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

Leiv Arne Rosseland 1 , 2 , Silje Endresen Reme 3 , 4 , Tone Breines Simonsen 5 , 6 , Magne Thoresen 7 , Christopher Sivert Nielsen 4 , 8 , and Malin Eberhard Gran 2 , 5 , 9
  • 1 Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
  • 2 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • 3 Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
  • 4 Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
  • 5 Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
  • 6 Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
  • 7 Oslo Centre of Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway
  • 8 Department of Chronic Diseases and Ageing, National Institute of Public Health, Oslo, Norway
  • 9 Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
Leiv Arne Rosseland
  • Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
  • Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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, Silje Endresen Reme
  • Corresponding author
  • Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
  • Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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, Tone Breines Simonsen
  • Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
  • Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
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, Magne Thoresen
  • Oslo Centre of Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway
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, Christopher Sivert Nielsen
  • Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
  • Department of Chronic Diseases and Ageing, National Institute of Public Health, Oslo, Norway
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and Malin Eberhard Gran
  • Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
  • Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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  • degruyter.comGoogle Scholar

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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