Women Who've Gotten Emergency C-Sections Have Higher Risk of PPD, Yet We're Still Doing Nothing to Improve Postpartum Care

The results of a new study have given even more urgency to our nation's current state of lax postpartum care.

Published in the journal Anesthesia and Analgesia, researchers discovered that the chances of a new mother having severe postpartum depression increase significantly when she has general anesthesia for a C-section delivery.

Although many C-sections use spinal anesthesia, in which the mother is able to stay awake, a smaller percentage require general anesthesia, particularly in emergencies when there isn't enough time to perform spinal anesthesia because the C-section needs to happen immediately or if the mother can't have spinal insertion due to a back injury or other medical reason.

For many women who've experienced traumatic childbirth, this need for better postpartum care isn't a new discovery, but one that has been sorely undervalued for decades.

Researchers pulled hospital records in New York State over a seven-year period from 2006 to 2013 and found that for 34,356 women who underwent general anesthesia when giving birth (compared to the more than 428,000 women who had C-sections of any type), there was a 54-percent increased risk of developing postpartum depression. More startling, undergoing general anesthesia in delivery was associated with 91-percent increased odds of suicidal ideation or self-inflicted injury.

The predicted reason?

"It delays the initiation of mother to infant skin-to-skin interaction and breastfeeding and often results in more acute and persistent postpartum pain," said Dr. Jean Guglielminotti, the lead author of the study. "These situations are often coupled with a new mother's dissatisfaction with anesthesia in general and can lead to negative mental health outcomes."

No other study has specifically evaluated the effect of general anesthesia on maternal mental health, and although the findings are preliminary, researchers concluded that the results "underscore the need to avoid the use of general anesthesia for cesarean delivery whenever possible."

It also highlighted another eminent need: "to provide mental health screening, counseling, and other follow-up services to obstetric patients exposed to general anesthesia."

For many women who've experienced painful childbirth — particularly those who've had unwanted or unplanned C-sections or endured traumatic labor experiences that resulted in emergency C-sections — this need for better postpartum care, to help with the physical and emotional fallout, isn't a new discovery, but one that has been sorely undervalued for decades.

The current health insurance system and models for reimbursement of maternity care in the US have impeded the ability for most women to receive universal, high-quality postpartum care. At present, the standard medical care for a new mother is a single doctor's visit at six weeks following childbirth. In 2018, the American College of Obstetricians and Gynecologists made a significant change in its recommendations for such care.

"All women should ideally have contact with a maternal care provider within the first three weeks postpartum," the release stated. "This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth."

Those suggested guidelines, however, have yet to be put into practice. So for now this study serves to shed yet another bright light on a key component missing from women's healthcare.