Factors influencing the choice of lumbar epidural analgesia and its association with postpartum depression risk

BACKGROUND: The use of lumbar epidural analgesia (LEA) during childbirth varies significantly among women. Factors influencing a woman's choice of LEA and its possible effects on postpartum depression (PPD) remain underexplored. OBJECTIVES: To investigate factors influencing the choice of LEA among women with intended vaginal deliveries. A secondary objective was to explore the association between LEA use and PPD. STUDY DESIGN: A longitudinal cohort study. SETTING: Uppsala University Hospital, Sweden, 2010 to 2019. POPULATION: Women with an intended vaginal delivery. EXCLUSIONS: Twins, elective caesarean section, induction of labour. METHODS: Data were collected by web-based self-completed questionnaires at gestational weeks 17, 32 and at 6 weeks and 6 months postpartum. The exposures were sociodemographic, resilience-related, medical and obstetric characteristics of all participants from the BASIC (Biology, Affect, Stress, Imaging and Cognition) study. Information on the use of LEA was retrieved from medical records. PPD was assessed using either the Edinburgh Postnatal Depression Scale, or the Depression Self-Rating Scale, and/or the Mini-International Neuropsychiatric Interview at 6 to 8 weeks and 6 months postpartum. Bayesian models were applied to investigate the associations of multivariate factors with the choice for LEA, and the association between the use of LEA and PPD. RESULTS: Among 4436 participants, 38% opted for LEA, while 62% did not. LEA users were younger, primiparous, reported higher rates of intimate partner violence (IPV) and had lower resilience. The adjusted model revealed primiparity, previous caesarean section, IPV, pregnancy length at least 280 days and fear of childbirth as independent predictors of LEA use. While LEA use was associated with higher odds of PPD in the crude regression model, it was no longer statistically significant after adjusting for possible confounders and mediators. CONCLUSION: Social and psychological vulnerabilities influence a woman's decision to opt for LEA during childbirth. LEA was not associated with PPD in adjusted models. TRIAL REGISTRATION: This is a longitudinal study which was not registered in 2010.