Mothers who experience pain while recovering from childbirth may be at risk of experiencing postnatal depression, according to a new study.
"For many years, we have been concerned about how to manage labour pain, but recovery pain after labour and delivery often is overlooked," said lead author Assistant Professor Jie Zhou. "Our research suggests we need to focus more on helping new mothers manage pain after the baby is born."
As part of the study, which was presented at the 2018 Anesthesiology annual meeting, Dr Zhou and his team examined the pain scores from 4,327 first-time mums, taken from the beginning of labour to being discharged from hospital. The mothers had delivered a single child either vaginally or via a caesarean section during 1 June 2015 and 31 December 2017 at Brigham and Women's Hospital. The researchers then compared the pain scores to mums' postnatal depression scores one week after delivery, measured by the Edinburgh postnatal depression scale (EPDS).
When they analysed the results, the team found that PND was associated with higher postpartum pain scores. Mums with PND had more pain-related complaints during their recovery and often needed more pain medication. They were more likely to have given birth via C-section and had more reports of inadequate pain control post bub.
PND was also higher among women who were overweight or obese; who suffered from a torn perineum; who had a history of depression, anxiety or chronic pain; and whose babies were small and had lower Apgar scores.
"While ibuprofen and similar pain medications are considered adequate for pain control after childbirth, clearly some women need additional help managing pain," Dr. Zhou. "We need to do a better job identifying who is at risk for postpartum pain and ensure they have adequate postpartum care."
It's important to note that the findings only show an association not a causal link between post-delivery pain and postnatal depression. The study also only looked at pain one week post discharge and didn't examine the impact of long-term pain on PND.
Despite these caveats, Dr Nicole Highet, Founder and Executive Director of the Centre of Perinatal Excellence, explains that pain experienced following birth is more likely to be enduring, "so it stands to reason that it may have a great impact on mental health status".
"In addition however, ongoing pain and the need for an unplanned C-section is also a constant reminder that birth may not have gone to plan, and these women may also be experiencing the psychological and emotional impacts of an unplanned or traumatic birth. When birth expectations are not met, we know that this can have a profound impact on a woman's emotional and mental health following the birth of their baby."
In Australia, more than 1 in 7 new mums experience postnatal depression each year.
Symptoms can include:
- Feeling low or numb – some people describe feeling nothing at all
- Lack of interest and/or pleasure in life, yourself and/or the baby
- No energy – finding it difficult to cope and get through the day (may also be attributed to lack of sleep)
- Loss of confidence, feeling helpless, hopeless and worthless
- Often feeling close to tears, highly sensitive to other's comments or emotional
- Feeling angry, irritable or resentful towards other mothers, the baby or your partner
- Changes in sleep – not being able to sleep even when you have the opportunity, or conversely, wanting to sleep all the time
- Changes in appetite – accompanied by weight loss or weight gain
- Difficulties concentrating, thinking clearly or making decisions (which could also result from lack of sleep)
- Feeling isolated, alone and disconnected from others
- Having thoughts of harming yourself, baby and/or other children.
If you need help urgently, please call Lifeline on 13 11 14.
You can also contact the PANDA Helpline on 1300 726 306, (Monday to Friday 9am - 7:30pm).