terms including “postpartum depression,” “labor analgesia,” “epidural anesthesia,” “regional anesthesia,” and “labor pain.”
  • Articles published between 2000 and 2025 were considered, including observational studies, randomized controlled trials, and meta-analyses; case reports and studies not directly addressing the relationship were excluded.
  • No formal systematic quality assessment was performed; emphasis was placed on higher-quality evidence such as large cohort studies and meta-analyses, and findings were synthesized narratively, including a comparison table of select studies.

Limitations

  • Stated in the paper: most studies are observational and susceptible to confounding; randomized controlled trials specifically evaluating PPD outcomes are practically and ethically difficult; PPD assessment timing varies widely (days to two years postpartum); unmeasured psychosocial variables (partner support, socioeconomic stress, prior trauma, access to mental health care) may influence associations; mechanistic studies directly linking neuraxial anesthesia to postpartum mood are lacking; and differential effects of specific anesthetic agents are not well characterized.
  • Evident from the text: as a narrative review, it did not perform a formal systematic quality assessment or reproducible systematic search, and comparison across studies is limited by heterogeneity in PPD ascertainment, including different screening instruments (EPDS vs. PHQ-9), variable cutoff thresholds, inconsistent assessment windows, and differing definitions based on screening scores versus diagnostic interviews.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2147/ndt.s579920

Cites

82 of 82 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

78 of 135 cited sources checked · 29 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    Mode of delivery may be linked to postpartum PTSD.

    “Additionally, mode of delivery may be linked to postpartum PTSD.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [67] Beck-Hiestermann, 2024, BMC Pregnancy Childbirth source
    • Rests on an assumption: The relationship between anesthetic technique and postpartum depression is subject to significant confounding by preexisting psychiatric history, severity of labor pain, and delivery characteristics such as emergency versus elective cesarean section.
  • Findingcitation

    Among 428,204 cesarean deliveries, general anesthesia (8.0%) was associated with increased odds of severe postpartum depression (aOR 1.54, 95% CI 1.21-1.95) compared with neuraxial anesthesia.

    “Among 428,204 cesarean deliveries, general anesthesia (8.0%) was associated with increased odds of severe postpartum depression (aOR 1.54, 95% CI 1.21–1.95) and suicidal ideation or self-inflicted injury (aOR 1.91, 95% CI 1.12–3.25) compared with neuraxial anesthesia, with no significant association observed for anxiety disorders or PTSD.35”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [35] Guglielminotti, 2020, Anesth Analg source
    • Rests on an assumption: The relationship between anesthetic technique and postpartum depression is subject to significant confounding by preexisting psychiatric history, severity of labor pain, and delivery characteristics such as emergency versus elective cesarean section.
  • Findingcitation

    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.”
    Quote in the paperSubstantial claim6 of 10 sources checked
    • cites [37] Ding, 2014, Anesth Analg source
    • cites [38] Sun, 2020, Biomed Res Int source

      The Conclusion (page unavailable) says epidural labor analgesia may be associated with a decreased risk of postpartum depression in this trial-of-labor-after-cesarean cohort. The Introduction (page unavailable) describes conflicting findings in earlier studies; the paper does not establish a conclusion across systematic reviews and meta-analyses or at the population level. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [39] Suhitharan, 2016, Neuropsychiatr Dis Treat source

      The Results and Conclusion report lower odds of postpartum depression among women who received labor epidural analgesia than among those who chose nonepidural methods. This supports no observed increase for epidural analgesia in this case–control study, but it does not establish the claim across systematic reviews, meta-analyses, all neuraxial anesthesia, or populations generally. The Discussion cautions that the findings cannot be generalized to other ethnic or socioeconomic groups. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [40] Lim, 2018, Anesth Analg source

      The Introduction and Discussion report studies associating labor epidural analgesia with lower postpartum depression risk, and this study found that more effective epidural pain relief was associated with lower depression scores. But the Methods include only women who received epidural analgesia, and the paper does not establish the claimed population-level conclusion across observational studies, systematic reviews, and meta-analyses. Page numbers were not provided in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [41] Hiltunen, 2004, Acta Obstet Gynecol Scand source
    • cites [42] Liu, 2019, Eur J Anaesthesiol source

      The Discussion reports lower depression at 6 weeks and 2 years among women who received neuraxial labour analgesia, supporting the narrower conclusion that it was not associated with increased risk in this cohort. But the paper limits its findings to nulliparous women with single cephalic term pregnancies planning vaginal delivery and explicitly cautions that generalisability is limited. It does not establish the claim across systematic reviews and meta-analyses or at the population level. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [43] Li, 2023, Medicine source

      The Results (§3.4; page not provided) report a pooled risk ratio of 0.75 (95% CI 0.56–1.00) for postpartum depression at four or more weeks, supporting the cautious claim that neuraxial labor analgesia does not appear to increase risk in the studies analyzed. However, this is one systematic review and meta-analysis of observational studies; it does not establish the claim across multiple systematic reviews and meta-analyses. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [44] Wu, 2018, Int J Obstet Anesth source
    • cites [45] Eckerdal, 2020, Anesth Analg source
    • cites [46] Almeida, 2020, BMC Womens Health source

      The Results report a meta-analysis of nine studies involving 4,442 patients, with no significant association between labor epidural analgesia and a positive postpartum-depression screen. The Conclusions likewise report no detected association. The claim is broader than this evidence: the paper evaluates labor epidural analgesia, not neuraxial anesthesia generally. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • Rests on an assumption: The relationship between anesthetic technique and postpartum depression is subject to significant confounding by preexisting psychiatric history, severity of labor pain, and delivery characteristics such as emergency versus elective cesarean section.
  • Findingcitation

    General anesthesia for cesarean delivery is consistently associated with higher rates of severe postpartum depression.

    “In contrast, general anesthesia for cesarean delivery is consistently associated with higher rates of severe postpartum depression.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [35] Guglielminotti, 2020, Anesth Analg source
    • cites [36] Stanisic, 2022, Medicina source

      The Discussion reports higher post-cesarean pain levels with general than regional anesthesia, and the Introduction says higher pain scores increase the risk of postpartum depression. The paper does not report depression rates by anesthesia type or establish a consistent association with severe postpartum depression. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Findingcitation

    A meta-analysis including over 86,000 participants, as well as multiple prospective cohort studies, observed significantly decreased rates of postpartum depression in patients who underwent neuraxial labor analgesia compared with patients who did not, with a difference seen as long as 2 years postpartum.

    “A meta-analysis including over 86,000 participants, as well as multiple prospective cohort studies have observed significantly decreased rates of PPD in patients who underwent neuraxial labor analgesia compared to patients who did not, with difference seen as long as 2 years postpartum.37,42,43”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [37] Ding, 2014, Anesth Analg source
    • cites [42] Liu, 2019, Eur J Anaesthesiol source
    • cites [43] Li, 2023, Medicine source

      The Abstract Results report 14 studies involving 86,231 women and a significant association with lower postpartum depression rates in the first week after neuraxial analgesia. The longer-term result was borderline (P = .05), and the Methods limit included outcomes to the first year postpartum; this paper does not support a difference persisting to two years. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 19
  • May combine two claims. 35

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    General anesthesia induces unconsciousness and is now reserved primarily for emergent/STAT cesarean deliveries when neuraxial anesthesia is contraindicated, unavailable, or when there is not enough time for neuraxial anesthesia to provide an adequate block.

    “General anesthesia induces unconsciousness and is now reserved primarily for emergent/STAT cesarean deliveries when neuraxial anesthesia is contraindicated, unavailable or when there is not enough time for neuraxial anesthesia to provide an adequate block.33,34”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [33] Raghavan, 2025, J Anesth source
    • cites [34] Ring, 2021, Curr Anesthesiol Rep source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Some studies demonstrate no significant association between neuraxial anesthesia and postpartum depression, suggesting that analgesia alone may not independently influence postpartum mood when broader psychosocial factors dominate.

    “Some studies demonstrate no significant association between neuraxial anesthesia and PPD, suggesting that analgesia alone may not independently influence postpartum mood when broader psychosocial factors dominate.46,53”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [46] Almeida, 2020, BMC Womens Health source

      The Discussion and Results report no significant association between labor epidural analgesia and postpartum depression. The Background identifies psychosocial risk factors, but the paper does not establish that they dominate analgesia’s effect; the Discussion also cautions that observational studies cannot account for unknown confounders. The evidence concerns labor epidural analgesia specifically, not all neuraxial anesthesia. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [53] Orbach-Zinger, 2021, Int J Obstetric Anesthesia source
    • Rests on an assumption: The relationship between anesthetic technique and postpartum depression is subject to significant confounding by preexisting psychiatric history, severity of labor pain, and delivery characteristics such as emergency versus elective cesarean section.

  • May combine two claims.

    Findingcitation

    Analysis of Variance revealed weak effects of delivery method on postpartum depression but medium to strong effects on PTSD.

    “Analysis of Variance (ANOVA) revealed weak effects of delivery method on PPD but medium to strong effects on PTSD.67”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [67] Beck-Hiestermann, 2024, BMC Pregnancy Childbirth source
    • Rests on an assumption: The relationship between anesthetic technique and postpartum depression is subject to significant confounding by preexisting psychiatric history, severity of labor pain, and delivery characteristics such as emergency versus elective cesarean section.

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [3] Neumark, 1985, Acta Anaesthesiol Scand source
    • cites [21] Riazanova, 2018, Rom J Anaesth Intensive Care source

      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)

      Experimental — accuracy not yet measured
    • cites [22] Deepak, 2022, Cureus source

      The Discussion (page unavailable) reports significantly lower pain scores and high satisfaction with epidural analgesia. It does not establish attenuation of maternal and neonatal physiologic stress responses: it reports no effect on maternal vital signs and no significant difference in five-minute neonatal Apgar scores. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    General anesthesia has been associated with higher postoperative pain and increased risk of postpartum depression compared with neuraxial anesthesia.

    “General anesthesia has been associated with higher postoperative pain and increased risk of PPD compared with neuraxial anesthesia.35,36”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [35] Guglielminotti, 2020, Anesth Analg source
    • cites [36] Stanisic, 2022, Medicina source

      The Discussion reports higher post-cesarean pain scores with general than regional anesthesia. The Introduction says higher pain scores increase the risk of postpartum depression, but the paper does not report a direct comparison of depression risk between anesthesia groups. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    One year postpartum, approximately one in eight women experience depression, with a pooled prevalence of 12.1% in a meta-analytic study, and one in fifteen of all women experience major depression.

    “One year postpartum, approximately one in eight women, a pooled prevalence of 12.1% in a meta-analytic study, experience depression, and one in fifteen of all women experience major depression.10”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Bai, 2023, Depress Anxiety source

      The Results (§3.1) report pooled prevalences of 12.1% for all depression and 7.0% for major depression, and the Discussion describes these as approximately one in eight and one in fifteen postpartum women. The estimates cover women within the first year postpartum, not specifically at the one-year time point; the major-depression estimate is for postpartum women, not all women generally. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The PHQ-9 directly assesses DSM-5 criteria for major depressive disorder, including sleep, appetite, energy, concentration, and other symptoms, which all may be inflated during the postpartum period for non-psychiatric reasons.

    “The PHQ-9 directly assesses DSM-5 criteria for major depressive disorder, including sleep, appetite, energy, concentration, and other symptoms, which all may be inflated during the postpartum period for non-psychiatric reasons.73”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [73] Zhong, 2014, J Affect Disord source

      The Methods (section 2.3.1; page not provided) list sleep, appetite, energy, and concentration among the symptoms assessed by the PHQ-9, but say it is based on DSM-IV, not DSM-5, criteria. The Discussion (section 4; page not provided) says postpartum somatic symptoms can overlap with depressive symptoms and may cause false positives; it does not extend that concern to every listed symptom, including concentration. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The development of postpartum depression is multifactorial, influenced by biological, psychological, and social determinants.

    “The development of PPD is multifactorial, influenced by biological, psychological, and social determinants.11,12”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [11] Yim, 2015, Annual Review of Clinical Psychology source
    • cites [12] Xu, 2026, Front Public Health source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Edinburgh Postnatal Depression Scale was designed specifically for the perinatal population and tends to focus on symptoms such as anxiety while minimizing somatic items that can overlap with normal postpartum recovery.

    “In contrast, the EDPS was designed specifically for the perinatal population and tends to focus on symptoms such as anxiety while minimizing somatic items that can overlap with normal postpartum recovery.73”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [73] Zhong, 2014, J Affect Disord source

  • May combine two claims.

    Interpretationcitation

    Reduction of severe intrapartum pain and improvement in perceived control and childbirth satisfaction are recognized contributors to postpartum psychological well-being and may mitigate known risk factors for postpartum depression, such as traumatic birth experiences and poorly controlled labor pain.

    “The reduction of severe intrapartum pain, and improvement in perceived control and childbirth satisfaction are recognized contributors to postpartum psychological well-being and may mitigate known risk factors for PPD, such as traumatic birth experiences and poorly controlled labor pain.4,52”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [4] Kwok, 2015, Trends Anaesth Crit Care source
    • cites [52] Du, 2022, J Pain Res source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Neuraxial anesthesia, including epidural, spinal, and combined spinal-epidural techniques, is the standard of care or gold standard for labor analgesia and cesarean delivery.

    “Neuraxial anesthesia including epidural, spinal, and combined spinal–epidural techniques is the standard of care for labor analgesia and cesarean delivery”
    • Also stated in: § Introduction · boosted
      “Neuraxial anesthesia, which includes epidural, spinal, and combined spinal–epidural techniques, is now considered the gold standard for intrapartum analgesia and anesthesia.5”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [5] Kearns, 2023, Best Pract Res Clin Anaesthesiol source

      The Introduction (p. 1) calls epidural analgesia the “gold standard” for labour pain relief, and Neuraxial analgesia (p. 2) describes epidural and combined spinal–epidural techniques as commonly used, safe and effective. The paper says an epidural can be converted to anaesthesia for operative delivery (p. 3), but these passages do not establish standalone spinal anaesthesia or neuraxial techniques collectively as the standard of care for cesarean delivery. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Among patients with symptoms of PTSD, secondary cesarean section, emergency cesarean section, and assisted vaginal delivery were all associated with elevated levels of PTSD.

    “Of patients who were found to have symptoms of PTSD, secondary cesarean section, emergency cesarean section, and assisted vaginal delivery were all associated with elevated levels of PTSD.67”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [67] Beck-Hiestermann, 2024, BMC Pregnancy Childbirth source
    • Rests on an assumption: The relationship between anesthetic technique and postpartum depression is subject to significant confounding by preexisting psychiatric history, severity of labor pain, and delivery characteristics such as emergency versus elective cesarean section.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Psychosocial stressors such as lack of support, prior psychiatric history, and negative childbirth experiences increase the risk of developing postpartum depression.

    “Psychosocial stressors such as lack of support, prior psychiatric history, and negative childbirth experiences further increase the risk of developing PPD.11”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [11] Yim, 2015, Annual Review of Clinical Psychology source

      The Discussion’s ‘Lessons Learned from the Psychosocial Literature’ identifies low social resources as increasing PPD risk, and the Introduction’s ‘Definitions, Classifications, and Assessment’ reports moderate-to-strong associations between prior depression, anxiety, or stress and PPD. However, the passages found for childbirth experience do not establish that negative childbirth experiences increase PPD risk; searches included ‘negative childbirth experiences’ and ‘traumatic childbirth.’ (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    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”
    Quote in the paperSubstantial claim6 of 10 sources checked
    • cites [37] Ding, 2014, Anesth Analg source
    • cites [38] Sun, 2020, Biomed Res Int source

      The Introduction (page not provided) describes conflicting findings: one earlier study found lower postpartum depression rates with epidural analgesia, while another found no difference. The Conclusion (page not provided) says epidural analgesia may be associated with decreased risk in the study’s trial-of-labor-after-cesarean context. The paper does not establish that the relationship is best characterized as neutral across delivery modes at the population level. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [39] Suhitharan, 2016, Neuropsychiatr Dis Treat source

      The Results and Discussion report lower odds of PPD among women receiving labor epidural analgesia than among those receiving nonepidural analgesia; the Conclusion likewise describes a protective association. The paper does not establish a neutral relationship at the population level or assess that relationship across delivery modes. Its Discussion also cautions that the case–control study cannot establish causation or generalize beyond its study population. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [40] Lim, 2018, Anesth Analg source

      The Discussion (page unavailable) associates effective labor epidural analgesia with lower postpartum depression symptom scores, supporting a potential protective association in the studied context. But the Methods and Results (page unavailable) show that the analysis included only women who received a labor epidural; cesarean deliveries without labor were excluded. It therefore does not establish a neutral population-level relationship across delivery modes. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [41] Hiltunen, 2004, Acta Obstet Gynecol Scand source
    • cites [42] Liu, 2019, Eur J Anaesthesiol source

      The Discussion reports a significant association between neuraxial labour analgesia and reduced depression at two years in nulliparous women planning vaginal delivery. It also says the study’s eligibility criteria limit generalisability. This supports a potential protective association in a specific clinical context, but not the claim of neutrality at the population level or a conclusion across delivery modes. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [43] Li, 2023, Medicine source

      The Results (§3.4–3.5; page unavailable) report a borderline lower PPD risk at ≥4 weeks, a significant lower risk in the first week, and potentially protective associations in subgroups. Calling the overall relationship neutral overlooks the first-week finding. The inclusion criteria (§2.2; page unavailable) specify women planning spontaneous vaginal delivery, so the paper does not establish a relationship across delivery modes. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [44] Wu, 2018, Int J Obstet Anesth source
    • cites [45] Eckerdal, 2020, Anesth Analg source
    • cites [46] Almeida, 2020, BMC Womens Health source

      The Abstract Results (page unavailable) report no significant overall association between labor epidural analgesia and a positive postpartum-depression screen. The Results (page unavailable) also list one study with significantly less PPD in the epidural group. The review addresses labor epidural analgesia, however, not neuraxial anesthesia across delivery modes, and it does not establish protective effects in particular clinical contexts. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • Rests on an assumption: The relationship between anesthetic technique and postpartum depression is subject to significant confounding by preexisting psychiatric history, severity of labor pain, and delivery characteristics such as emergency versus elective cesarean section.

  • May combine two claims.

    Findingcitation

    Cesarean delivery is linked to a threefold higher risk of experiencing chronic pain, affecting 22% of women at one year postpartum, which may directly correlate with more severe depressive symptoms.

    “Furthermore, another study demonstrate that this delivery mode is linked to a threefold higher risk of experiencing chronic pain, affecting 22% of women at one year postpartum, which may directly correlate with more severe depressive symptoms.65,66”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [65] Ilska, 2020, Midwifery source
    • cites [66] Ning, 2024, Front Psychiatry source

      The Discussions (page unavailable) link pain after repeat cesarean delivery with increased postpartum depression risk. They do not report a threefold higher risk of chronic pain or that chronic pain affects 22% of women at one year postpartum; the pain discussion concerns repeat cesareans and the early postpartum period. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • Rests on an assumption: The relationship between anesthetic technique and postpartum depression is subject to significant confounding by preexisting psychiatric history, severity of labor pain, and delivery characteristics such as emergency versus elective cesarean section.

  • May combine two claims.

    Premisecitation

    General anesthesia during cesarean delivery is associated with delayed first skin-to-skin contact and delay in first breastfeeding attempt.

    “General anesthesia during cesarean delivery eliminates maternal participation in childbirth and is associated with delayed first skin-to-skin contact and delay in first breastfeeding attempt, which may contribute to the observed elevation in severe PPD risk.35”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [35] Guglielminotti, 2020, Anesth Analg source

  • May combine two claims.

    Study design and conductcitation

    Most studies regarding neuraxial anesthesia and postpartum depression are observational, increasing susceptibility to confounding variables.

    “Most studies regarding neuraxial anesthesia and PPD are observational, increasing susceptibility to confounding variables.43,47”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [43] Li, 2023, Medicine source
    • cites [47] Kountanis, 2020, J Clin Anesth source

  • May combine two claims.

    Interpretationcitation

    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”
    • Also stated in: § Conclusion · hedged
      “Current evidence indicates that neuraxial anesthesia is not associated with increased PPD risk and is more likely to confer protective psychological effects, particularly when compared with general anesthesia for cesarean delivery.”
    Quote in the paperSubstantial claim6 of 10 sources checked
    • cites [37] Ding, 2014, Anesth Analg source
    • cites [38] Sun, 2020, Biomed Res Int source

      The Results (section 3.2; page unavailable) report fewer elevated postpartum-depression screening scores among women who received epidural labor analgesia during trial of labor after cesarean, supporting a possible protective association. The study does not establish the broader claim for all neuraxial anesthesia or compare neuraxial with general anesthesia for cesarean delivery. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [39] Suhitharan, 2016, Neuropsychiatr Dis Treat source

      The Results and Conclusion report that labor epidural analgesia was associated with lower odds of postpartum depression than nonepidural labor analgesia, supporting the citing sentence’s suggestion of a possible protective effect in labor. The study does not establish this for neuraxial anesthesia generally or compare it with general anesthesia for cesarean delivery. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [40] Lim, 2018, Anesth Analg source

      The Discussion (page not provided) associates effective epidural labor analgesia with reduced postpartum depression symptoms, supporting the labor-related portion of the claim. The study examined women who received epidural analgesia during labor; it does not support the claim’s added comparison with general anesthesia for cesarean delivery, which is absent from the verbatim citing sentence. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [41] Hiltunen, 2004, Acta Obstet Gynecol Scand source
    • cites [42] Liu, 2019, Eur J Anaesthesiol source

      The Discussion reports lower postpartum depression at 6 weeks and a significantly decreased risk of depression at 2 years among women who received neuraxial labour analgesia. The study included women planning vaginal delivery and compared neuraxial analgesia with no neuraxial analgesia; it does not support the claim’s comparison with general anesthesia for cesarean delivery. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [43] Li, 2023, Medicine source
    • cites [44] Wu, 2018, Int J Obstet Anesth source
    • cites [45] Eckerdal, 2020, Anesth Analg source
    • cites [46] Almeida, 2020, BMC Womens Health source

      The Results (Postpartum depression) found no significant association between labor epidural analgesia and postpartum depression (OR 1.02, 95% CI 0.62–1.66). The Discussion says recipients were not less likely to develop postpartum depression, so the paper does not establish even a modest protective effect. It studies labor epidurals, not neuraxial anesthesia broadly or a comparison with general anesthesia for cesarean delivery. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Postpartum depression is related to factors including obstetric complications, psychosocial factors, hormonal changes, and physical health.

    “PPD is related to factors including obstetric complications, psychosocial factors, hormonal changes, and physical health.12,84”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [12] Xu, 2026, Front Public Health source

      The Abstract (Conclusions) identifies psychosocial, biological, and obstetric risk factors, while the Major outcomes section reports associations for birth complications, poor social support, and physical conditions including anemia and postpartum pain. It also reports associations for thyroid autoimmunity and polycystic ovary syndrome, but does not establish an association specifically with hormonal changes. No page numbers are provided in our copy. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [84] Yang, 2026, World J Psychiatry source

  • May combine two claims.

    Study design and conductcitation

    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”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [41] Hiltunen, 2004, Acta Obstet Gynecol Scand source
    • cites [42] Liu, 2019, Eur J Anaesthesiol source

      The Methods (Collection of perinatal data; Follow-up at 2 years after childbirth) assess depression at 6 weeks and again at 2 years, and the Results report different proportions at those times. The paper does not establish that assessments across studies begin within days postpartum or that differences in assessment timing cause variability in reported prevalence. Page numbers are unavailable in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the same study, 38.5% of mothers met the criteria for postpartum depression at six weeks.

    “EPDS is a universal screening method that showed that nearly 40% of these mothers had depressive symptoms two days following delivery, and 38.5% of these mothers met the criteria for PPD at six weeks.82”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [82] Ahmad, 2023, PLoS One source

  • May combine two claims.

    Interpretationcitation

    Delayed first skin-to-skin contact and delay in first breastfeeding attempt may contribute to the observed elevation in severe postpartum depression risk.

    “General anesthesia during cesarean delivery eliminates maternal participation in childbirth and is associated with delayed first skin-to-skin contact and delay in first breastfeeding attempt, which may contribute to the observed elevation in severe PPD risk.35”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [35] Guglielminotti, 2020, Anesth Analg source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Postpartum depression prevalence at two months postpartum was 16.7%.

    “PPD prevalence at two months postpartum was 16.7%.77”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Doncarli, 2025, J Clin Psychiatry source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Factors associated with an increased risk for postpartum depression are age 29 to 40, birth in North Africa, lower health literacy, history of psychological disorders, receiving little or no support during pregnancy, reporting feelings of sadness, and having an instrumental vaginal delivery.

    “Factors associated with an increased risk for PPD are an age of 29 to 40, birth in North Africa, a lower level of health literacy, having a history of psychological disorders, receiving little/no support during pregnancy, reporting feelings of sadness, and having an instrumental vaginal delivery.77”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Doncarli, 2025, J Clin Psychiatry source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In a study using the Japanese version of the Edinburgh Postnatal Depression Scale, the peak prevalence of depressive symptoms was at one month postpartum.

    “Another study examined PPD prevalence one, two, four, and six months postpartum by using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS), which showed that the peak prevalence of depressive symptoms was at one month postpartum.78”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [78] Iwata, 2016, J Affect Disord source

  • May combine two claims.

    Interpretationnone given

    Variability in assessment timing contributes to heterogeneity in reported postpartum depression prevalence and should be considered when interpreting associations with anesthesia exposure.

    “Additionally, variability in assessment timing contributes to heterogeneity in reported prevalence and should be considered when interpreting associations with anesthesia exposure.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Neuraxial anesthesia is considered the gold standard technique for cesarean delivery, and patient-reported pain is more common with general anesthesia compared with spinal or combined spinal-epidural anesthesia.

    “Neuraxial anesthesia is considered the gold standard technique for cesarean delivery, and patient-reported pain is more common with general anesthesia compared to spinal or combined spinal-epidural anesthesia.57”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Charles, 2025, Anesthesiology source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Postpartum depression is typically assessed using validated screening tools such as the Edinburgh Postnatal Depression Scale and Patient Health Questionnaire-9, with most studies evaluating symptoms between 4 weeks and 12 months postpartum.

    “PPD is typically assessed using validated screening tools such as the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9), with most studies evaluating symptoms between 4 weeks and 12 months postpartum.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In cesarean delivery, neuraxial anesthesia has largely replaced general anesthesia because of its favorable safety profile for mother and infant, reduced risk of aspiration, failed airway mask ventilation and endotracheal intubation, and lower rates of neonatal respiratory depression.

    “In cesarean delivery, neuraxial anesthesia has largely replaced general anesthesia because of its favorable safety profile for both mother and infant, reduced risk of aspiration, failed airway mask ventilation and endotracheal intubation, and lower rates of neonatal respiratory depression.8”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] LWW. Anesthesiology. Accessed December 19, 2025. https://journals.lww.com/anesthesiology/fulltext/2016/02000/practice_guidelines_for_obstetric_anesthesia__an.14.aspx.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Neuraxial anesthesia is the most effective form of intrapartum analgesia and is commonly used for labor and delivery.

    “Neuraxial anesthesia is the most effective form of intrapartum analgesia and is commonly used for labor and delivery.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Smith, 2021, Am Fam Physician

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    As a narrative review, a formal systematic quality assessment was not performed; however, emphasis was placed on higher-quality evidence, including large cohort studies and meta-analyses.

    “As this is a narrative review, a formal systematic quality assessment was not performed; however, emphasis was placed on higher-quality evidence, including large cohort studies and meta-analyses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Severe or inadequately controlled pain during childbirth can increase maternal stress, elevate circulating stress hormones, and negatively influence the perception of the birth experience.

    “Severe or inadequately controlled pain during childbirth can increase maternal stress, elevate circulating stress hormones, and negatively influence the perception of the birth experience.15”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] Mo, 2022, J Affect Disord source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Labor pain is among the most intense forms of pain experienced in a woman's life and can produce significant physiological and psychological stress.

    “Labor pain is among the most intense forms of pain experienced in a woman’s life and can produce significant physiological and psychological stress.3,4”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [3] Neumark, 1985, Acta Anaesthesiol Scand source
    • cites [4] Kwok, 2015, Trends Anaesth Crit Care source

  • May combine two claims.

    Premisecitation

    ACOG notes that "baby blues" typically begin around 3 days after childbirth and usually resolve within 1-2 weeks, so studies screening very early postpartum are not measuring the same construct as studies assessing women at 6 weeks, 3 months, or 6-12 months postpartum.

    “ACOG notes that “baby blues” typically begin around 3 days after childbirth and usually resolve within 1–2 weeks, so studies screening very early postpartum are not measuring the same construct as studies assessing women at 6 weeks, 3 months, or 6–12 months postpartum.74”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] 2026

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Effective pain relief through neuraxial anesthesia may reduce physiological stress responses and improve maternal satisfaction.

    “Conversely, effective pain relief through neuraxial anesthesia may reduce physiological stress responses and improve maternal satisfaction.15,16”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Mo, 2022, J Affect Disord source
    • cites [16] Wang, 2022, J Affect Disord source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    Different postpartum depression assessment tools are not interchangeable.

    “These different assessment tools are not interchangeable.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Primiparity, education, and prior psychological diagnosis are factors associated with postpartum psychopathology.

    “Additional factors such as primiparity, education, and prior psychological diagnosis should be considered to guide preventive efforts against postpartum psychopathology.83”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [83] Handelzalts, 2022, J Psychosom Obstet Gynaecol source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Epidural anesthesia is the gold standard for pain management during labor.

    “Epidural anesthesia is the gold standard for pain management during labor.81”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] Anim-Somuah, 2018, Cochrane Database Syst Rev source

  • May combine two claims.

    Interpretationreasoning

    These findings highlight the burden of early-onset postpartum depression in specific cohorts, despite overall improvements in population trends.

    “These findings highlight the burden of early-onset PPD in specific cohorts, despite overall improvements in population trends.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    These differences can alter measured prevalence and reduce the validity of direct pooled comparisons.

    “Together, these differences can alter measured prevalence and reduce the validity of direct pooled comparisons.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Neuraxial anesthesia is a facilitating component of comprehensive perinatal care, capable of modifying, but not determining, postpartum depression risk.

    “Neuraxial anesthesia should therefore be understood as a facilitating component of comprehensive perinatal care, capable of modifying, but not determining, PPD risk.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Prolonged second-stage births and postpartum fatigue are associated with increased risk of postpartum psychopathology.

    “Special attention should also be devoted to women who experience prolonged second-stage births and/or suffer from postpartum fatigue, as both are associated with increased risk of postpartum psychopathology.83”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [83] Handelzalts, 2022, J Psychosom Obstet Gynaecol source

  • May combine two claims.

    Premisecitation

    Local anesthesia provides targeted procedural pain control but is not commonly used to manage the visceral pain associated with labor.

    “Local anesthesia provides targeted procedural pain control but is not commonly used to manage the visceral pain associated with labor.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [30] Colacioppo, 2009, Midwifery source
    • cites [31] Schinkel, 2010, Int J Obstet Anesth source
    • cites [32] Cardaillac, 2024, BJOG source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The potential differential effects of specific anesthetic agents, including local anesthetics and opioids, on neurobiological pathways involved in mood regulation are not well characterized.

    “Additionally, the potential differential effects of specific anesthetic agents, including local anesthetics and opioids, on neurobiological pathways involved in mood regulation are not well characterized and warrant further investigation.”
    Quote in the paperSubstantial claim
44 of 44

  • The paper relies on this without support.

    The relationship between anesthetic technique and postpartum depression is subject to significant confounding by preexisting psychiatric history, severity of labor pain, and delivery characteristics such as emergency versus elective cesarean section.

    “Importantly, the relationship between anesthetic technique and postpartum depression is subject to significant confounding, including preexisting psychiatric history, severity of labor pain, and delivery characteristics such as emergency versus elective cesarean section.”
1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. Smith, 2021, Am Fam Physician, 103, 355
  2. LWW. Anesthesiology. Accessed December 19, 2025. https://journals.lww.com/anesthesiology/fulltext/2016/02000/practice_guidelines_for_obstetric_anesthesia__an.14.aspx.
  3. Msdmanuals. Analgesia and Anesthesia for Labor and Delivery - Gynecology and Obstetrics. MSD Manual Professional Edition. Available from: https://www.msdmanuals.com/professional/gynecology-and-obstetrics/labor-and-delivery/analgesia-and-anesthesia-for-labor-and-delivery. Accessed December 2, 2025.
  4. 2025, StatPearls
  5. Canser, 2006, Rev Esp Anestesiol Reanim, 53, 82
  6. 2026, StatPearls
  7. Anim-Somuah, 2018, Cochrane Database Syst Rev, 5, CD000331, 10.1002/14651858.cd000331.pub4 · DOI · Paper page

Cited by

Still being checked.

Related

Authors
Fagan, J., Dufour, S., Duet, S., Downs, E., Siddaiah, H., Viswanath, O., Shekoohi, S., & Kaye, A.
Affiliations
  • Louisiana State University (US)
  • Creighton University (US)
Corresponding author
Shekoohi, Sahar
ORCID
Venue
Neuropsychiatric Disease and Treatment
Publisher
Informa UK Limited
Published
2026-04
Volume
Volume 22
Pages
1-12
ISSN
  • 1176-6328 (ISSN-L)
  • 1178-2021
DOI
10.2147/ndt.s579920
PMC
PMC13092565
OpenAlex
W7154182177
Cited by
0
References
78
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
Locations
  • Neuropsychiatric Disease and Treatment (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
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, neuraxial anesthesia, epidural analgesia, spinal anesthesia, combined spinal-epidural anesthesia, dural puncture epidural, cesarean section, vaginal delivery, labor pain, general anesthesia, maternal mental health, perinatal care

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-11-03.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-11-03.

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