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Licensed Unlicensed Requires Authentication Published by De Gruyter May 29, 2020

Are labor pain and birth experience associated with persistent pain and postpartum depression? A prospective cohort study

Leiv Arne Rosseland, Silje Endresen Reme, Tone Breines Simonsen, Magne Thoresen, Christopher Sivert Nielsen and Malin Eberhard Gran

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.


*Corresponding author: Prof. Silje Endresen Reme, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway; and Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway

  1. Authors’ statements

  2. Research funding: While the original study was funded by the Norwegian Research Council (project number 191098), no funding was received for this particular study.

  3. Conflict of interest: The authors declare that they have no competing interests related to the work presented.

  4. Informed consent: Written informed consent was obtained from all participants, and all women invited to participate in the ABC study were informed that participation was voluntary.

  5. Ethical approval: The study was approved by Regional Committee for Ethics in Medical Research in Norway, approval number S-08013a. The study is performed and reported according to STROBE guidelines [24].

  6. Availability of data and material

  7. The dataset analysed during the current study is not publicly available due to data privacy restrictions and ethical restrictions established by the Norwegian Regional Committee for Ethics in Medical Research. Data are, however, available through application to the ABC study. All enquiries about access to data should be sent to the ABC steering group, attention: Nina.odegard@ahus.no. All requests to access personal data will be handled in accordance with the procedures by the Ethics Committee.

  8. Authors’ contributions

  9. All authors have read and approved the paper. The ABC study was designed by ME-G, while the current study was proposed by LAR and SER; TBS was responsible for the data collection in the ABC study, LAR and SER designed and put together the first draft, while MT and SER carried out the statistical analysis; all authors contributed towards writing and completing the manuscript and data interpretation.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/sjpain-2020-0025).


Received: 2020-02-07
Revised: 2020-04-17
Accepted: 2020-04-22
Published Online: 2020-05-29
Published in Print: 2020-07-28

©2020 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.