Can having an epidural in labour reduce the risk of postnatal depression?

Research has found that women who receive an epidural in labour may be less likely to experience postnatal depression. The study, by Grace Lim of the University of Pittsburgh Medical Centre, looked at the medical records of 201 women who had an epidural and had their pain assessed on a 0 to 10 scale during labour.

They calculated the percentage improvement in pain (PIP) throughout labour after a woman had an epidural. The researchers then looked at depression risk using the Edinburgh Postnatal Depression Scale (EPDS) six weeks after birth. They found the higher the PIP scores, the lower the EPDS scores.

We have to be cautious about how we interpret the results. It was a small study, which hasn’t yet been published (the news story was based on a conference paper). We can’t be sure about the causal relationship. And we know that in France, where epidurals are common, PND rates are roughly the same as in the UK.

But it wouldn’t be completely surprising to find a causal relationship. One national 2014 survey found that only 63% of women received the pain relief they wanted during labour. Anecdotally, I’ve heard plenty of stories of women being denied epidurals on the grounds that it was too early in labour or too late, or that there was no anaesthetist available.

The truth is that for some women labour is agonizingly painful, and it would be strange if being left in extreme pain for hours didn’t have a psychological impact. Certainly some women with postnatal PTSD talk about the denial of pain relief as a contributing factor to their PTSD. One woman I spoke to for my book was told by her husband that during the hours of being denied an epidural, she threatened to throw herself out of the hospital window. (This is a memory that she had, perhaps fortunately, blocked out.)

Epidurals carry risks, so sometimes health professionals can be reluctant to let women have them when they ask for them. But not giving an asked-for epidural can also carry risks – something that is all too easily forgotten.

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