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Are labor pain and birth experience associated with persistent pain and postpartum depression? A Prospective Cohort Study

Rosseland, Leiv Arne; Reme, Silje Endresen; Simonsen, Tone Breines; Thoresen, Magne; Nielsen, Christopher Sivert; Eberhard Gran, Malin
Journal article; PublishedVersion; Peer reviewed
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Item resctricted until:2021-05-29
10-1515-sjpain-2020-0025.pdf (454.9Kb)
Year
2020
Permanent link
http://urn.nb.no/URN:NBN:no-81575

CRIStin
1813442

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Appears in the following Collection
  • Institutt for klinisk medisin [5635]
  • Psykologisk institutt [2924]
  • Institutt for medisinske basalfag [1415]
  • CRIStin høstingsarkiv [15978]
Original version
Scandinavian Journal of Pain. 2020, 20 (3), 591-602, DOI: https://doi.org/10.1515/sjpain-2020-0025
Abstract
Background and aims

A considerable research-literature focuses on pain during labor and associations with postpartum persistent pain and depression, with findings pointing in various directions. The aim of this study was to examine the role of labor pain and overall birth experience in the development of pain and depression 8 weeks after delivery.

Methods

The study sample was drawn from the Akershus Birth Cohort. Data from multiple sources were used, including the hospital’s birth record (n = 4,391), questionnaire data from gestational week 17 of pregnancy (n = 3,752), 8 weeks postpartum (n = 2,217), and two questions about pain and birth experience asked within 48 h after delivery (n = 1,221). The Edinburgh Postnatal Depression Scale was used to measure postpartum depression, a single question was used to measure persistent pain 8 weeks postpartum, while pain and birth experience were measured by numeric rating scales. A history of pre-pregnant depression and chronic pain were measured through self-report questions in gestational week 17. A total of 645 women had complete data from all sources. We applied multiple imputation techniques to handle missing responses on the two questions about pain and birth experience.

Results

The results showed that neither labor pain nor birth experience were associated with persistent pain 8 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. 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 8 weeks after delivery.

Conclusions and implications

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.
 
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