Mothers’ Reports of Postpartum Pain Associated with Vaginal and Cesarean Deliveries: Results of a National Survey

Department of Maternal and Child Health, Boston University School of Public Health, Boston, MA 02118-2526, USA.
Birth (Impact Factor: 1.26). 04/2008; 35(1):16-24. DOI: 10.1111/j.1523-536X.2007.00207.x
Source: PubMed


As cesarean rates increase worldwide, a debate has arisen over the relationship of method of delivery to maternal postpartum physical health. This study examines mothers' reports of their postpartum experiences with pain stratified by method of delivery.
Listening to Mothers II was a survey of a total of 1,573 (200 telephone and 1,373 online) mothers aged 18 to 45 years, who had a singleton, hospital birth in 2005. They were interviewed by the survey research firm, Harris Interactive, in early 2006. Online respondents were drawn from an existing Harris panel. Telephone respondents were identified through a national telephone listing of new mothers. Results were weighted to reflect a United States national birthing population. Mothers were asked if they experienced any of eight postpartum conditions and the extent and the duration of the problem. Responses were compared by method of delivery.
The most frequently cited postpartum difficulty was among mothers with a cesarean section, 79 percent of whom reported experiencing pain at the incision in the first 2 months after birth, with 33 percent describing it as a major problem and 18 percent reporting persistence of the pain into the sixth month postpartum. Mothers with planned cesareans without labor were as likely as those with cesareans with labor to report problems with postpartum pain. Almost half (48%) of mothers with vaginal births (68% among those with instrumental delivery, 63% with episiotomy, 43% spontaneous vaginal birth with no episiotomy) reported experiencing a painful perineum, with 2 percent reporting the pain persisting for at least 6 months.
Substantial proportions of mothers reported problems with postpartum pain. Women experiencing a cesarean section or an assisted vaginal delivery were most likely to report that the pain persisted for an extended period.

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    • "While many mothers and infants transition through this time uneventfully, others find it overwhelming or develop significant health issues that may persist for weeks and months after giving birth. For example, up to 50% of women report tiredness [1-6] and backache [1-7], while a significant proportion describe headaches [1,3-5,7], perineal [2,3,5,6,8] and caesarean wound pain [8]. Many women experience problems such as breast engorgement, sore nipples, mastitis, postpartum anxiety, prolonged bleeding and urinary tract infections [6,9]. "
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    ABSTRACT: While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care. PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument. Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest. Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines.
    BMC Pregnancy and Childbirth 01/2014; 14(1):51. DOI:10.1186/1471-2393-14-51 · 2.19 Impact Factor
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    • "Therefore, the perceived risk of each health outcome among women after delivery was classified into three categories (underestimated, accurately estimated, or overestimated) according to the range of the risk of that outcome reported in the literature. If no range was available, the calculated 95% confidence interval was used instead (Table  1) [19-33]. Both overestimation and underestimation were regarded as inaccurate perceptions. "
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    ABSTRACT: Misperceptions regarding maternal health outcomes after vaginal delivery (VD) and cesarean delivery (CD) may contribute to the increasing trend towards CD. The effects of mode of delivery on parents' perceived risks of health outcomes are unclear. This study aimed to compare the perceived risks of maternal health outcomes among pregnant women and their partners before and after delivery, and to evaluate factors related to inaccurate perceptions among women after delivery. Consecutive eligible nulliparous women at 36-40 weeks gestation were approached during antenatal registration for electronic fetal monitoring, regardless of whether CD or VD was planned. Eligible women were aged 18-45 years, received antenatal care and planned delivery at the First Hospital of Tsinghua University, Beijing, and had partners who could be approached. Concerns about 12 maternal health outcomes were identified by literature search and validated using the content validity index. Women and their partners were questioned anonymously about the perceived risks of outcomes after CD and VD before delivery, and the perceived risks of the delivery experienced at 2-3 days after delivery. Perceived risks were compared with reported risks, and factors associated with inaccurate perceptions were evaluated. Among 272 couples approached, 264 women (97%) and 257 partners (94%) completed the questionnaire both before and after delivery. After CD, the perceived risk of seven health outcomes decreased in women and the perceived risk of two health outcomes increased in partners. After VD, the perceived risk of two outcomes decreased and of one outcome increased in women, and the perceived risk of three outcomes increased in partners. Women perceived higher risks of long-term perineal pain, pelvic organ prolapse, urinary/fecal incontinence, sexual dissatisfaction, and negative impact on the couple's relationship after VD than after CD (all p < 0.05). CD was the most common factor associated with inaccurate perceptions among women after delivery. The perceived risks of maternal health outcomes decreased after delivery in women and increased after delivery in their partners. Women continued to have inaccurate perceptions of the risks of health outcomes after delivery, indicating that further education is important.
    BMC Pregnancy and Childbirth 01/2014; 14(1):12. DOI:10.1186/1471-2393-14-12 · 2.19 Impact Factor
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    • "Although caesarean section births have been identified as contributing to reductions in women’s postnatal physical wellbeing, more recently there has been interest in exploring the impact of assisted vaginal births. In the first few months after birth, assisted vaginal births have been associated with a greater likelihood of perineal pain [7,8] urinary incontinence, haemorrhoids, and sexual problems [7,9-11] than unassisted vaginal births, even when taking into account aspects related to the birth such as the length of labour and degree of perineal trauma [7,11]. Women who have assisted vaginal births, particularly forceps-assisted vaginal births may also be at risk for ongoing and continuing physical problems [12]. "
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    ABSTRACT: Background Physical and psychological problems after childbirth are common, and may have a significant negative and long-term impact on women’s wellbeing and daily functioning. The method of birth may be a particularly important factor influencing women’s health and wellbeing following birth, however, population-wide evidence is limited. This study uses data from 5,332 women who responded to a national survey of women’s experiences of maternity care in England. We examined women’s postnatal wellbeing in the first three months after birth, and whether these varied by mode of birth. Methods This is a secondary analysis of survey data using a random sample of women selected from birth registration. We used multinomial logistic regression models to examine the association between women’s self-reported psychological symptoms, health problems and mode of birth. Results Women who had forceps-assisted vaginal births and unplanned caesarean section births reported the poorest health and wellbeing, while those of women who had unassisted vaginal births and planned caesarean section births were less affected by the birth process. Most women’s physical and emotional health appeared to improve with time, however, those who had a forceps-assisted vaginal birth were more likely to report ongoing posttraumatic-type symptoms several months after the birth. Conclusions Mode of birth was associated with differences in outcomes at three months. By comparison to women who had unassisted vaginal births, the risk of reduced postnatal health and wellbeing was higher amongst the women who had forceps-assisted vaginal births but not amongst women who had ventouse-assisted vaginal births. This would suggest that it is important to differentiate the different types of instrumental birth in outcome studies. Of concern was the higher rate of posttraumatic-type symptoms among women who had forceps-assisted vaginal births relative to the other modes of birth. Women who have forceps-assisted births should be monitored carefully by health professionals in the postnatal period, and in the months after childbirth, when they could be offered the opportunity to discuss their labour and birth.
    BMC Pregnancy and Childbirth 11/2012; 12(1). DOI:10.1186/1471-2393-12-138 · 2.19 Impact Factor
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