Understanding the postpartum cesarean pain experience in publicly insured individuals

Abstract

Although recent work has focused on interventions to decrease opioid use in the postpartum period, few reports have explored birthing individuals’ perspectives on the postpartum pain experience. Our objective was to qualitatively assess patient experiences related to postpartum pain management. This is a prospective qualitative study of patients’ experiences with postpartum pain management after cesarean delivery at a single large tertiary care center (12/2020-7/2021). Individuals were eligible if they had publicly funded prenatal care, were English- or Spanish-speaking, and underwent cesarean birth. Purposive sampling was used to ensure a racially/ethnically diverse cohort. Participants underwent in-depth interviews using a semi-structured interview guide at two time points: postpartum day 2-3 and 2-4 weeks after hospital discharge. Interviews addressed perceptions and experiences of postpartum pain management and recovery. Data were analyzed using the constant comparative method. Of 41 participants, 56.1% identified as non-Hispanic Black and 36.6% as Hispanic. The majority (58.9%) had experienced a prior cesarean birth (Table 1). Thematic analysis yielded four overarching domains with subthemes. First, participants consistently reported themes of hesitancy and perceived judgement regarding opioid use. In the theme of desire for non-pharmacologic pain management, subthemes included desire for multimodal pain management, importance of mobility, and the neonate as a motivator in recovery. Finally, we identified a theme of frustrations about limitations of daily life caused by experience of pain, which addressed activities of daily living, caring for family and the neonate, and the impact on mood (Table 2). Understanding experiences regarding postpartum cesarean pain management and recovery is essential to improving patient-centered care. This analysis highlights the need to improve counseling about and provisions of opioid use, increase use of non-pharmacologic methods of pain control, and focus on strategies to enhance patient preparedness for post-cesarean recovery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)