Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression

Abstract

Cesarean delivery rates continue to increase, and surgery is associated with chronic pain, often co-existing with depression. Also, acute pain in the days after surgery is a strong predictor of chronic pain. Here we tested if mode of delivery or acute pain played a role in persistent pain and depression after childbirth. In this multicenter, prospective, longitudinal cohort study, 1288 women hospitalized for cesarean or vaginal delivery were enrolled. Data were obtained from patient interviews and medical record review within 36 h postpartum, then via telephone interviews 8 weeks later to assess persistent pain and postpartum depressive symptoms. The impact of delivery mode on acute postpartum pain, persistent pain and depressive symptoms and their interrelationships was assessed using regression analysis with propensity adjustment. The prevalence of severe acute pain within 36 h postpartum was 10.9%, while persistent pain and depression at 8 weeks postpartum were 9.8% and 11.2%, respectively. Severity of acute postpartum pain, but not mode of delivery, was independently related to the risk of persistent postpartum pain and depression. Women with severe acute postpartum pain had a 2.5-fold increased risk of persistent pain and a 3.0-fold increased risk of postpartum depression compared to those with mild postpartum pain. In summary, cesarean delivery does not increase the risk of persistent pain and postpartum depression. In contrast, the severity of the acute pain response to childbirth predicts persistent morbidity, suggesting the need to more carefully address pain treatment in the days following childbirth.

Figure 1

Patient Flow Chart

Figure 2

Distribution of numerical rating score (NRS) of average pain for the first 24 hr after vaginal and cesarean delivery.

Figure 3. Interrelationships among delivery variables (mode of delivery and acute postpartum pain) and the 8 week outcomes (persistent pain and depression scores)

After controlling for propensity to deliver via a Cesarean delivery (not depicted), every point increase in acute pain after delivery was associated with an 8.3% increase in 8-week depressive symptoms and a 12.7% increase in the odds of experiencing pain at 8 weeks. The two 8-week outcomes were highly correlated (p < 0.0001). Giving birth via cesarean delivery was not associated with either outcome (p > 0.34).