Labour pain as a risk factor for postpartum depression: strategies for management in contemporary Ukrainian realities

In the context of the full-scale russian-Ukrainian war, the psycho-emotional state of women during the gestational period is inevitably affected by excessive stress. Against this backdrop, any acute event increases the likelihood of adaptive mechanism exhaustion, potentially leading to psychosomatic pathological conditions. Labour is a unique stressor for the female organism, particularly in terms of the pain response. According to current data, the perception of labour pain depends significantly on a woman’s psychological state, which highlights the importance of expanding the use of epidural analgesia (EA) as a preventive measure against postpartum depression (PPD).
The objective: to determine the role and significance of labour pain relief through EA in the context of PPD development and the potential to reduce its incidence among women in frontline regions.
Materials and methods. A prospective comparative study was conducted involving two clinical groups: the EA+ group included 98 women who gave birth with EA; while the EA− group involved 297 women who delivered without EA. Symptoms of prenatal and PPD were assessed using the Edinburgh Postnatal Depression Scale on the 2nd – 3rd days and in 6 weeks after delivery. Additionally, a psychodiagnostic examination using online testing was conducted on the sample contingent. Pain intensity during and after labour was assessed using the Visual Analogue Scale (VAS). EA was provided with the local anaesthetic ropivacaine. EA was initiated when cervical effacement and dilation reached 1 cm or more. A bolus dose of 10 mL of 0.2% ropivacaine was administered via an epidural catheter. A repeat dose was given 20 minutes later if the VAS score remained above 3–4 cm.
Results. The woman’s choice “pain-free childbirth” was influenced by a higher incidence of complications in previous deliveries. The EA+ group demonstrated a higher proportion of planned pregnancies with preconception preparation, more frequent attendance of antenatal education classes, and a lower rate of labour induction. Cesarean section rates (especially urgent) were lower in the EA+ group, with a corresponding increase in the rate of spontaneous vaginal deliveries and a relatively higher incidence of vacuum-assisted births.
In the EA+ group, pain scores on the VAS at 10 cm cervical dilation and during the 1st postpartum day were significantly lower. It was found that oxytocin stimulation without EA was associated with an increased risk of PPD. The proportion of women with PPD on the 2nd – 3rd days after delivery was 5 times lower among those who received EA compared to those women who gave birth without EA. Pain-free labour was also positively associated with improved lactation function.
Conclusions. PPD is a common complication among women in conditions of martial law. To reduce the risk of its development and prevent negative medical and social consequences, it is necessary to identify in advance the contingent of women with a high risk of PPD, clarify the appropriateness of using EA, which is the gold standard of labor pain relief, and expand the practice of its use.
The optimal choice of anaesthetic for EA under current circumstances is the domestically produced local anesthetic Ropilong (ropivacaine, manufactured by LLC “YURIA-PHARM”).