Women who undergo general anesthesia during C-sections are more likely to have postpartum depression

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. 

Pictured: Jean Guglielminotti, MD, PhD

Pictured: Grace Lim, MD, MS

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. 

Postpartum Depression: Signs and Symptoms 

Postpartum depression, or PPD, is a mental illness that affects women after giving birth.

While some women experience the ‘baby blues’ for a few weeks after child birth, PPD can cause feelings of loneliness, sadness, restlessness and anxiety for a much longer period of time.

PPD can be worrisome when it begins to interfere with an individual’s ability to complete daily tasks or take care of their family. 

It can be caused by different factors like hormonal changes after birth and emotional stress. 

PPD can bring a range of symptoms, including: 

  • Feeling sad, hopeless, empty, or overwhelmed
  • Crying more often than usual or for no apparent reason
  • Worrying or feeling overly anxious
  • Feeling moody, irritable, or restless
  • Oversleeping, or being unable to sleep even when her baby is asleep
  • Having trouble concentrating, remembering details, and making decisions
  • Experiencing anger or rage
  • Losing interest in activities that are usually enjoyable
  • Suffering from physical aches and pains, including frequent headaches, stomach problems, and muscle pain
  • Eating too little or too much
  • Withdrawing from or avoiding friends and family
  • Having trouble bonding or forming an emotional attachment with her baby
  • Persistently doubting her ability to care for her baby
  • Thinking about harming herself or her baby

Because symptoms of PPD are so wide and varied, only a health care provider can diagnose a woman with the illness. 

While not every woman will experience PPD, some risk factors have been noted as a possible indicator:

  • Symptoms of depression during or after a previous pregnancy
  • Previous experience with depression or bipolar disorder at another time in her life
  • A family member who has been diagnosed with depression or other mental illness
  • A stressful life event during pregnancy or shortly after giving birth, such as job loss, death of a loved one, domestic violence, or personal illness
  • Medical complications during childbirth, including premature delivery or having a baby with medical problems
  • Mixed feelings about the pregnancy, whether it was planned or unplanned
  • A lack of strong emotional support from her spouse, partner, family, or friends
  • Alcohol or other drug abuse problems

A health care provider can help zero in on the best treatment plan for a patient, but forms of counseling and medication can be used. Lifestyle changes, such as a new sleep schedule, can also be prescribed.   

Call 911 for emergency services or go to the nearest emergency room.

Call the toll-free 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889).

 Source: National Institute of Mental Health and Mayo Clinic 

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