Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

Association of postpartum depression and epidural analgesia in women during labor: an observational study

Associação entre depressão pós-parto e analgesia peridural em mulheres durante o trabalho de parto: um estudo observacional

Ipek Saadet Edipoglu, Duygu Demiroz Aslan

Downloads: 0
Views: 746


Background and objectives
Postpartum depression affects women, manifesting with depressed mood, insomnia, psychomotor retardation, and suicidal thoughts. Our study examined if there is an association between epidural analgesia use and postpartum depression.

Patients were divided into two groups. One group received epidural analgesia during labor while the second group did not. The Edinburgh postnatal depression scale (EPDS) was administered to patients prior to birth and 6 weeks postpartum. Pain severity was assessed by the Visual Analogue Scale (VAS) during labor and at 24 hours postpartum.

Of the 92 patients analyzed, 47.8% (n = 44) received epidural analgesia. We detected significantly higher VAS score during labor (p =  0.007) and 24 hours postpartum (p = 0.0001) in the group without epidural analgesia. At 6 weeks postpartum, a significant difference was observed between the EPDS scores of both groups (p =  0.0001). Regression analysis revealed higher depression scores in patients experiencing higher levels of pain during labor (OR = 0.572, p =  0.039). Epidural analgesia strongly correlated with lower scores of depression (OR = 0.29, p =  0.0001).

The group that received epidural analgesia had lower pain scores. A high correlation between epidural analgesia and lower depression levels was found. Pregnant women giving birth via the vaginal route and having high pain scores could reduce postnatal depression scores using epidural labor analgesia. Pregnant women should opt for epidural analgesia during labor to lessen postpartum depression levels.


Postpartum depression;  Edinburgh postnatal depression scale;  Epidural analgesia;  Visual Analogue Scale;  Vaginal birth


1 World Health Organization Monitoring Emergency Obstetric Care: A Handbook WHO Press, Geneva, Switzerland (2009) WHO

2 H. Bayrampour, C. Salmon, A. Vinturache, et al. Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions J. Obstet Gynaecol Res., 41 (2015), pp. 1040-1048

3 American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (4th edition; text revision), American Psychiatric Press, Washington, DC (2000)

4 T. Ding, D.X. Wang, Y. Qu, et al. Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study Anesth Analg., 119 (2014), pp. 383-392

5 S. Orbach-Zinger, R. Landau, A.B. Harousch, et al. The Relationship Between Women’s Intention to Request a Labor Epidural Analgesia, Actually Delivering With Labor Epidural Analgesia, and Postpartum Depression at 6 Weeks: A Prospective Observational Study Anesth Analg., 126 (2018), pp. 1590-1597

6 G. Lim, L.M. Farrell, F.L. Facco, et al. Labor Analgesia as a Predictor for Reduced Postpartum Depression Scores: A Retrospective Observational Study Anesth Analg., 126 (2018), pp. 1598-1605

7 M. Anim-Somuah, R.M. Smyth, L. Jones Epidural versus non-epidural or no analgesia in labor Cochrane Database Syst Rev., 7 (2011), Article CD000331

8 V. Zanardo, L. Giliberti, F. Volpe, et al. Cohort study of the depression, anxiety, and anhedonia components of the Edinburgh Postnatal Depression Scale after delivery Int J Gynaecol Obstet., 137 (2017), pp. 277-281

9 S. Matthey, K. Souter, K. Mortimer, et al. Routine antenatal maternal screening for current mental health: evaluation of a change in the use of the Edinburgh Depression Scale in clinical practice Arch Womens Ment Health, 19 (2016), pp. 367-372

10 S. Aksu, F.G. Varol, N. Hotun Sahin Long-term postpartum health problems in Turkish women: prevalence and associations with self-rated health Contemporary Nurse., 53 (2017), pp. 167-181

11 M. Boudou, F. Teissèdre, V. Walburg, et al. Association between the intensity of childbirth pain and the intensity of postpartum blues Encephale., 33 (2007), pp. 805-810

12 J.C. Eisenach, P.H. Pan, R. Smiley, et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression Pain., 140 (2008), pp. 87-89

13 C.C. Dias, B. Figueiredo Breastfeeding and depression: a systematic review of the literature Affect Disord., 171 (2015), pp. 142-154

14 B. Figueiredo, C. Canário, T. Field Breast feeding is negatively affected by prenatal depression and reduces postpartum depression Psychol.Med., 43 (2014), pp. 1-10

15 T. Verbeek, C.L. Bockting, M.G. van Pampus, et al. Postpartum depression predicts offspring mental health problems in adolescence independently of parental lifetime psychopathology J Affect Disord., 136 (2012), pp. 948-954

16 P.L. Pugliese, G. Cinnella, P. Raimondo, et al. Implementation of epidural analgesia for labor: is the standard of effective analgesia reachable in all women? An audit of two years Eur Rev Med Pharmacol Sci., 17 (2013), pp. 1262-1268

17 I. Sikdar, S. Singh, R. Setlur, et al. A prospective review of the labor analgesia programme in a teaching hospital Med J Armed Forces India., 69 (2013), pp. 361-365

18 N. Sweed, N. Sabry, T. Azab, et al. Regional versus IV analgesics in labor Minerva Med., 102 (2011), pp. 353-361

19 H. El-Kerdawy, A. Farouk Labor analgesia in preeclampsia: remifentanil patient controlled intravenous analgesia versus epidural analgesia Middle East Journal of Anesthesiology., 20 (2010), pp. 539-545

20 B. Head, J. Owen, R. Vincent, et al. A randomized trial of intrapartum analgesia in women with severe preeclampsia Obstetrics & Gynecology., 99 (2002), pp. 452-457

21 D.R. Gambling, S.K. Sharma, S.M. Ramin, et al. A randomized study of combined spinal epidural analgesia versus intravenous meperidine during labor: impact on cesarean delivery rate Anesthesiology., 89 (1998), pp. 1336-1344

22 Q. Lian, X. Ye The effects of neuraxial analgesia of combination of ropivacaine and fentanyl on uterine contraction Anesthesiology., 109 (2008), p. A1332

23 J. Long, Y. Yue Patient controlled intravenous analgesia with tramadol for pain relief Chinese Medical Journal., 116 (2003), pp. 1752-1755

6036c670a953955aaa5fda23 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections