Women who have general anesthesia during C-sections are significantly more likely to experience severe postpartum depression resulting in hospitalization, suicidal thoughts or self-harm, according to a study published last week.
That might be because general anesthesia can delay breastfeeding and skin-to-skin interaction between the mother and infant, and often results in more acute and persistent pain after childbirth, researchers from Columbia University Mailman School of Public Health explained.
'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, lead author and an assistant professor of anesthesiology at Columbia, in a news release.
The study, published in the journal Anesthesia and Analgesia, is the first to examine how specific types of anesthesia for cesarean delivery affect the risk of postpartum depression.
General anesthesia increased odds of postpartum depression
The researchers used hospital discharge records of cesarean delivery cases from New York state hospitals between 2006 and 2013. Out of the 428,304 cases they examined, 34,356 women -- or 8% -- received general anesthesia during delivery.
General anesthesia induces sleep, meaning that mothers won't be able to see, feel or remember anything during childbirth. It also prevents them from being able to see their child immediately after birth.
The study found that 1,158 of the women who received general anesthesia, or about 3%, experienced severe postpartum depression that required hospitalization. Women who had general anesthesia were also 54% more likely to experience postpartum depression and 91% more likely to have thoughts about suicide or self-harm, compared to those who had regional anesthesia such as spinal blocks or epidurals.
Women who had general anesthesia during C-sections were also older, and more often non-white and on Medicaid or Medicare, compared to those who had regional anesthesia, the study said.
The authors caution that their findings don't necessarily mean that general anesthesia causes postpartum depression.
'We don't want people to believe that general anesthesia is always bad,' Guglielminotti told CNN. '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 is rarely used
General anesthesia for cesarean delivery is not the norm in North America.
Fewer than 5 out of every 100 C-sections in the US are done with general anesthesia, according to the Society for Obstetric Anesthesia and Perinatology.
When general anesthesia is used, it's typically in emergency C-sections or in cases when typical numbing anesthesia like spinal blocks or epidurals cannot be used, says Grace Lim, director of obstetric anesthesiology at UPMC Magee-Womens Hospital in Pittsburgh.
Emergency cesareans are more likely to be needed for babies who are pre-term or sick in some way, or for mothers with certain health problems, which Lim says could explain the increased odds of postpartum depression.
'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,' she wrote in an email to CNN.
About one in nine women nationally experience symptoms of postpartum depression, according to CDC research.
The authors say more studies are needed
Though researchers and medical experts have not previously studied the link between general anesthesia in C-sections and harmful psychological outcomes, other studies have examined the link between C-sections and postpartum depression.
A 2019 study from the United Kingdom found that first-time mothers who have emergency C-sections are 15% more likely to experience postnatal depression, and a 2017 analysis of previous research suggested that C-sections and emergency C-sections increase the risk of postpartum depression.
Another study from 2018 found that epidurals, which reduce the pain experienced during labor, were linked to a reduced risk of postpartum depression, although its authors cautioned that other factors might play a larger role.
Because the Columbia University study is the first of its kind, Guglielminotti said that there needed to be more research to confirm the link between general anesthesia during cesarean deliveries and postpartum depression.
Since the researchers used administrative hospital records instead of clinical data, they don't know the exact reasons that general anesthesia was used in the cases they studied. Lim said it is difficult to capture all of the reasons a patient may need general anesthesia based only on administrative data, rather than a more complete health record.
The authors also noted that they might have underestimated the actual instances of postpartum depression, because their study identified cases of postpartum depression based on delivery hospitalization and hospital readmission. The data did not include outpatient visits or emergency department visits.
Additionally, since the study only looked at cesarean deliveries in New York state, the authors noted that their findings may not apply to cases in other states.