Women who have general anesthesia during C-sections are significantly more likely to experience postpartum depression resulting in hospitalization, suicidal ideation, self-harm and anxiety, according to recent study.
This may be because general anesthesia during C-section deliveries can delay skin-to-skin interaction or breastfeeding from mother to infant, and can cause more acute postpartum pain.
‘These situations are often coupled with a new mother’s dissatisfaction with anesthesia in general, and can lead to negative mental health outcomes,’ said Jean Guglielminotti, MD, PhD, in the Department of Anesthesiology at Columbia University and lead author, in a statement.
The study, published in Anesthesia and Analgesia, is the first of its kind to examine the role general anesthesia during C-sections play in postpartum depression, or PPD, and how regional anesthesia may have a ‘protective effect.’
Research published in Anesthesia and Analgesia suggests women who use general anesthesia during C-sections are more likely to experience postpartum depression
Around one in nine women experience PPD in the United States.
Researchers used hospital discharge records of C-section deliveries performed in New York State hospitals between 2006 and 2013.
Of the 428,304 individual cases they analyzed, 34,356 women – or eight percent – received general anesthesia during child birth.
1,158 of the women, or three percent, who received general anesthesia experienced severe PPD that led to hospitalization.
The study found women who underwent general anesthesia were 91 percent more likely to have thoughts of suicide or self harm, and 54 percent more likely to experience PPD.
Women who had general anesthesia during C-sections tended to be non-white, older and on Medicare or Medicaid.
This is compared to women who had regional anesthesia, like spinal blocks and epidurals.
Jean Guglielminotti (left) cautioned against believing general anesthesia is always bad and Grace Lim (right) said the ‘nature of the emergency delivery’ may also play a role in developing PPD
However, researchers maintain that the findings don’t directly mean general anesthesia causes PPD.
Guglielminotti told CNN: ‘We don’t want people to believe that general anesthesia is always bad. It can be good in some situations, when you require an emergency C-section. What we’re saying is that general anesthesia is not always good, and when it can [it should] be avoided.’
General anesthesia isn’t often used in North America and fewer than five out of every 100 C-sections are done with it in the United States.
General anesthesia is usually used in emergency C-sections or in instances when regional anesthesia cannot be utilized, said says Grace Lim, director of obstetric anesthesiology at UPMC Magee-Womens Hospital in Pittsburgh.
Lim says the emergency C-sections, which are more likely used for babies who are early or ill, or for mother’s with health problems, could also explain the increase in PPD.
She told CNN: ‘Thus, the nature of the emergency delivery, rather than the general anesthetic itself, may be the real reason why these women end up with higher odds of depression.’
While researchers have not previously studied the connection between general anesthesia, C-sections and psychological outcomes, others have monitored the link between C-sections and PPD.
Lim: ‘Thus, the nature of the emergency delivery, rather than the general anesthetic itself, may be the real reason why these women end up with higher odds of depression’
A 2017 analysis suggested C-sections and emergency C-sections can raise the risk of PPD, and a 2019 study from the United Kingdom found first-time mothers who have C-sections were 15 percent more likely to experience PPD.
In 2018, researchers found that epidurals were linked to to a reduced risk of PPD, but authors warned that other factors could play a larger role.
Guglielminotti said more research is needed to formally confirm the link between general anesthesia in C-sections and PPD.
For instance, researchers used administrative hospitals as opposed to clinical data, meaning they don’t know the exact reason why general anesthesia was used in the cases.
It can be difficult to grasp all the reasons a patient may choose to use general anesthesia.
The new study also doesn’t account for women who sought outpatient visits, emergency department visits and only tracked women in New York.