The pain reported by postpartum women in rooming-in according to the mode of delivery

Rocha, Mariana Nunes Miranda Carasek da; Knobel, Roxana; Arruda, Yasmin Lima Gouveia; Nandi, Vitor Leonardo; Pereira, Jessica Goedert; Velho, Manuela Beatriz

doi:10.5935/2595-0118.20240007-en

Brasil

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ORIGINAL ARTICLE • BrJP 07 • 2024 • https://doi.org/10.5935/2595-0118.20240007-en linkcopy

The pain reported by postpartum women in rooming-in according to the mode of delivery

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES: Pain is the most frequently reported symptom in the immediate puerperium. The aim of this study was to quantify pain levels and sociodemographic, obstetric, and care characteristics associated with severe pain and inadequate analgesia according to the mode of delivery.

METHODS: Observational, descriptive, cross-sectional study conducted between October and December 2020, with a sample of 229 postpartum women considered eligible (baby born alive, weighing > 500 g and/or gestational age > 22 weeks) to answer the study questionnaire.

RESULTS: The mean reported pain was 5.34 by Visual Analogue Scale (VAS) and there was a difference (p<0.001) between modes of delivery. Cesarean section was associated with severe pain (p=0.006) and pain above eight on the VAS (p=0.02). Vaginal delivery was associated with the perception of inadequate analgesia (p=0.04). Severe pain reported was associated with the admission of the baby to the ICU (p=0.01) and cases of postpartum hemorrhage (p=0.002). Among women who gave birth vaginally, there was an association between severe pain and instrumental delivery (p=0.05). Reported severe pain was associated with difficulties in self-care (p<0.001) and care of the newborn (p= 0.02), sensation of weakness (p<0.001), and fainting (p=0.002). The perception of inadequate analgesia was associated with vaginal birth (p=0.04) end non-white skin color (p=0,03).

CONCLUSION: The average reported pain was moderate. Intense pain and the perception of inadequate analgesia were associated with instrumental delivery, newborns being referred to the NICU, postpartum hemorrhage, and non-white skin color.

Keywords Cesarean section; Cross-sectional study; Postpartum period; Vaginal delivery.

HIGHLIGHTS

More women undergoing cesarean section reported severe postpartum pain.

More women with vaginal deliveries perceived inadequate analgesia.

Admission of the newborn to the NICU was associated with pain and perception of inadequate analgesia.

Severe pain was associated with difficulty in self-care and newborn care.

Variables	Average	SD
Age (n=229)	28.7	6.3
Gestational age at time of birth (n=229)	38.6	2.2
	n	%
Self-declared skin color (n=229)
White or yellow	146	63.8
Brown	53	23.1
Black	27	11.8
Indigenous	3	1.3
Schooling (n=229)
Incomplete elementary school	22	9.6
Incomplete high school	28	12.2
Complete high school	119	52.0
Higher education	60	26.2
Socioeconomic class ABEP (n=229)
A2, B1, B2	122	56.5
C1, C2	87	40.3
D, E	7	3.2
Living with a partner (n=226)
No	36	15.9
Yes	190	84.1
Parity (n=229)
Primiparous	114	49.8
Multiparous	115	50.2
Do you have a paid job? (n=207)
No	76	36.7
Yes	131	63.3
Proper prenatal care (n=219)
No	123	56.2
Yes	96	43.8
Had a companion at the time of delivery
(n=229)
No	28	12.2
Yes	201	87.8
Mode of delivery (n=229)
Vaginal ^* * 13 instrumental deliveries (9.0% of vaginal deliveries); † no woman undergoing cesarean section had a perineal suture; SD = standard deviation	144	62.9
Cesarean section	85	37.1
Perineum (n=143)
Intact	20	14.0
1st degree laceration	62	43.4
2nd degree laceration	56	39.2
3rd degree laceration	1	0.7
Episiotomy	4	2.8
Postpartum hemorrhage (n=229)
No	208	90.8
Yes	21	9.2
NB referred to NICU (n=229)
No	212	92.6
Yes	17	7.4
Perineal suture (n=144†)
No	49	34.0
Yes	95	66.0

	All	Vaginal	Cesarean section	p-value
	n (%)	n (%)	n (%)
Severe pain referred (n=229)	82 (35.8)	42 (29.2)	40 (47.1)	0.006^* * = Chi-squared test; † = Fisher’s Exact test; VAS = Visual Analogue Scale.
Pain by VAS (n=216)				0.004^* * = Chi-squared test; † = Fisher’s Exact test; VAS = Visual Analogue Scale.
From zero to three	86 (39.8)	66 (48.2)	20 (25.3)
Three to eight	58 (26.9)	33 (24.1)	25 (31.6)
Higher than eight	72 (33.3)	38 (27.7)	34 (43.0)
Felt not adequately treated for pain (n=200)	22 (11.0)	18 (14.6)	4 (5.2)	0.04†

	All			Severe pain referred Vaginal			Cesarean section
	No	Yes	p-value	No	Yes	p-value	No	Yes	p-value
	n (%)	n (%)		n (%)	n (%)		n (%)	n (%)
Difficulty with self-care	11 (7.5)	28 (34.1)	<0.001^* * Chi-squared test; † = Fisher’s Exact test	7 (6.9)	7 (16.7)	0.17†	4 (8.9)	21 (52.5)	<0.001^* * Chi-squared test; † = Fisher’s Exact test
Difficulty caring for the NB	17 (11,6)	23 (28.0)	0.002^* * Chi-squared test; † = Fisher’s Exact test	11 (10.8)	6 (14.3)	0.57†	6 (13.3)	17 (42.5)	0.003^* * Chi-squared test; † = Fisher’s Exact test
Feeling weak	35 (23.8)	54 (65.9)	<0.001^* * Chi-squared test; † = Fisher’s Exact test	27 (26.5)	31 (73.8)	<0.001^* * Chi-squared test; † = Fisher’s Exact test	8 (17.8)	23 (57.5)	<0.001^* * Chi-squared test; † = Fisher’s Exact test
Feeling faint	4 (2.7)	11 (13.4)	0.002^* * Chi-squared test; † = Fisher’s Exact test	3 (2.9)	6 (14.3)	0.02†	1 (2.2)	5 (12.5)	0.09†

	All			Severe pain referred Vaginal			Cesarean section
	Yes	No	p-value	Yes	No	p-value	Yes	No	p-value
	n (%)	n (%)		n (%)	n (%)		n (%)	n (%)
Non-white skin color	30 (36.6)	53 (36.1)	0.94^* * Chi-squared test; † = Fisher’s Exact test	17 (40.5)	37 (36.3)	0.63^* * Chi-squared test; † = Fisher’s Exact test	13 (32.5)	16 (35.6)	0.76^* * Chi-squared test; † = Fisher’s Exact test
Socioeconomic class ABEP	32 (40.5) C/D/E	62 (45.3)	0.5^* * Chi-squared test; † = Fisher’s Exact test	18 (43.9)	41 (43.6)	0.97^* * Chi-squared test; † = Fisher’s Exact test	14 (36.8)	21 (48.8)	0.28^* * Chi-squared test; † = Fisher’s Exact test
Primiparous	39 (47.6)	75 (51.0)	0.61^* * Chi-squared test; † = Fisher’s Exact test	19 (45.2%)	58 (56.9)	0.20^* * Chi-squared test; † = Fisher’s Exact test	20 (50.0)	17 (37.8)	0.25^* * Chi-squared test; † = Fisher’s Exact test
Instrumental delivery	7 (8.5)	6 (4.1)	0.23†	7 (16.7)	6 (5.9)	0.05†	-	-	-
2nd-degree laceration	18 (22.0)	43 (29.3)	0.91^* * Chi-squared test; † = Fisher’s Exact test	18 (42.9)	43 (43.9)	0.91^* * Chi-squared test; † = Fisher’s Exact test	-	-	-
NB referred to NICU	11 (13.4)	6 (4.1)	0.01^* * Chi-squared test; † = Fisher’s Exact test	1 (2.4)	3 (2.9)	1†	10 (25.0)	3 (6.7)	0.02^* * Chi-squared test; † = Fisher’s Exact test
Postpartum hemorrhage	14 (17.1)	7 (4.8)	0.002^* * Chi-squared test; † = Fisher’s Exact test	7 (16.7)	4 (3.9)	0.01†	7 (17.5)	3 (6.7)	0.18†

	Yes	All No	p-value	Inadequate analgesia Vaginal Yes No p-value			Yes	Cesarean section No	p-value
	n (%)	n (%)		n (%) n (%)			n (%)	n (%)
Non-white skin color	13 (59.1)	62 (34.8)	0,03^* * Chi-squared test; † = Fisher’s Exact test	11 (61.1) 36 (34.3) 0.03^* * Chi-squared test; † = Fisher’s Exact test			2 (50.0)	26 (35.6)	0.62†
Socioeconomic class 12 (54.5)		71 (41.8)	0,25^* * Chi-squared test; † = Fisher’s Exact test	10 (55.6)	41 (41.4)	0.26^* * Chi-squared test; † = Fisher’s Exact test	2 (50.0)	30 (42.3)	1†
ABEP C/D
Primiparous	11 (50.0)	90 (50.6)	0,96^* * Chi-squared test; † = Fisher’s Exact test	10 (55.6)	57 (54.9)	0.92^* * Chi-squared test; † = Fisher’s Exact test	1 (25.0)	31 (42.5)	0.64†
Instrumental delivery	0 (0)	10 (5.6)	0,61†	0 (0)	10 (9.5)	0.35†	-	-	-
2nd degree laceration or episiotomy	6 (33.3)	49 (45.8)	0,32^* * Chi-squared test; † = Fisher’s Exact test	6 (33.3)	49 (45.8)	0.32^* * Chi-squared test; † = Fisher’s Exact test	-	-	-
NB referred to NICU	3 (13.6)	13 (7.3)	0,39†	3 (16.7)	0 (0)	0.003†	0 (0)	13 (17.8)	0.47†
Postpartum hemorrhage	0 (0)	19 (10.7)	0,13†	0 (0)	10 (9.5)	0.35†	0 (0)	9 (12.3)	1†

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[TFN1] ^*
13 instrumental deliveries (9.0% of vaginal deliveries); † no woman undergoing cesarean section had a perineal suture; SD = standard deviation