Do Epidurals Cause Postpartum Depression: What the research shows

Epidurals have all sorts of risks and benefits, but how doe epidurals correlate with postpartum depression? Today we’re going to dive into what the studies show on epidurals, and coping with the pains during labor, along with what I saw in my 20 years in labor and delivery. It’s important to know what types of risks you’re expecting with an epidural, so I’m glad you’re here.

As a note — it’s difficult to get a lot of quality info about the epidural online prior to getting it. Make sure you’re getting info from an expert. This is part of my Complete Guide to Epidurals — but if you want all the info about pregnancy & birth in one easy spot check this out!

What is Postpartum Depression (PPD)?

It’s depression related to hormonal and life shifts after having a baby. It can happen any time in that first year.

That being said — I wish these studies talked more about postpartum anxiety as well. I think a lot of people feel very anxious after a baby — not particularly depressed, but maybe panic attacks. I had this (more on that coming up).

I honestly do think these results would work for both situations — but I wanted to put that out there too.

Want to know more info about postpartum? — check out these posts:

• Epidural Side Effects After Birth
• First Poop After Delivery: Make it less-hard (literally)
• Your Guide to Your Postpartum Plan with Free Template
• Postpartum Essentials for a Great Recovery
• Things to NOT Do After You Have Your Baby

Oh, and be SURE that your birth class covers postpartum. This has helped so many couples make that transition easier!

What Do the Studies Show?

I found a few decent studies on this…

This one from 2021 had just under 100 patients (honestly, the sample size in all of these is pretty disappointing — this is NOT a hard one to study) and did show that those who got an epidural had lower rates of postpartum anxiety.

It showed they were about 70% less likely to get postpartum depression. Which is a good number (even if sample size is poor).

A few things to pull out from this study:

• Women who did get an epidural did say they had less pain in labor (makes sense)
• They also said they had less pain 24 hours later (not sure this is true)
• Depression scores in both groups were similar prior to having their baby
• They link out to a few other studies that correlate increased pain with postpartum depression (and that can show impacts on the baby as they grow into adulthood)
• They recommend using an epidural to prevent postpartum depression (not sure this is true — we’ll talk more about it)

Here is a review of studies on this topic, and they again found that postpartum depression increased with the amount of pain you felt during labor. However, some of the studies did not show a correlation within their search.

This one from 2014 had about 200 patients. It showed about a 70% decrease in postpartum depression as well.

I thought it was interesting that that study also showed that

• Taking childbirth classes decreased your chance of getting PPD by 70% as well. I recommend this one.
• Continuing to breastfeed had a 98% chance of decreasing PPD (but do women experiencing PPD stop breastfeeding — hard to tell on this one)

Sources:

Edipoglu IS, Aslan DD. Association of postpartum depression and epidural analgesia in women during labor: an observational study. Braz J Anesthesiol. 2021 May-Jun;71(3):208-213. doi: 10.1016/j.bjane.2021.02.021. Epub 2021 Feb 19. PMID: 33941362; PMCID: PMC9373269. You can also see the full article on science direct.

Parise DC, Gilman C, Petrilli MA, Malaspina D. Childbirth Pain and Post-Partum Depression: Does Labor Epidural Analgesia Decrease This Risk? J Pain Res. 2021 Jun 25;14:1925-1933. doi: 10.2147/JPR.S305485. PMID: 34211295; PMCID: PMC8242125.

Ding, T., Wang, D.-X., Qu, Y., Chen, Q., & Zhu, S.-N. (2014). Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study. Anesthesia & Analgesia, 119(2), 383–392.

Want to know more information on pain in labor? — check out these posts:

• What makes labor hurt more?
• The Benefits of an Epidural No One Talks About
• Epidural Myths vs. Facts: What Social Media Gets Wrong About Labor Pain Relief
• Why People Get An Epidural Even When They’re Not Planning On It
• Why Labor Pain Can Feel So Different For Each Person

What Did I See in Labor & Delivery

I think patients who are prepared for the pain in labor and delivery and successfully cope with the pain of labor without an epidural feel empowered after delivery.

But, the key there is being prepared, and also being able to cope with the pains.

The thing is that you don’t know what that labor’s pains are going to feel like. Even if you’ve previously had children, every labor is unique and can bring unique challenges to the situation.

The big question is if you’re coping with the pains. And some are. Some patients do beautifully with it.

But a lot just grit their teeth and don’t get the epidural and stress hormones course through their body during the experience. And THAT I think is where the real issue comes in. I talked more about it in my article about stress at delivery. Often, after that type of delivery we see baby come out stressed out, and just doesn’t transition as well to the real world.

I think real labor preparation should help you know how to make the choice that an epidural is right for you (along with giving you lots of natural pain mangement techniques as well!).

Do I think that decreasing postpartum depression is a reason for all pregnant women to consider an epidural? I don’t think so. I think it’s more about coping, and your birth experience. The fact that you don’t have to just grit your teeth and bear it — there are other options. And, most of all — being prepared to make choices during your labor.

Mostly, I am grateful it did show that a more positive birth experience does decrease your chance of postpartum depression. That’s good news overall and can be worked on with both pain management, but overall labor experience for the birthing person.

If you’re not sure WHAT you want — my free birth plan series might help you out!

My Own Experience

I got epidurals with all 3 of my kids.

I got postpartum anxiety on two of them. The worst on the 3rd. Her epidural was also in the shortest period of time.

I didn’t get help because it wasn’t depression — I knew it was a few panic attacks daily that I dreaded, along with generalized anxiety and anxious thoughts throughout the day.

I wish I’d called my doctor and gotten help. I wish the hospital hadn’t so strongly asked if I was depressed, but maybe ask more just about how I was doing. I wasn’t doing well, but I wasn’t depressed.

She’s 17 now though, and I hope we’re doing better at this.

I very much agree with the studies that show when a patient wants an epidural they should get one (well, at least when they’re in labor — I would’ve asked for one at 35 weeks if I could have 😅).

I also think that if you want to aim for a birth without an epidural you need to prepare for it, and practice those skills throughout your pregnancy — it’s not just a “I took the class” situation.

When you’re having Braxton hicks or annoying ligament pains — use those techniques to help you cope then (and it will help you cope in labor as well). I recommend The Online Prenatal Class for Couples to help you do this (it has a whole chapter on the epidural and a long bonus video on natural pain management as well).

And I very much would love to see more studies on what increases birth satisfaction overall. We study a lot of things, but somehow that doesn’t make it on the list often enough.

What do YOU think? Do you think there is a correlation for you? Tell us in the comments!