New Research on Fearful Mothers and Postpartum Depression

Somewhere between 70 and 80 percent of new mothers run into some version of the baby blues, which is hardly surprising. Bringing a child into the world is an enormous physical and emotional event. The idea of raising a baby frightens plenty of parents on its own, and the worry about labor pain and physical strain can tip that worry into outright panic. Research has tied this fear to something more lasting: women who were clinically diagnosed with fear of the birth process turned out to be three times as likely to develop postpartum depression.

BMJ Open recently carried findings from the University of Eastern Finland pointing to a link between dread of childbirth and later depressive symptoms. Among mothers who already had a documented history of clinical depression, 5.3 percent went on to receive a postpartum depression diagnosis. The figure that stands out, though, is different: roughly one in three women who had never dealt with depression of any kind before giving birth still reported depressive symptoms afterward. Episodes like these show up often, particularly with a first baby. The takeaway the Finnish researchers push is that fear itself can flag who is at risk.

So what separates postpartum depression from the blues? The two are not the same thing. In the days after birth, a lot of women feel sad, anxious, short-tempered, or swamped by emotions they cannot quite name. That comes with the territory, given how much the body and its hormones are shifting. Postpartum depression runs deeper. Its symptoms are heavier and its fallout more serious, and rather than fading in a week or two it can drag on for months. Mothers describe hopelessness, a hollow feeling, persistent sadness. There may also be no appetite, trouble sleeping or concentrating, and a general withdrawal from the daily things that used to matter.

The stakes reach beyond the mother. Postpartum depression can interfere with the bond forming between parent and child. Attachment theory holds that the emotional ties built early between a parent and a baby shape that child's psychological and emotional health for years. A depressed mother may find it hard to connect with her newborn. Infants need to feel safe and loved, and when a caregiver cannot meet their basic needs, emotional and behavioral trouble can follow later on.

Severe detachment can also signal postpartum psychosis, which is a different and far more dangerous situation. This should be handled as an emergency. Everyone close to the mother can be at risk, including the children. A woman in the grip of postpartum psychosis may have sensory hallucinations, act on delusions, and feel driven to harm herself or her babies. Family, friends, and the mother herself need to reach a professional without delay.

How might any of this be prevented? Tying fear of labor pain to postpartum depression has real weight because the Finnish study relied on medical diagnoses of both the prenatal fear and the postnatal depression rather than on guesswork. Nobody can forecast with certainty which new mothers will become depressed, least of all among women with no prior mental health history. Still, the data opens up a fresh angle: treating postpartum depression partly as a question of pain management. Medical and mental health providers can sit down with pregnant women ahead of time and build a plan for handling labor pain and the discomfort that comes after.

Katherine Wisner, M.D., who directs Northwestern's Asher Center for the Study and Treatment of Depressive Disorders, took up this theme in an editorial for Anesthesia & Analgesia. She was responding to a new Chinese study in which women who got an epidural during labor and delivery proved less likely to show postpartum depressive symptoms. Among those participants, 14 percent of the women who had an epidural reported depression, compared with 35 percent of those who did not. The researchers left caesarean births and other pain-relief methods out of this particular analysis. Separate evidence suggests that good pain control can also improve a mother's odds of breastfeeding and of forming a close attachment to her baby.

"These findings are quite exciting," Wisner said. "Pain control gets mothers off to a good beginning rather than starting off defeated or exhausted." Beyond her work at the Asher Center, Wisner is a professor at Northwestern University Feinberg School of Medicine, where she teaches psychiatry and behavioral sciences along with obstetrics and gynecology, and she practices as a psychiatrist at Northwestern Memorial Hospital.

Put the pieces together and a picture forms. If acute and chronic pain can predict postpartum depression, and if a clinically diagnosed fear of that pain triples a woman's risk, then addressing pain management during pregnancy looks like an obvious step. Working alongside an obstetrician, an anesthesiologist, and when appropriate a mental health professional, a woman can get ready for both the apprehension and the physical pain of labor. She deserves to know every option for managing pain during delivery and afterward. Above all, women dealing with acute or chronic pain should be screened for postpartum depression.

Fear and chronic pain before birth can predict postpartum depression. - Melissa Lavery, M.S.

References: Northwestern University. (2014, July 23). Controlling childbirth pain tied to lower depression risk. ScienceDaily. Retrieved January 7, 2015. Postpartum Depression-Topic Overview. (2012, April 16). WebMD. Retrieved January 7, 2015. Postpartum Psychosis. (2012, March 8). WebMD. Retrieved January 7, 2015. University of Eastern Finland. (2014, January 3). Fear of childbirth predicts postpartum depression. ScienceDaily. Retrieved January 6, 2015.