Postpartum pain: maternal perception of pain management
Abstract Number: S-16
Abstract Type: Original Research
Introduction: During the postpartum period women do not usually have health issues reviewed until 6 weeks. During an evaluation of women's postpartum perineal pain, we discovered many women had pain during the first week postpartum yet they failed to use physical measures or pharmacological agents to relieve their discomfort1 Our questions were “What were the major problems following hospital discharge?” and “What problems did they have managing pain since hospital discharge?”
Objective: The purpose of this qualitative study was to examine information on how women perceive their postpartum morbidity and identify specific impediments to better pain management.
Methods: 32 women delivering at Mount Sinai Hospital were consented to participate in semi-structured postpartum home interviews conducted one month after delivery. Recruitment involved purposive sampling of: parity, gestational age, maternal age, socioeconomic groups, type of delivering physician, type of delivery, degree of perineal trauma amongst vaginal deliveries, groups, type of cesarean delivery, type of anesthesia for cesarean delivery. Interviews were audiotaped and transcribed verbatim. The qualitative analysis of the interviews included primary coding and clustering these codes to identify common themes and subthemes. The relationships between the themes and subthemes were analyzed and interpreted to determine main health outcomes following delivery.
Results: Out of 32 participating women, most were primiparous, delivered vaginally, over 30 years and were higher socioeconomic class. Most women (30/32) women had physical recovery after delivery hindered by four major concerns including breastfeeding pain and difficulties, delivery pain (perineal or incisional), reduced mobility and wound complications. An important finding of this study was the sense of abandonment from the health care providers that some first-time mothers expressed. Only 50% of women received a follow up phone call from the community public health nurse. Suggestions for improving postpartum experience for future mothers were mainly focused around preparation, getting help from family and friends, acknowledging the fact that personal reaction to the events that happen in postpartum period varies and most of the time is hard to predict and prepare for.
Conclusion: The women in this study reported the range of unanticipated and unwanted physical and emotional health outcomes following delivery. This relevant missing information can be used in the design of a future, multidisciplinary (nursing, obstetrics, family practice, anesthesia and community health workers) clinical trial of postpartum management program.
Reference: Macarthur et al. Incidence, severity, and determinants of perineal pain after vaginal delivery. ACOG 2004; 191: 1199 – 204.