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The impact of labor and delivery on patients’ depression, post-traumatic stress ratings and pain preferences
Abstract Number: F-20
Abstract Type: Original Research
Introduction: Vaginal birth is one of the most painful and strenuous events women experience.1 The aim of this study was to assess the impact of labor and delivery on maternal depression, post-traumatic stress disorder (PTSD), and pain preferences. We hypothesized the birth experience will negatively impact psychological well-being and pain preferences.
Methods: Forty healthy parturients scheduled for induction of labor with term singleton pregnancies were enrolled in this IRB-approved, prospective cohort study. Subjects were asked to complete three questionnaires (Edinburgh Depression Scale, Primary Care PTSD Screen and Pain Preference Survey) prior to the onset of active labor and again within 24 hours post-delivery. The Pain Preference Survey developed by the investigators consisted of 6 questions with 2 options evaluating pain intensity versus duration (Table). All options presented the same overall pain burden (i.e. identical area-under-the curve pain score). Demographic, obstetric, and labor analgesic variables were recorded. Statistical tests were applied to assess scores and outcome measures (p<0.05 considered statistically significant).
Results: 37 of the 40 participants enrolled completed the questionnaires. The median (IQR) depression scores significantly decreased 4(2-6) to 3(1-5) from the pre-labor to the post-delivery evaluation (p=0.014). There were no significant changes in the pre- and post-delivery PTSD screen (p=0.317). No women were found to have depression scores ≥13 (a score that requires psychiatric evaluation). One woman had a positive PTSD screen. The pain preference survey results are outlined in the Table. Patients generally opted for lower pain intensity over a longer duration than higher pain intensity over a shorter duration, a preference even more pronounced post-delivery.
Discussion: Labor and delivery did not result in significant depression or PTSD. Although post-natal depression prevalences up to 14% has been reported,2 we did not identify any significant depression and depression scores actually improved post-delivery. Patients’ preference is for less pain intensity at the cost of longer duration. This appears to be reinforced post-delivery which suggests pain assessments, such as verbal pain scores that measure pain intensity (and not pain duration) may be appropriate.
1)Can Med Assoc J. 1984;130:579–584
2)Women Birth. 2006;19:11-6