A new study published online in the journal Anesthesia and Analgesia found a mom's odds of having severe postpartum depression increase significantly when they have general anesthesia for a C-section delivery.
Researchers looked at hospital records for 428,204 women who had C-sections in New York State, 34,356 of whom had the surgery under general anesthesia rather than spinal anesthesia, when the mom stays awake. General anesthesia is used in emergencies where there isn't enough time to do spinal anesthesia because the C-section needs to happen ASAP or when a mom can't have spinal anesthesia because she's had a back injury or something else that prevents it.
Giving birth under general anesthesia was associated with a 54% increased-odds of postpartum depression. "General anesthesia for cesarean delivery may increase the risk of postpartum depression because it delays the initiation of mother to infant skin-to-skin interaction and breastfeeding, and often results in more acute and persistent postpartum pain," says Jean Guglielminotti, MD, PhD, in the Department of Anesthesiology and the Department of Epidemiology at Columbia Mailman School, lead author of the study.
According to Guglielminotti, "These situations are often coupled with a new mother's dissatisfaction with anesthesia in general, and can lead to negative mental health outcomes."
This research underscores the importance of postpartum support for mothers and the seriousness of birth trauma. For some women, an emergency C-section under general anesthesia is a very traumatic experience, especially in a culture which, in recent years, has seen an aspirational narrative about "natural childbirth" (all childbirth is natural, mama) take over social media.
Severe depression is not the only mental health complication that can arise from a C-section. A 2017 study examining the relationship between C-sections and Post Traumatic Stress Disorder (PTSD) found that in "patients with a high degree of dissociative experiences during the C-section, or when maternal or anesthesia complications occur, the risk for a postpartum PTSD profile increases significantly. These patients are likely to benefit from a close follow up by members of the obstetrics and/or anesthesia team. If needed, intensive psychological support should be put in place as soon as possible."
No matter what kind of anesthesia a mother has during her C-section a sense of grief may be felt afterward, especially if a low-intervention birth was her plan. It's okay to mourn the experience you wanted to have mama.
Writer Shannon Kelley had a C-section and described her grief in a piece for the Washington Post: "In the immediate aftermath, the loss of the birth I'd imagined felt as acute and traumatic as the one that actually occurred. I'd looked forward to the experience from the same place that sagged with awe at pregnancy—a mind-blowing miracle that, somehow, I'd gotten lucky enough to taste. Yet I'd experienced no labor at all. Plus, now that I'd had one C-section, I'd have to fight and bear additional risk were I to attempt a vaginal birth in the future."
Her feelings were complex and they were valid. It's okay to go through a C-section and be totally thrilled with your birth experience (after all, C-sections can be beautiful) but it is also okay to grieve for an experience you thought you would have.
What is not okay is a medical system and society that isn't prepared to support you in that grief.
New research published in the British Journal of Midwifery in September 2019 suggests, "maternity providers should consider offering a postnatal listening service to meet women's needs in relation to understanding their experience of giving birth. This will also serve to identify women with [post-traumatic stress] symptoms and offer further support."
Mothers need support, and Guglielminotti's research suggests they also need providers to avoid using general anesthesia in the first place. "Our findings underscore the need to avoid using general for cesarean delivery whenever possible, and to provide mental health screening, counseling, and other follow-up services to obstetric patients exposed to general anesthesia," says Guglielminotti's co-author Guohua Li, MD, DrPH, Finster Professor of Epidemiology and Anesthesiology.
The findings also underscore something Diana Spalding, Motherly's Digital Education Editor and author of the upcoming book, The Motherly Guide to Becoming Mama (April 2020), has said about birth plans: "Plans do not always... well, go to plan, and the last thing on earth that I want for you is to feel like somehow you failed your birth."
She wants mothers like Kelley to know that it is impossible to fail at birth. Giving birth, whether vaginally or by C-section is not something you can fail at. Having a birth plan can be good so that you can outline your birth preferences ahead of time, but there's got to be room for unexpected detours. Sometimes people have to have C-sections and that can be part of the discussions you have with your provider ahead of time, even if it isn't part of your ideal plan.
"I am a huge fan of you feeling empowered and actively involved in the decision of your birth." Spalding says.
Bottom line: Birth is beautiful no matter how it happens, but mothers deserve to be supported to ensure their birth is as close to their vision as possible—and supported after their birth occurs, too.