Postnatal depression affects about 10-15% of women after childbirth. Approximately 3-5% of women experience a moderate-to-severe depression that requires medical attention. This study aims to investigate the implication of pain relief choice in reducing the postnatal depression of women who deliver their babies.
If the patients have not decided on which pain relief method to be used, and would like to take part in this study, they will be assigned to either epidural or non-epidural pain relief for labour based on the study randomization result. Blood samples will be drawn to study the presence of known functional polymorphisms in candidate genes associated with depression, pain, stress and anxiety. Patients will be followed up with study questionnaires related to pain and postnatal depression screening during the study. For some of the patients, a discrete choice experiment (DCE) on pain relief choice will be conducted, and their preferences on epidural analgesia will be asked. During any time of the labour period, the patient is allowed to switch the pain relief option upon request.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
881
Epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution.
Entonox will be given upon request in non-epidural group.
Intramuscular pethidine (75mg/1.5ml) will be given upon request in non-epidural group.
KK Women's and Children's Hospital
Singapore, Singapore
The incidence of major postnatal depression in both groups
Edinburgh Postnatal Depression Scale (EPDS) score\>=13
Time frame: 6-10 weeks after delivery
The incidence of (clinically significant, probable) postnatal depression in both groups
Edinburgh Postnatal Depression Scale (EPDS) score\>=10
Time frame: 6-10 weeks after delivery
The incidence of acquiring post-delivery persistent pain in both groups
Pain score\>3 in the perineal, surgical scar or abdomen region that lasts for at least 6 weeks post-delivery
Time frame: 6-10 weeks after delivery
Pain vulnerability in both groups (1)
Assessment via Pain Catastrophizing Scale (PCS) questionnaire before and after delivery
Time frame: Upon recruitment until 6-10 weeks after delivery
Pain vulnerability in both groups (2)
Assessment via Central Sensitisation Inventory (CSI) questionnaire before and after delivery
Time frame: Upon recruitment until 6-10 weeks after delivery
Pain vulnerability in both groups (3)
Assessment via Angle Labor Pain Questionnaire (A-LPQ) during first stage of labor when the participants experience labor pain
Time frame: Upon recruitment till end of first stage of labor (1 day)
Psychological vulnerability in both groups (1)
Assessment via Fear-Avoidance Components Scale (FACS) questionnaire before delivery
Time frame: Upon recruitment until 5 days after delivery
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Intravenous patient controlled remifentanil (20-40mcg/ml) is only given when the patient rejects or cannot receive pethidine and entonox in non-epidural group..
Epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution.
Epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution.
Psychological vulnerability in both groups (2)
Assessment via State Trait Anxiety Inventory (STAI) questionnaire before delivery
Time frame: Upon recruitment until 5 days after delivery
Psychological vulnerability in both groups (3)
Assessment via Perceived Stress Scale (PSS) questionnaire before delivery
Time frame: Upon recruitment until 5 days after delivery
Pain severity in both groups
Pain score\>3 during labour
Time frame: During labour till one day after delivery
Preferences for labor analgesia
Recruited patients will be administered a survey on Discrete Choice Experiment (DCE) and other questions on their preferences for labor analgesia. For DCE, nine tasks will be included in which parturients will choose one of four hypothetical forms of labor analgesia: 1) epidural analgesia, 2) pethidine, 3) Entonox (nitrous oxide-oxygen mixture), and 4) no labor analgesia, which varies with regards to six attributes: 1) pain intensity following treatment, 2) duration of second stage of labor, 3) risk of instrumental delivery, 4) risk of back pain, 5) risk of permanent nerve injury, and 6) out-of-pocket cost.
Time frame: Prior to labor and delivery
Preferences for epidural analgesia
Recruited patients will be administered a survey on their preferences and opinions on epidural analgesia, including their concerns on possible risk of epidural analgesia e.g. instrumental delivery, prolonged duration of second stage of labor, back pain etc.
Time frame: Prior to labor and delivery
Chinese version of Angle Labor Pain Questionnaire (A-LPQ)
Assessment via Angle Labor Pain Questionnaire (A-LPQ) during first stage of labor when the participants experience labor pain. The tool comprises 22 items divided into five subscales on the childbirth pain experience: the enormity of the pain, the fear and anxiety, uterine contraction pain, birthing pain, and the back pain/ long haul. Each item is scaled from 0 to 10, implying a range from non to worst possible or extremely (where applicable), and therefore has a total score ranged from 0 to 220. The higher the score, the greater the labor pain.
Time frame: Upon recruitment till end of first stage of labor (1 day)