Postpartum depression risk may be higher for new mothers who experience persistent pain after childbirth.
Symptoms of postpartum depression include increased crying, withdrawal from loved ones, and feelings of worry and guilt, primarily about hurting the baby or the ability to care for the child.
Stress, changes in hormone levels after childbirth, financial problems, having a child with special needs, and a family history of depression are some of the well-known risk factors for postpartum depression.
Now, researchers from Singapore suggest persistent pain following childbirth should be added to the list, after finding mothers who had pain for longer than 4 weeks after giving birth were more likely to develop postpartum depression.
Study co-author Wei Du, a medical student at Duke-NUS Medical School in Singapore, and colleagues came to their conclusion after an analysis of 200 healthy women, all of whom received pain relief through epidural during the delivery of their first child.
At 6-8 weeks after childbirth, the new mothers completed a telephone survey, in which they were asked whether they had been experiencing pain, and if so, for how long.
The Spielberger State Trait Anxiety Inventory (STAI) was also used to determine their anxiety status, and the presence of postpartum depression was evaluated using the Edinburgh Postnatal Depression Scale (EPDS).
Higher EPDS scores for women with persistent childbirth pain
Using statistical modeling, the researchers assessed whether childbirth pain might be associated with postpartum depression.
Of the 138 new mothers included in the final analysis, 5.8 percent had developed postpartum depression - determined by an EPDS score of 12 or more - at 4 weeks after giving birth or later.
Compared with women whose childbirth pain waned within 4 weeks of delivery and those who had no pain following childbirth, women whose childbirth pain persisted for longer than 4 weeks had much higher EPDS scores.
The EPDS score for women with persistent childbirth pain was an average of 2.44 points higher than that of women whose pain resolved by 4 weeks after delivery, and it was an average of 4.07 points higher than the score for women who never had postpartum childbirth pain.
New mothers who reported higher stress levels, greater pain vulnerability during labor or delivery, and greater anxiety at 6-8 weeks after childbirth also had higher EPDS scores, the researchers report.
Overall, Du and colleagues believe their findings suggest ongoing pain following childbirth - as well as stress, anxiety, and higher pain vulnerability - may raise the risk of postpartum depression.
"The research findings support the need to address pain comprehensively to lessen the risk of developing PND [postnatal depression], and a larger study is being conducted to evaluate the impact of pain and PND in pregnant women."