Pain after delivery linked to childbirth depression

Even though babies bring so much joy to mothers and families, many women — especially first-time mothers — are apprehensive about the delivery process due to the pain that accompanies it.

Indeed, many studies have linked the pain to postpartum depression, which is a mental condition that affects women after they give birth, leading to low moods and feelings of hopelessness.

But a new research conducted by Harvard University researchers shows that the depression is mainly aggravated by pain that mothers experience after delivery rather than during labour or the delivery process.

Previous studies have demonstrated that pain associated with giving birth may increase the risk of postpartum depression.

However, none has specified which part of the labour process (before, during or after delivery) may be the source of the problem.

This new research, which was presented at the recently concluded 2018 Anaesthesiology annual meeting at San Francisco in the US, is the first study to differentiate after-birth pain from labour or delivery pain, and identify it as a significant risk factor for postpartum depression.

"For many years, we have been concerned about how to manage labour pain, but recovery pain after labour and delivery is often overlooked," said Dr Jie Zhou, lead author of the study and assistant professor of anaesthesia at Harvard Medical School.

"Our research suggests that we need to focus more on helping new mothers manage pain after the baby is born."

In the study, Dr Zhou's research group reviewed pain scores (from the start of labour to hospital discharge) for 4,327 first-time mothers delivering a single child vaginally or by caesarean delivery (C-section) at Brigham and Women's Hospital between 2015 and 2017.

They compared the pain scores to the mothers' Edinburgh Postnatal depression Scale (EPDS) scores one week after delivery.

The scale is a psychological tool used to gauge depression levels in people.

Results showed that postpartum depression was significantly associated with higher after-birth pain scores.

Mothers with postpartum depression demonstrated more pain related complaints during recovery and often needed additional pain medication.

A majority of those affected were women who had delivered by C-section. They also had more reports of inadequate after-birth pain control.

"While ibuprofen and similar pain medications are considered adequate for pain control after childbirth, clearly some women need additional help in managing pain," said Dr Zhou.

"We need to do a better job identifying who is at risk of after-birth pain and ensure they have adequate care."

Nelly Bosire, a Nairobi based consultant gynaecologist, notes that due to misconceptions about pain management among different medical professionals, sometimes patients end up not getting the right care after delivery.

Most effective pain management drugs are narcotics, which most health practitioners perceive as addictive. As a result of such reservations, doctors may fail to give these pain relief drugs to women who have undergone so much pain after a C-section surgery. This can then contribute to postpartum depression.

“The mother will go home and struggle with pain which will increase her risk of having the depression,” Dr Bosire states.

The Ministry of Health has been training health professionals in the appropriate use of pain relief narcotic drugs (opioids) to help manage severe pain among those that have undergone surgeries and other critical medical procedures.

People interpret pain in different ways, as the feelings are largely subjective. Therefore, clinicians may, at times, underestimate the pain patients are going through or assume that they are exaggerating their experiences, hence failing to offer those affected the required care to ease their discomfort.

According to Dr Bosire, effective management of after-birth pain does not only involve medicine.

“Sometimes mothers need to have someone to hold their hand or support them as they walk. Others will need physiotherapy for pain management and quick recovery. But most people don't know this. All these services should be made accessible to women in need of them.”

She notes that during the initial stages, both the doctor and mother might easily miss postpartum depression.

“Doctors only see the mother for a short time, mainly during her clinic appointments. And not unless the mother is aware and mentions it, the doctor will not be able to detect the condition early enough and offer timely care.”

When depression sets in, says Dr Bosire, the affected mother may not even know it.

“People keep saying that motherhood is tough. So she may assume that the constant low moods and spirits are nothing to worry about. That’s why we need to create awareness about postpartum depression so mothers or their families can detect the symptoms early enough.”

Symptoms of postpartum depression include extreme sadness, low energy, anxiety, crying episodes, irritability and changes in sleep or eating patterns.