According to a new, credible study, having an epidural during childbirth can increase a woman's risk of postnatal depression and breastfeeding difficulties.
Birth is a normal physiological event, and anytime we deviate from normal and intervene, we run the risk of complications.
When women give birth in an environment conducive to following their instincts, with a provider supportive of physiological birth, we see less interventions, and therefore less complications.
Of course, even the most natural of bodily functions occasionally require intervention and in those cases the benefits clearly outweighs the risks – but that is an exception and not the rule.
Birth is also an emotionally charged event. We want to know we are making the best and safest choices for ourselves and for our babies.
When we hear about risks it can make us uneasy and question our past choices.
But studies aren't emotional, and nor are they personal. They are done to provide us with factual information to help us weigh up the benefits and risks of our future choices.
They also help us prepare for possible side effects when we decide the benefit of an intervention outweighs the risks.
What Did The Study Find?
The study, including 6,410 mothers from 59 countries, found an increase in postnatal depression and a decrease in exclusive breastfeeding rates among mothers that gave birth with an epidural.
Researchers also took into consideration other factors that might increase a woman's risk of PND, including a history of depression, sexual assault, socioeconomic status and more. It also found that women who perceived their birth as long and painful, and who experienced postnatal complications, were at an increased risk of postnatal depression.
Why Do These Findings Contradict Other Research?
This study contradicts other research that found no correlation between birth interventions and postnatal depression and breastfeeding rates. The reason for this is the previous studies did not include enough women to control for other risk factors for PND and breastfeeding duration.
This study is the first one of its size to look at epidural use and postnatal complications, and to be able to properly control for other risk factors. Even after controlling for these risk factors, there was a statistically significant increase in postnatal depression, and a decrease in exclusive breastfeeding rates associated with epidural use.
Doctor Thomas Hale is the Professor of Pediatrics at Texas Tech University School of Medicine and is the Executive Director of the InfantRisk Center and Associate Dean of Research. Doctor Hale is considered one of the foremost leading experts in the field of perinatal pharmacology and the use of medications.
Does This Mean Women Should Not Use Epidurals?
Every birth is unique. Each woman's needs and each baby's needs will vary.
This study doesn't mean epidurals should never be used, it means we have better understanding of their impact and can make fully informed decisions.
Dr. Kendall-Tacket explains, “The significance of our study is that even after we controlled for all these other factors, epidurals still increased risk for depression. For an individual mother, having an epidural can be the right choice. But we should not assume that that choice has no consequence. It does. We should be sure to monitor mothers who have epidurals for signs of either breastfeeding difficulties or depressive symptoms.”
What Does This Study Mean For Mothers?
As an individual, this study can help you weigh the benefits and risks of epidural use. You might decide to learn more about natural comfort measures for labour. You might decide to use a maternity care provider more familiar with facilitating normal physiological birth.
If you choose to use an epidural, or it becomes necessary (e.g. during a c-section birth) this study can help you prepare for possible side effects. If you experience lactation difficulties you will known to contact a lactation professional, such as an IBCLC lactation consultant. You can learn about the symptoms of PND and reach out to your provider immediately if you notice any of these symptoms.
If you have a history of depression, it might be even more important to you to try a physiological birth free of interventions. If you experienced lactation difficulties or PND following a previous epidural birth, you might decide to learn more about giving birth without an epidural.
What Does This Study Mean For Maternity Care Providers?
For your maternity care providers this study provides a resource for offering fully informed consent. It can be used to help birthing women weigh the benefits and risks of epidural use. It also educates maternity care providers about the importance of adequate PND screening for all women but especially those using epidurals, and the importance of proper lactation support.
This study reinforces that we cannot interfere with natural processes without consequences. It reminds us that our bodies were designed to give birth in a way that supports the natural progression from pregnancy to lactation and facilitates mental wellness for mothers.
There will always be exceptions to the rule, there will be times the benefits of interventions outweigh the risks. It's important to remember that a risk isn't a guarantee. It means that doing something increases the likelihood of a complication. However, knowing these risks are important because the possibility of experiencing them is real and as birthing women we have the right to make fully informed choices.