A recent report in Anesthesiology News highlighted a recent study that links postpartum depression with the use of general anesthesia for cesarean section (C-section). As an anesthesiologist, I found this interesting and was intrigued by the study. It was reported that work published in the journal Anesthesia and Analgesia, which retrospectively examined the charts of 428,204 women who had delivered by C-section, revealed that the women who had general anesthesia, as opposed to spinal or epidural, had a 54% greater risk of developing postpartum depression. This level of depression was severe enough to require hospitalization and even involved thoughts of self-harm, including suicide
The link between general anesthesia and depression is already present in the literature, but this is the first study of this size to show a clear link between depression in mothers who deliver by the surgical route, as opposed to vaginal delivery, and the use of general anesthesia. The investigators proposed theories behind why this link might be present. They noted that the delayed skin-to-skin contact between mother and newborn, along with delays in first breastfeeding and an increase in postoperative maternal pain levels, might be contributing factors. The study covered roughly a four-year period and has furthered the argument that, whenever possible, regional (spinal or epidural) anesthesia might be preferable to general anesthesia for this and other procedures.
In the many C-section deliveries where I have given anesthesia, the bonding between mother and newborn is clear and apparent when the mother is awake and able to interact with her baby. Obviously, women under general anesthesia are unconscious and unable to immediately bond with the newborn child or, in the case of twins and other multiples, children. This bonding is evidently so strong and ingrained in our human psyche that any interruption to the process appears to have possible negative psychologic consequences.
So, if you are an expectant mother, you might want to talk to your doctor about this choice of anesthesia before it becomes an issue. If you have no contraindications for regional (spinal or epidural) anesthesia, like a bleeding disorder, anatomical issue, preexisting spinal problems, etc., I strongly suggest you consider this route over general anesthesia should you require a C-section for delivery. Not only will your options for postoperative pain control be wider, but you might spare yourself psychological heartache as well.For more with Dr. Sherer, click here for his podcast and video interviews, and here to buy David’s books, Hospital Survival Guide: The Patient Handbook to Getting Better and Getting Out and What Your Doctor Won’t Tell You