Ellen Penchuk asks for comments on a study she found the abstract to.
(http://www.mdlinx.com/ObGynLinx/thearts.cfm?artid=855161&specid=5&ok=yes)
It is a study looking at EPDS scores for depression postnatally, dependent
on what kind of analgesia the woman had in labor.  The women seem to have
had either epidurals/paracervical blocks (I didn't know anyone was still
doing PCB's!) or acupuncture and nitrous oxide, or 'no pain relief'.  From
the names of the authors (Hiltunen, Raudaskoski, Ebeling and Moilanen) I am
guessing it was done in Finland.
The aim was 'to test the hypothesis that sufficient pain relief during
delivery decreases the risk of postnatal depression'.  I am guessing (again)
that by delivery they mean the first and second stages of labor, after any
latent phase is over.
Women with epidural or paracervical blocks had lower depressive scores on
the Edinburgh Postnatal Depression Scale than women with no pain relief.  I
noticed that the women in the epidural group also had shorter labors than
the others, which seems odd, since where I work the odds of getting an
epidural increase proportionally with the length of labor.  We tend to
recommend them when the woman has been at it a long time, is getting worn
out, progressing slowly, and needs some respite so she will have some energy
left to enjoy her baby afterwards.  Our epidural rate is low by US
standards, around 15%.  The women with the fastest labors have no chance of
getting an epidural in our hospital because we have about a 20 minute wait
for an anesthesiologist if it's just for analgesia for a normal labor, and
by then they are practically pushing.  (We can do crash CS in less than 5
minutes, including running up a 100 yard ramp between labor ward and OR,
pushing a bed with the woman in it!)
The thing that stands out for me is that the abstract doesn't mention
whether there was any difference in depressive scores between the
acupuncture/nitrous group and either of the other groups, suggesting that
any difference was so small as to be statistically not significant.  There
was no difference between any of the groups at 4 months either.
Other researchers have found that when women feel respected, the most
horrible labors seem all right in retrospect, and when they feel trampled
upon, it doesn't matter if they grunted once and dropped the baby without a
tear, they will remember the experience as bad.  I wonder whether
'sufficient pain relief' as judged by the laboring woman, is a marker for
being respected, and it wouldn't surprise me to learn they felt less
depressed than women who felt they hadn't gotten what they needed.
PPD and breastfeeding aren't a great combination, so we should continue to
keep in mind that it's a good idea to treat women well, in labor (and
otherwise).
Rachel Myr
Kristiansand, Norway

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