Are labor pain and birth experience associated with persistent pain and postpartum depression? A longitudinal cohort study
Abstract Background: Managing labor pain and early postpartum pain has been linked to a reduced risk for postpartum depression and pain. However, the role of labor pain and the overall birth experience in the development of postpartum depression and persistent pain still remains unclear. Methods: The study sample (n=2217) was drawn from the Akershus Birth Cohort, which targeted all pregnant women scheduled to give birth at Akershus University Hospital in Norway between 2008-2010. Data from the hospital’s birth record as well as questionnaire data from gestational week 17 of pregnancy and eight weeks postpartum were used. An additional questionnaire about labor pain and birth experience was answered by 1 244 women within 48 hours after delivery. The Edinburgh Postnatal Depression Scale was used to measure postpartum depression, a single question was used to measure persistent pain eight weeks postpartum, while pain and birth experience were measured by numeric rating scales within 48 hours after delivery. Results: The results showed that neither labor pain nor birth experience were associated with persistent pain eight weeks postpartum, whereas pain before pregnancy (OR 3.70; 95% CI 2.71-5.04) and a history of depression (OR 2.31; 95% CI 1.85-2.88) were statistically significant predictors of persistent pain. A negative birth experience was significantly (OR 1.16; 95% CI 1.04-1.29) associated with postpartum depression, whereas labor pain intensity was not. Again, a history of depression (OR 3.95; 95% CI 2.92-5.34) and pre-pregnancy pain (OR 2.03; 95% CI 1.37-3.01) were important predictors of postpartum depression eight weeks after delivery. Discussion: Whilst the relationship between labor pain intensity and postpartum pain and depression remain unclear, our results do imply the need to screen for previous depression and chronic pain conditions in pregnant women, as well as consider preventive measures in those who screen positive.