Abstract
BackgroundPostpartum depression is one of the most commonly experienced psychological disorders for women after childbirth, usually occurring within one year. This study aimed to clarify whether women with delivery with anesthesia, including epidural analgesia, spinal-epidural analgesia, and paracervical block, had a decreased risk of postpartum depression after giving birth in Japan.MethodsThe Japan Environment and Children’s Study (JECS) was a prospective cohort study that enrolled registered fetal records (n = 104,065) in 15 regions nationwide in Japan. Binomial logistic regression analyses were performed to calculate the adjusted odd ratios (aORs) for the association between mode of delivery with or without anesthesia and postpartum depression at one-, six- and twelve-months after childbirth.ResultsAt six months after childbirth, vaginal delivery with anesthesia was associated with a higher risk of postpartum depression (aOR: 1.233, 95% confidence interval: 1.079–1.409), compared with vaginal delivery without analgesia. Nevertheless, the risk dropped off one year after delivery. Among the pregnant women who requested delivery with anesthesia, 5.1% had a positive Kessler-6 scale (K6) score for depression before the first trimester (p < 0.001), which was significantly higher than the proportions in the vaginal delivery without analgesia (3.5%).ConclusionsOur data suggested that the risk of postpartum depression at six months after childbirth tended to be increased after vaginal delivery with anesthesia, compared with vaginal delivery without analgesia. Requests for delivery with anesthesia continue to be relatively uncommon in Japan, and women who make such requests might be more likely to experience postpartum depressive symptoms because of underlying maternal environmental statuses.
Highlights
Postpartum depression is one of the most commonly experienced psychological disorders for women after childbirth, usually occurring within one year
Among the 80,419 pregnancies with vaginal deliveries who were included in the analysis, vaginal delivery without anesthesia occurred in 97.1% (n = 78,082) and vaginal delivery with anesthesia in 2.9% (2,337)
As for the outcomes, a significant difference in the incidence of postpartum depressive symptoms at one month after delivery was observed according to the mode of delivery
Summary
Postpartum depression is one of the most commonly experienced psychological disorders for women after childbirth, usually occurring within one year. This study aimed to clarify whether women with delivery with anes‐ thesia, including epidural analgesia, spinal-epidural analgesia, and paracervical block, had a decreased risk of postpar‐ tum depression after giving birth in Japan. Epidural anesthesia during delivery is the most common and widely accepted method of pain relief during labor [1,2,3]. Since a common maternal myth in Japan is that labor pains are conducive to forming a strong maternal instinct [5], we assumed that this belief might be one of the reasons why delivery with anesthesia is uncommon in Japan, compared with other countries. Even in healthy mothers, suppressing hyperventilation arising from pain and suppressing the deterioration in blood flow to the placenta as a result of the release of stress hormones are possible merits of epidural delivery. Analgesia and the accompanying reduction in childbirth stress might be beneficial to mothers with chronic diseases, such as cardiovascular disease
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