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The effect of prelabor analgesic plan and actual analgesia during labor on postpartum depression and breast feeding outcome
Abstract Number: T-61
Abstract Type: Original Research
Postpartum depression (PPD) is a common disorder with rates around 13%. A recent study showed epidural analgesia (EA) decreases PPD and increases breast feeding (BF) possibly due to decreased intrapartum pain.In this study we compared the patient’s preconceived plan for labor analgesia with her actual labor analgesia. We assessed how this comparison was associated with labor satisfaction, BF, and rates of PPD.
The study was conducted at a tertiary hospital. Women completing a vaginal delivery for a healthy singleton at > 37 weeks were included. On postpartum day 1 women were given a questionnaire detailing demographic data, prelabor medical history, initial desire for EA , final decision for EA, adequacy of pain relief and satisfaction with labor (verbal numeric score (VNS) 0-10). Women were divided into 4 groups:
1. Initially wanted EA and received EA
2. Initially wanted EA and did not receive EA
3. Initially did not want EA and did receive EA
4. Initially did not want EA and did not receive EA
On both postpartum day 3 and 6 weeks postpartum, the parturient was called and assessed for signs of PPD using Edinburgh Postpartum Depression scale. She was also asked if her baby breastfed and if she breast fed exclusively.
1189 women completed the study: 607 in Group 1, 153 in Group 2, 230 in Group 3 and 199 in group 4. There were significant differences in groups in age, gravidity, parity, and intention to BF (Table). Groups 1 and 3 had significantly higher vacuum rates than groups 2 and 4 (Table). Women in groups 2 and 4 had much higher average pain during labor than the other two groups but in spite of this Group 4 had the highest satisfaction with labor. At 3 days postpartum, Group 1 had a significantly higher proportion of women having PPD. Women in Group 1 also had a significantly less BF rate than the other 3 groups. At 6 weeks postpartum, Group 1 had a significantly lower and Group 4 a significantly higher incidence of BF than other groups but no difference in incidence of PPD.
Using a logistic regression analysis to determine who would develop PPD at 3 days, only parity (p=0.005, OR 0.82) and instrumental delivery (p=0.012, OR 2.03). At 6 weeks, only previous history of depression (p=0.013, OR 4.5) and instrumental delivery (p=0.01, OR 2.1) were determinants.
Conclusion:There was no obvious association between the severity of intrapartum pain (or the use of epidural analgesia) with either the incidence of PPD or BF rate. This study is limited by the use of 4groups and by inability of an observational study to identify causation. While data like these may be useful for generating hypotheses, the reader is cautioned against over interpretation of the data.