Can having an epidural reduce your chance of developing postnatal depression?

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When Jenny* was pregnant with her first baby, she knew she didn't want an epidural.

She was scared about its risks, and also worried that having one would stop her ability to "feel the birth in its entirety".

But when she was in labour, Jenny realised she was unable to focus on anything but the pain.

"It took every ounce of my being just to get through it," she says.

She eventually asked for an epidural.

"Once it took effect, my first thought was, 'Why hadn't I done it sooner?'"

Jenny was both physically and mentally exhausted afterwards.

"I likened the feeling to being in a car crash, not to feeling like a woman who'd just given birth."

Jenny's baby had complications at birth and was transferred to the neonatal intensive care unit. And in the months that followed, Jenny started feeling disconnected from her husband and baby.


She became socially isolated and felt "empty". When her son was six months old, Jenny sought help and was diagnosed with postnatal depression (PND).

While she believes the pain of giving birth wasn't the reason she developed PND, she feels the discomfort and recovery afterwards may have contributed to it.

Now new research from the American Society of Anesthesiologists (ASA) suggests that women who had epidurals and less pain in labour had a reduced chance of developing postpartum depression (PPD).

The researchers came to this conclusion after reviewing the medical records of 201 women who used epidurals in labour.

The less pain a woman reported after having an epidural, the lower her depression score (as assessed six weeks later).

"Labour pain matters more than just for the birth experience," said lead investigator on the study, Dr Grace Lim. 

"We found that certain women who experience good pain relief from epidural analgesia are less likely to exhibit depressive symptoms in the postpartum period."

However, that doesn't mean that having an epidural will ensure you won't develop postnatal depression, notes Dr Lim.

"Postpartum depression can develop from a number of things, including hormonal changes, psychological adjustment to motherhood, social support, and a history of psychiatric disorders."

Nicole Highet, a doctor of clinical psychology who specialises in perinatal maternal health, is also the founder and executive director of COPE: Centre of Perinatal Excellence. She believes a woman's birth experience can contribute to PPD, but says it's actually "down the list" when it comes to predicting who will develop it.

She also notes that pain in labour is only one aspect of a birth experience.

As she says, you can have a "very painful" birth, but still consider it a positive birth experience.

She says that other factors that occur during the delivery - such as lack of support, feelings of lack of control and not feeling acknowledged - are "more likely to have [a] greater impact on emotional and mental health than the pain itself".

Louisa, another mum, agrees.

She says the pain of her second delivery was "excruciating" - yet, despite it, Louisa had "no psychological trauma at all".

If you had a painful birth, Dr Highet reassures there are lots of ways to help you recover emotionally.

She says it's key not to judge yourself, reminding that your birth experience is not a reflection on who you are. She also advises seeking support - both practical help with your baby, and an emotional shoulder to lean on.

Debriefing with hospital staff can help, too.

However, if you feel you're not coping or are worried you have PPD, see your GP.

And if you're worried you may harm yourself or your baby, call an ambulance immediately.

But, if your due date is looming and you're not sure what pain relief to choose, Dr Highet says you don't need to change your plans based on this study's findings. Be informed, but remember the ultimate decision about pain relief lies with you.

Two years after having her son, Jenny had her second baby. She opted for an epidural "as early as possible" that time, and had a much more fulfilling birth experience.

"I was coherent … [and] engaged in the experience, and my recovery time was minimal."

* Name has been changed