Epidurals may reduce the risk of postpartum depression


The mainstream media has been reporting on a new study that shows that epidurals may decrease the risk of postpartum depression.

According to CBS News:

New research published in the journal Anesthesia & Analgesia found that women with acute pain during birth had a 2.5-fold increased risk for chronic pain as a new mother and a 3 times greater risk for postpartum depression…

Research suggests managing a woman’s pain during childbirth is critical to helping her gain footing as a new mother. Less pain during childbirth is associated with shorter post-labor recovery time, which enables a mother to bond, care for and nurse her baby much more effectively.

The study, Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study, appears in the August issue of Anesthesia and Analgesia. The study has some significant limitations including small sample size and different cultural expectations of the participants. Moreover, as we know, correlation does not prove causation.

Nonetheless, this is not the first study that has raised the possibility that epidurals decrease the risk of postpartum depression and/or PTSD. It’s not difficult to imagine a method of action.

First, there is a known connection between pain and depression.

Second, trauma can lead to depression.

Third, as Dr JaneMaree Maher of the Centre for Women’s Studies & Gender Research at Monash University in Australia notes in her article The painful truth about childbirth: contemporary discourses of Caesareans, risk and the realities of pain:

… Pain will potentially push birthing women into a non-rational space where we become other; ‘screaming, yelling, self-centered and demanding drugs’. The fear being articulated is two-fold; that birth will hurt a lot and that birth will somehow undo us as subjects. I consider this fear of pain and loss of subjectivity are vitally important factors in the discussions about risks, choices and decisions that subtend … reproductive debates, but they are little acknowledged. This is due, in part, to our inability to understand and talk about pain.

As she explains:

… [W]hen we are in pain, we are not selves who can approximate rationality and control; we are other and untidy and fragmented. When women give birth, they are physically distant from the sense of control over the body that Western discourses of selfhood make central …

So epidurals, as the most effective form of pain relief, give women control over their own bodies and control over the way in which they behave. This allows women to represent themselves to others in the ways in which they wish to be seen, instead of pushing them into a “non-rational” space.

In other words, the excruciating pain of labor is traumatic, not simply because of the agony, but because being in agony makes it almost impossible to advocate for oneself, to make important decisions, and to exert control over your care.

Imagine if labor were painless, or nearly so. Would it be as traumatic? Would it render women unable to advocate for themselves or exert control over their care? Of course not. A woman who is not in excruciating pain can have reasoned discussions with her providers about her preferences, which is particularly important if an unanticipated complication arises.

Natural childbirth advocates are not entirely wrong in pointing out that a lack of supportive care and a lack of feeling in control contribute to birth trauma and PTSD, but they are looking at downstream effects of the real problem, pain. The support is needed to cope with the pain; the feeling of not being in control is because of the pain.

Natural childbirth advocates may actually be promoting psychological complications of childbirth. By insisting that relieving labor pain is a moral weakness and a danger to the baby (both of which are completely untrue), they encourage women to forgo relief of the excruciating pain and increase the risk that women may develop long term psychological sequelae like postpartum depression and PTSD.

How ironic! I can’t wait to see how natural childbirth advocates are going to spin this one.