Obstetric anesthesia and postpartum mental health: implications from delivery to long-term recovery

Obstetric anesthesiologists have traditionally focused on providing effective labor analgesia and ensuring safe cesarean delivery. However, growing evidence suggests that anesthetic choices and childbirth experiences influence maternal mental health beyond the immediate intrapartum period. Postpartum depression (PPD) and postpartum post-traumatic stress disorder (PP-PTSD) are linked to impaired mother-infant bonding, reduced quality of life, and adverse long-term outcomes in mothers and children. Therefore, this review aimed to synthesize the current evidence on antenatal risk factors, delivery mode, anesthetic management, labor epidural analgesia (LEA), perioperative pharmacological prevention, and long-term outcomes, emphasizing the expanding role of obstetric anesthesiologists in postpartum mental health care. General anesthesia for cesarean delivery is linked to an increased risk of severe PPD and suicidality, although its relationship with PP-PTSD remains unclear. LEA does not appear to protect against PPD or PP-PTSD when assessed by binary exposure. Instead, the quality of pain relief, intraoperative pain, failed neuraxial anesthesia, and conversion to general anesthesia may be clinically relevant determinants of postpartum mental health. Perioperative ketamine and esketamine may help prevent the risk of early PPD following cesarean delivery, although evidence of sustained long-term benefits remains limited. These findings support an expanded role for obstetric anesthesiologists beyond intrapartum safety, including trauma-informed communication, optimized pain management, early identification of high-risk women, and prompt referral to multidisciplinary perinatal mental health care.