24 Maternal Psychosocial Factors associated with Postpartum Pain

Abstract

The experience of pain is shaped by a host of psychological, cultural, and social factors. Our objective was to examine the relationship between self-reported postpartum (PP) pain and psychosocial factors including relationship status, pregnancy intendedness, employment, education, and mood disorder. This was a prospective observational study of PP patients at one institution (5/2017-7/2019) who utilized an oral opioid at least once during their PP hospitalization. Enrolled participants completed a survey which included questions regarding their social situation (including relationship status), psychiatric diagnoses, and perceptions of pain control during their PP hospitalization. The primary outcome for this analysis was self-reported overall pain during the PP hospitalization (score of 0-100). Multivariable analyses accounted for age, BMI, nulliparity and mode of delivery. Self-identified race and insurance status were not included given their collinearity with other exposures. In this cohort of 428 PP patients, the majority (84.0%) underwent cesarean delivery and 42.0% were nulliparous. Participants reported a median pain score of 40 out of 100 (IQR 30-60). On bivariable analyses, there was no significant difference in pain score between patients with and without an unplanned pregnancy or a mood disorder. Patients who were un-partnered, those without a college education, and those who were unemployed reported significantly higher pain scores (57.5 vs. 44.8, p<0.001; 52.6 vs 44.6, p<0.001; and 53.6 vs. 44.6; p<0.001, respectively). On multivariable analyses, patients who were un-partnered (aβ 8.3, 95% CI 2.0-14.7) and unemployed (aβ 7.5, 95% CI 2.5-12.6) remained significantly more likely to report a higher pain score (Table). Psychosocial factors such as relationship and employment status, which are indicators of social support, may contribute to the experience of pain PP. These findings suggest that addressing social support –such as via enhanced support from the health care team–warrants exploration as a non-pharmacologic means of improving PP pain experience.