Epidural Increases Risks of PND and Breastfeeding Troubles, Study Finds

Epidural Increases Risks of PND and Breastfeeding Troubles, Study Finds

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.

The study was published by leading experts in their fields, including world renown Kathleen Kendall-Tackett, PhD, IBCLC, FAPA and Thomas W. Hale, PhD, along with Zhen Cong, PhD.

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.

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CONTRIBUTOR

Maria Silver Pyanov is the mom of four energetic boys, a doula, and a childbirth educator. She is an advocate for birth options, and adequate prenatal care and support. She believes in the importance of rebuilding the village so no parent feels unsupported.


5 comments

  1. I can agree with the study findings, though I never thought there was a connection. With both of my children I had an epidural. Both times I could only breastfeed for about a month and had mild depression. After reading this I think I will research alternative pain management methods for future children.

  2. Unfortunately there are major methodological issues related to the study design. Based on the univariate analyses, women with epidurals had a PHQ-2 score which was 0.16 points higher than those without epidurals, which was even smaller (in the multivariate analysis). The timing of PHQ-2 scoring was not standardized. No information is given of how these scores were collected. No statistical information is provided on model fit or calibration,presence of outliers, or the distribution of the residuals. There are also major issues with residual confounding as the multivariate analyses failed to account for other factors that may have also influenced the association between mode of labor analgesia and PHQ-2 scoring. The authors provide no biological justification to substantiate their study hypothesis. Lastly, PHQ-2 scores are used to screen for depression and not for depression diagnosis. Due to the major statistical and methodological concerns, the quality of this study data is questionable at best. In view of these issues, I strongly disagree with this being a ‘credible’ study. However, it seems that data from this study may be being used to mislead readers. I am concerned that the authors may use these study data to substantiate their prejudices against epidural analgesia. I hope that Renee reconsiders future pain relief options and wont take these study findings to heart.

  3. Alex raises a number of methodological concerns that I would like to address. But before that, i’d like to re-emphasize the our study was exploratory. We would not consider it to be the final word on this topic. Our major strength was our very large, diverse sample. Most of the studies on this topic have had very small samples. We also collected data on a lot of the other factors that increase the risk for depression and we’re able to control for those. We didn’t have any a priori. hypotheses. As for prejudice, we didn’thave that either. Two of us have had epidurals. If we were dead set against them that wouldn’t be true.
    The first issue i’d like address is the PHQ2. Alex correctly notes that the PHQ-2 is a screening tool, It’s a measure of depressive symptoms, and should not be used to diagnose depression. That is why we were careful to only call these depressive symptoms, not major depression. But as previous studies found, the PHQ is a good measure and is predictive of depression.
    Second is biological mechanism. We weren’t in a position to measure that directly but there are a couple of possibilities. One is a central nervous system effect. A related mechanism is the suppression of oxytocin. Kirsten Uvnas-Moberg, oxytocin researcher extraordinaire, has found that epidurals suppress oxytocin. It’s particularly bad when there is no labor. In that case, even skin to skin produces no surge in oxytocin. If oxytocin is suppressed the inflammatory response system is upregulated, which increases risk of depression. I told Kirsten about our findings and she thought they were quite consistent with her work
    Third, our information was collected as part of a larger study on maternal infant sleep. The data are cross sectional, so it is just a snapshot. There are limits to this type of data, but for the type of exploratory study we were doing, it’s really quite acceptible. We realize that it is not perfect so we’re careful with our language. Also, our second author is a statistician. I’m confident in her judgment.
    I’m happy to discuss this further. I’d also refer people to my Uppitysciencechick.com site, which has a lot of articles about the biological mechanisms that can explain our findings. My email is [email protected]

    1. Kathy I would like to ask, who chose the image for this article. I have an interest in the use of re-triggering images in general, and specifically for articles around birth trauma. Why do we do this?
      To me it suggests an incomplete understanding of what traumatised women need. I would be interested to hear your views

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