New research looks at how women fare after giving birth and their risk for postpartum depression.
Researchers have long known that childbirth pain can increase the risk of postpartum depression in women.
Up until now, though, research was predominantly focused on the pain women experienced during labor and delivery. But a new study suggests the pain that follows delivery may be an even bigger issue.
Pain experienced after childbirth, rather than during, may significantly contribute to postpartum depression, according to new research presented at the Anesthesiology 2018 annual meeting.
To measure the impact postpartum pain has on new mothers, researchers from Brigham and Women's Hospital in Boston studied pain scores for 4,327 women from the start of labor through delivery and to hospital discharge.
The participants were first-time mothers who were delivering a single child vaginally or through cesarean delivery, commonly known as a C-section.
The research team then compared the pain scores to the mothers’ Edinburgh postnatal depression scale scores one week after they gave birth.
Those who had higher postpartum pain scores were more likely to have postpartum depression. Those who experienced postpartum depression had more pain-related complaints during recovery and required more pain-relief medication.
Furthermore, women who had a cesarean delivery were more prone to postpartum depression and had more reports of inadequate pain control.
Researchers also determined that women who were overweight or had a history of depression or anxiety were more likely to develop postpartum depression, as were those whose babies were born smaller and had lower Apgar scores. This is a measurement system used to assess the health of newborns one and five minutes after birth.
It’s completely normal to experience some degree of "baby blues,” a mix of anxiety, loneliness, and lethargy new mothers commonly feel after giving birth. But if the negative feelings linger or worsen, it could very well be postpartum depression.
Affecting up to 1 in 7 women, postpartum depression is a very severe mood disorder that causes excessive irritability, feelings of guilt and worthlessness, disinterest in the baby, and difficulty concentrating, the American Psychological Association states.
If left untreated, postpartum depression can take quite the toll on both mom and baby.
“New mothers who struggle with depression often feel they are unworthy of being a mother because of feeling sad and disillusioned at a time when they are ‘supposed to feel’ elated, happy, and celebrating the birth of the baby,” Dr. Mayra Mendez, a licensed psychotherapist with Providence Saint John's Child and Family Development Center in Santa Monica, California, told Healthline.
Postpartum depression can lower rates of breastfeeding and interrupt bonding with the baby. Additionally, children whose mothers had postpartum depression are more likely to develop mental health issues later in life, such as ADHD and autism, previous research suggests.
According to Mendez, the attachment or bonding phase of an infant’s life is a critical period of development and social-emotional regulation. Postpartum depression can inhibit the mother’s ability to care for and nurture her baby, and, consequently, hinder the baby’s development during this time.
“The depression limits the mother’s ability to demonstrate reciprocity with her infant, and the back-and-forth patterns of interaction are disrupted and secure attachment compromised,” Mendez said.
Postpartum pain can be extremely debilitating for many women.
The length and severity of it varies from woman to woman. While some may experience cramps and constipation, others may have an agonizing cesarean recovery or vaginal soreness.
Because recovery pain can be quite severe and persistent for some, many health experts aren’t surprised that postpartum pain may have a major role in postpartum depression.
“Pain in the postpartum period can be more insidious, nagging, and occurs in the context of taking care of a newborn,” Dr. Daniel Kort, a reproductive endocrinologist with Neway Fertility, told Healthline.
“While the absolute amount of pain may be less than during labor and delivery, it makes sense having pain or generalized discomfort immediately following a delivery would put patients at higher risk for depression,” Kort added.
While previous research has measured the impact pain has on postpartum depression — regardless of when and how the woman experienced it — this is the first study to isolate postpartum pain as a significant risk factor of postpartum depression.
Looking forward, doctors need to focus more on screening who's at risk for postpartum pain and providing women with the necessary care after delivery.
While ibuprofen and similar pain medications have traditionally been used to treat women’s pain after childbirth, it’s clear that certain women need additional support managing their pain, the researchers said in a statement.
“This study clearly shows that in addition to the pain of labor and delivery, it is critical that healthcare providers properly evaluate and treat postpartum pain,” Kort said. “On a broader lever, it shows the potential benefits to limiting the amount of pain, such as trying to limit perineal tears and treating pain earlier and more aggressively.”
If doctors can get ahead of the pain, they may very well be able to step in and intervene before postpartum depression sets in.