Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature

Postpartum depression (PPD) is a prevalent mood disorder affecting 10-20% of women and represents a major contributor to maternal and infant morbidity. Labor pain, delivery mode, and anesthetic technique have been proposed as potential modifiers of postpartum psychological outcomes. Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural techniques is the standard of care for labor analgesia and cesarean delivery, yet its association with PPD remains incompletely defined. This narrative review synthesizes current evidence evaluating the relationship between neuraxial anesthesia and dural puncture epidural (DPE) during vaginal and cesarean delivery and subsequent risk of postpartum depression. Across observational studies, cohort analyses, systematic reviews, and meta-analyses, neuraxial anesthesia does not appear to increase the risk of PPD at the population level. Many studies demonstrate a neutral association, while select analyses suggest modest protective effects, particularly among women experiencing severe labor pain or high intrapartum stress. Proposed mechanisms include attenuation of physiologic stress responses, improved pain control, and enhanced maternal satisfaction. These effects, however, are inconsistent across patient populations, and neuraxial anesthesia does not independently prevent PPD. In contrast, general anesthesia for cesarean delivery is consistently associated with higher rates of severe postpartum depression. Overall, postpartum depression is multifactorial condition in which anesthetic technique functions as a modifying rather than determining factor. Optimizing intrapartum pain management, minimizing unnecessary general anesthesia exposure, and implementing systematic postpartum mental health screening are essential components of comprehensive perinatal care.