To assess the association between opioid exposure in the childbirth period and persistent postpartum opioid use and to evaluate whether there are differential associations based on specific medication exposure. Retrospective cohort study that used 2015-2021 Pennsylvania Medicaid claims of women aged 19-50 years with vaginal or cesarean delivery and Medicaid enrollment for at least 10 months during the postpartum year. Primary exposure was filled opioid prescription from 7 days before delivery to 8 weeks after delivery (childbirth period). The main outcome measure was persistent postpartum opioid use , defined as either a diagnosis of opioid use disorder or at least one filled opioid prescription in two or more calendar quarters from 8 weeks to 14 months postpartum. Multivariable logistic regression analyses included demographic information, mental health and behavioral comorbidities, obstetric trauma, and pre-existing pain conditions with subgroup analysis of the prepregnancy opioid-naïve population. Of 286,003 births in the Pennsylvania Medicaid program, 172,839 met inclusion criteria (patient demographics: 41,628 Black [24.1%], 102,733 White [59.4%], 26,841 Hispanic [15.5%], mean age at delivery 26.9 years). Childbirth opioid exposure was present in 25% of births (n=43,263). The prevalence of persistent postpartum opioid use was 5.7% (n=9,876). Transition to postpartum persistent use occurred in 7.9% of patients with childbirth opioid exposure and in 4.5% of those without (adjusted odds ratio [aOR] 1.88, 95% CI, 1.79-1.96). Among 132,941 births to opioid-naïve people, 2.6% of patients developed postpartum persistent opioid use; the adjusted odds were higher among those exposed during childbirth compared with those unexposed (aOR, 2.66; 95% CI, 2.49-2.85). The risk of persistent use was highest with tramadol exposure: 30.9% of people exposed to tramadol transitioned to persistent use compared with 7.3% of those exposed to oxycodone (tramadol vs oxycodone: aOR 4.58; 95% CI, 3.87-5.43). Opioid use for childbirth pain management was associated with persistent postpartum use, including among opioid-naïve patients and those without pre-existing pain conditions. These findings support clinical practice guidelines that balance effective postpartum pain management with minimizing opioid-related risks and underscore the importance of postpartum care coordination.

BACKGROUND Labor pain triggers robust hypothalamic-pituitary-adrenal-axis activation, releasing adrenocorticotropic hormone (ACTH)/cortisol that fuels systemic inflammation and predicts postpartum depression (PPD). Although epidural ropivacaine is standard in China, adding the κ-agonist butorphanol may synergistically block pain and restrain this neuroendocrine stress response, offering a novel strategy to protect maternal mental health. AIM To investigate the effects of the combined use of butorphanol and ropivacaine on the plasma levels of ACTH and cortisol in patients undergoing labor analgesia as well as the incidence of PPD. We also compared the incidence of adverse reactions between the two groups. This study aimed to evaluate the regulatory effects of drug combinations and their side effects on the stress response of pregnant women, providing a basis for clinical intervention. METHODS Between June 2020 and June 2023, 114 pregnant women were randomly divided into study and control groups, with 57 participants in each group. The research group received a combination therapy of butorphanol and ropivacaine, whereas the control group received a combination therapy of sufentanil and ropivacaine. All participants received combined spinal epidural anesthesia to alleviate delivery pain. The Visual Analog Scale was used to assess the pain levels at different timepoints. We compared the incidence of adverse reactions and evaluated the incidence of PPD in the delivery room at 2 hours, 1 day, and 7 days postpartum using the Edinburgh Postnatal Depression Scale. Venous blood samples were collected using a fully automated chemiluminescence analyzer to measure ACTH and cortisol. RESULTS The Visual Analog Scale scores of the study group were significantly lower than those of the control group at all timepoints (P < 0.05). In addition, the Edinburgh Postnatal Depression Scale scores of the study group on days 1 and 7 postpartum were significantly lower than those of the control group (P < 0.05), indicating a lower risk of PPD in the study group. There was no significant difference in 24-hour neonatal behavioral neurological assessment, 1-minute Apgar score, and total treatment cost between the two groups of newborns (P > 0.05), and no respiratory depression was observed. The incidence rates of adverse reactions were 5.26% and 17.54% in the study and control groups, respectively. Two hours after delivery, both groups showed a decreasing trend in ACTH and cortisol; however, the levels in the study group were significantly lower than those in the control group (P < 0.05). CONCLUSION The combination of butorphanol and ropivacaine for labor analgesia can significantly reduce pain scores in women and lower the risk of postpartum pain. Additionally, it reduces the incidence of adverse reactions without compromising the safety of both the mother and newborn. This effect may be attributed to the synergistic analgesic effects of the drugs, neuroendocrine regulation, and the improved psychological and physiological conditions of the mother.

To evaluate the association between episiotomy and postpartum pain, perineal healing, pelvic floor function, and sexual function, and to develop a prediction model for identifying women at high risk of moderate-to-severe perineal pain following vaginal delivery. This retrospective cohort study included 638 women who underwent vaginal delivery between January 2023 and December 2024. Propensity score matching (PSM; 1:1, caliper 0.02) balanced baseline characteristics between episiotomy (n = 268) and non-episiotomy groups (n = 268). Visual Analog Scale (VAS) pain scores were assessed at six time points up to 3months postpartum. Pelvic floor dysfunction, perineal healing, and Female Sexual Function Index (FSFI) were evaluated at 3months. A logistic regression prediction model was developed and internally validated. After PSM, 516 patients completed 3-month follow-up (96.3% retention). The episiotomy group demonstrated significantly higher VAS pain scores at all time points (P < 0.001), with effect sizes decreasing from 1.2 at 24h to 0.2 at 6weeks. At 3months, the episiotomy group showed poorer perineal healing (P < 0.001), higher stress urinary incontinence (32.8% vs 22.2%, P = 0.028, OR 1.58), and lower FSFI scores (24.2 vs 27.6, P < 0.001), with sexual dysfunction prevalence of 75.7% vs 55.0%. A prediction model for moderate-to-severe perineal pain (VAS ≥ 4) demonstrated good discrimination (training AUC 0.819, validation AUC 0.804) and calibration (Hosmer-Lemeshow P = 0.445). Key predictors included primiparity (OR 2.32), instrumental delivery (OR 2.1), and prolonged second stage (OR 1.9). Risk stratification identified three groups with observed pain incidence of 28.9%, 55.8%, and 72.0%, respectively. Episiotomy is associated with increased postpartum pain, impaired perineal healing, higher stress urinary incontinence risk, and reduced sexual function at 3months. The prediction model shows promise for early postpartum risk stratification. External validation is needed before clinical implementation.

The association between sleep trajectories throughout pregnancy and postpartum pain in individuals with overweight or obesity: A prospective cohort study.

Postpartum Pain and Vaginal–Gut Microbiota Interactions: An Integrative Narrative Review with Implications for Maternal Recovery and Pain Modulation

To evaluate an initial intravenous loading dose of ketorolac 60 mg compared with 30 mg immediately after cesarean delivery and postoperative opioid requirements. This was a randomized, controlled, single-blind trial of pregnant individuals undergoing cesarean delivery under regional anesthesia at a large academic medical center between June 2022 and October 2023. Enrolled participants were randomized to receive an initial loading dose of 60 mg (intervention) or 30 mg (control) of intravenous ketorolac in the operating room at the end of surgery. Demographics, pregnancy, and surgical characteristics were collected. The primary outcome was morphine milligram equivalents (MMEs) in the first 24 hours after delivery. Secondary outcomes included MMEs postoperatively during the delivery admission, postpartum pain scores (scored 0-10) assessed with the Defense and Veterans Pain Rating Scale, and time from the end of cesarean delivery to first opioid administration. Summary statistics and bivariate analysis were performed. Outcomes were compared between the two study groups with the two-sample t test or the Wilcoxon rank-sum test as appropriate. Of 418 patients screened for eligibility, 92 were enrolled and randomized to receive a 60-mg (n=46) or 30-mg (n=46) loading dose of intravenous ketorolac. Baseline characteristics were similar between the two groups. The median opioid consumption in the first 24 hours postoperatively was 7.5 MMEs (interquartile range 0-15 MMEs) in the intervention group and 7.5 MMEs (interquartile range 0-22.5 MMEs) in the control group (P=.02). Participants receiving a 60-mg ketorolac load used an average of 15 MMEs (interquartile range 0-37.5 MMEs) postoperatively during the delivery admission compared with 30 MMEs (interquartile range 7.5-54.5 MMEs) in the 30-mg dose group (P=.043). The intervention group had a longer time interval between the end of surgery to first opioid administration (15 [3-25] vs 2.75 [2-5] hours, P=.002), as well as lower pain scores on admission to the postpartum unit (3 [0-5] vs 5 [3-6], P<.001). No treatment-related adverse effects were observed in either group. An initial loading dose of 60 mg compared with 30 mg of intravenous ketorolac after cesarean delivery resulted in lower postoperative opioid use without an increase in treatment-related adverse events. However, the effect size was small, and future studies may better address the clinical utility of ketorolac loading dose. ClinicalTrials.gov, NCT05248984.

Labor and postpartum pain represent complex, multidimensional experiences shaped by physiological, psychological, and sociocultural factors. Effective pain management whether pharmacological (epidural analgesia) or non-pharmacological (acupuncture, massage) is integral to respectful maternity care and maternal well-being. Despite extensive clinical research, no comprehensive bibliometric analysis of the global scientific literature in this domain has been conducted. A bibliometric study was performed using data from the Web of Science Core Collection (2000–2025). The search strategy combined terms related to “labor or postpartum pain” and “analgesia, anesthesia, non-pharmacological interventions, or pain management.” Bibliometric indicators including co-authorship, co-citation, and keyword co-occurrence were analyzed using VOSviewer with fractional counting. Inclusion thresholds were: ≥5 documents and ≥50 citations per country, ≥30 occurrences per keyword, and ≥10 citations per cited source. Bibliometric indicators including co-authorship, co-citation, and keyword co-occurrence were analyzed using VOSviewer with fractional counting. Total link strength (sum of link strengths connecting a node to all others) served as the primary metric of collaborative influence and intellectual connectivity. Of the 80 countries identified, 36 were included in the visualization based on total link strength. The United States dominated in publications (n = 388), citations (5,412), and collaboration intensity (total link strength = 1,026), followed by the United Kingdom, Canada, and Australia. Thematic mapping revealed three core clusters: (1) psychological and physiological dimensions of pain, (2) pharmacological interventions (notably epidural analgesia), and (3) patient-centered, experiential care. High-impact journals spanned obstetrics (Obstetrics & Gynecology), anesthesiology (Anesthesia & Analgesia), and pain science (Pain). Low- and middle-income countries remained underrepresented despite bearing a disproportionate burden of maternal morbidity. This study maps the evolving, interdisciplinary landscape of labor and postpartum pain research and reveals persistent geographic, linguistic, and epistemic inequities. It underscores the need for equitable global research partnerships, inclusion of non-English literature, and context-sensitive, community-engaged approaches to ensure inclusive, respectful, and evidence-based pain management for all birthing individuals. Not applicable. Importantly, this article is based exclusively on a secondary analysis of publicly indexed scientific literature retrieved from the Web of Science main collection. This article does not involve any primary data collection, human subjects, animal experiments, or clinical interventions. Consequently, this study is exempt from ethical approval and no ethics committee approval was required or requested.

Maternal morbidity and mortality remain largely preventable, yet current risk-assessment tools identify only a fraction of women who experience severe complications. This review synthesizes recent advances in artificial intelligence and machine learning for early prediction, decision support, and procedural guidance in obstetric anesthesia, with a focus on postpartum hemorrhage, hypertensive disease, sepsis, hemodynamic instability, neuraxial procedures, and peripartum pain. Recently, electronic health record (EHR)-integrated and imaging-based machine learning models have outperformed traditional risk scores for postpartum hemorrhage, placenta accreta spectrum, and pre-eclampsia, and are beginning to incorporate multiomics and genetic data. Obstetric-specific early warning systems and parsimonious machine learning models for maternal sepsis and epidural-related fever show promise but remain limited by sensitivity and external validation. Waveform analytics, noninvasive hemodynamic indices, and artificial intelligence-assisted ultrasound can anticipate hypotension and enhance neuraxial and regional block placement. Machine learning frameworks for postcesarean and chronic postpartum pain, together with virtual reality interventions, support more individualized analgesia. Artificial intelligence-enabled tools are poised to augment, rather than replace, clinician judgment in obstetric anesthesia. Real-world impact will depend on rigorous external validation, equitable implementation, interpretable model design, seamless EHR integration, and close collaboration between clinicians, data scientists, and vendors.

BackgroundStrengthening the pelvic floor muscles through non-invasive Kegel exercises before the onset of clinical symptoms is the most effective method for reducing postpartum complications.AimThis study seeks to investigate the impact of the Kegel exercise on maternal postpartum pain, pelvic floor dysfunction, and sexual function among women in the obstetrics and gynecology department of the National Guard Hospital, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia.Methodsa quasi-experimental design with six weeks apart pre- and post-tests was used, having 31 participants per group recruited with a convenience sample method. An interviewer-administered questionnaire containing a 20-item Pelvic Floor Disability Index (PFDI-20), a 19-item Female Sexual Function Index (FSFI), and the Visual Analog Scale with the Faces Pain Rating Scale was used to measure pelvic floor dysfunction, sexual function, and postpartum pain, respectively. These tools were valid and reliable.ResultsResults revealed a significant increase in the Female Sexual Function Index in the experimental group after the intervention and a substantial decrease in the Visual Analog Scale with the Face Pain Rating Scale in both groups after the intervention. There were no statistically significant differences between the experimental and control groups in the total score of pelvic floor dysfunction. However, the Colorectal-Anal Distress Inventory subscale showed a substantial increase in the control group post-test. In conclusion, the current study has shown that Kegel exercises can increase sexual drive and reduce pain in women with postpartum complications.

Musculoskeletal pain is a common complaint during pregnancy and can persist into the postpartum period, negatively impacting maternal quality of life. While physical activity has demonstrated preventive benefits in various clinical settings, its specific role in the evolution of perinatal musculoskeletal pain remains unclear. The aim of this study was to examine whether daily time spent exercising moderates the trajectory of musculoskeletal pain from pregnancy to the postpartum period, considering pain experienced during the first 48 h after delivery as a potential mediating variable. Methods: A longitudinal study was conducted with a sample of 117 women assessed at three time points: during the third trimester of pregnancy, 48 h postpartum, and three months postpartum. A model of moderate mediation was tested using PROCESS Macro (Model 7) for SPSS. Pain in the third trimester was specified as a predictor (X), pain at 48 h postpartum as a mediator (M), pain at three months postpartum as an outcome (Y), and exercise during pregnancy as a moderator (W) of the relationship between X and M. Results: pain in the third trimester significantly predicted pain at three months postpartum (p &lt; 0.001), and this relationship was partially mediated by pain at 48 h postpartum. Physical exercise significantly moderated this pathway (p = 0.0057), and higher levels of exercise were associated with less association across time over time. The moderate mediation index was significant (95% CI [0.0093, 0.1095]), highlighting physical activity as a relevant protective factor against persistent postpartum pain.

Pain can be experienced by mothers during labor or after labor (postpartum), which can disrupt the mother's comfort and activities. This must be handled quickly and appropriately to prevent more serious complications, one of which is related to massage therapy. The purpose of this study was to determine the effectiveness of massage therapy in reducing pain in postpartum mothers. The research method used was a literature review, with articles searched through Scopus, PubMed, and Medline databases. The inclusion criteria were randomized controlled trials (RCTs), quasi-experimental studies (QE), experimental studies, and comparative studies, all of which used primary data, articles published between 2019 and 2024, study population of postpartum mothers, independent variable of massage therapy and dependent variables of pain in postpartum mothers, articles in Indonesian and English, accessible, and available in full text. The keywords used were "Postpartum" OR "Postpartum period" Massage therapy", "Nursing intervention", "Pain management". The quality of the studies was assessed using the Joanna Briggs Institute (JBI). From the results of the research selection of 55 articles, there were 10 articles that met the inclusion and eligibility criteria for analysis. All research results showed that massage therapy interventions can be used by postpartum mothers to reduce pain, namely Massage and Acupressure, Effleurage Massage, Effleurage Massage and Relaxation, Deep Tissue Massage, Hand and Foot Massage, Foot Massage, and Foot Reflexology. Based on the findings obtained, massage therapy interventions can reduce pain in postpartum. Massage therapy can be recommended as an intervention to reduce postpartum pain.

Adverse childhood experiences and post-cesarean pain and in-hospital opioid use: a prospective cohort study.

Patient experiences of chronic postsurgical pain after caesarean delivery: findings from a prospective qualitative study.

To explore the association between postpartum pain and discharge readiness after delivery, and examine the mediating effects of social support and quality of discharge guidance. This study included puerperae who delivered and were discharged from a tertiary hospital affiliated to Peking University between April and July 2021 by the convenience sampling method. The Chinese versions of the OB-RHDS, OB-QDTS, PSQ, and VAS were used to evaluate discharge readiness, quality of discharge guidance, social support, and postpartum pain, respectively. The path analysis was performed based on the Andersenmodel. A total of 306 questionnaires were distributed in this study, and 276 (90.20 %) valid questionnaires were collected. The postpartum pain at discharge was 2.62±1.89 (possible range: 0-10). The average score of postpartum social support (importance) was 210.98±30.08, and the average score of postpartum social support (actually received) was 201.17±34.21, respectively. The postpartum pain at discharge significantly affected maternal discharge readiness. The path analysis showed that the quality of discharge guidance had the mediating effect of the association between pain at discharge and discharge readiness, and postpartum social support was a moderator for the association between pain at discharge and quality of discharge guidance, and the association between quality of discharge guidance and discharge readiness. The postpartum pain at discharge was associated with discharge readiness, and the quality of discharge guidance and postpartum social support might mediate the association.

This study explored the status of postpartum lactation in caesarean section mothers and identified the factors that influence lactation insufficiency. A total of 265 mothers who delivered via cesarean section between November 2021 and November 2022 were followed for six months. Lactation efficiency was measured by collecting daily milk output using a breast pump from postpartum days 1 to 10; insufficient lactation was defined as a total daily milk volume <500 mL on day 10. Lactation typically began between 25 and 48 hours postpartum (45.1%), with a delayed onset of lactogenesis incidence of 19.6% and an overall lactation insufficiency rate of 48.3%. Multivariate logistic regression analysis identified advanced maternal age (>35 years), excessive weight gain during pregnancy (≥5.6 kg/m²), high postpartum pain scores (≥4), gestational diabetes mellitus, and postpartum depression as significant risk factors for insufficient lactation. In contrast, early skin-to-skin contact and suckling significantly reduced the risk. Furthermore, infants in the exclusive breastfeeding group showed significantly better nutritional outcomes, as measured by the Kaup index, compared to partially or non-breastfed infants. These findings underscore the need for targeted clinical interventions during the perinatal period, including effective pain management, mental health support, and promotion of early breastfeeding, to enhance lactation outcomes among cesarean section mothers.

Background Postpartum lumbopelvic pain associated with pregnancy and childbirth is common in expectant mothers. However, previous studies have not continuously investigated during pregnancy and the postpartum period, and the incidence of acute lumbopelvic pain in postpartum are largely unknown. We aimed to investigate the lumbopelvic pain during pregnancy and the postpartum period, and evaluate changes in lumbopelvic alignment.

Postpartum depression (PPD) poses significant risks to maternal and infant well-being. This study aimed to assess the effect of low-dose epidural esketamine combined with labor analgesia on postpartum depressive symptoms and pain scores in women undergoing spontaneous labor. A randomized controlled trial was conducted with 299 participants assigned to three groups: Group A (esketamine 0.5 mg/kg + labor analgesia), Group B (labor analgesia alone), and Group C (no analgesia). The primary outcome was the Edinburgh Postnatal Depression Scale (EPDS) score at 42 days postpartum. Secondary outcomes included Visual Analogue Scale (VAS) pain scores and serum hormone levels. Overall, EPDS scores were low across the cohort. At 42 days postpartum, no statistically significant difference in EPDS scores was observed between the esketamine group and the analgesia-only group (Group A: 1.97 ± 1.74 vs. Group B: 2.01 ± 1.68). The mean difference was -0.03 (95% CI: -0.46 to 0.39, p = 0.88). The incidence of screen-positive depression (EPDS ≥10) was also comparable among groups (4% vs. 2% vs. 6%). Longitudinally, all groups showed temporal improvements in depressive symptoms and pain scores, which coincided with the physiological decline in estrogen and rise in cortisol levels post-delivery. In this low-risk cohort with low baseline depressive symptoms, the addition of low-dose esketamine to labor analgesia did not result in a significant reduction in EPDS scores at 42 days compared to labor analgesia alone. These findings suggest that the potential benefits of esketamine might be limited in populations with a low risk of PPD, and future studies focusing on high-risk groups are warranted. https://www.chictr.org.cn/showproj.html?proj=247161, identifier ChiCTR2500104037.

Effect of Educational Program on Nurses' Knowledge and Practice regarding Non-Pharmacological Postpartum Pain Relief Measures

To evaluate the effects of immediate perineal cryotherapy during labor on early postpartum outcomes, with a special focus on pain relief, reduction of perineal edema, and promotion of pelvic floor recovery, among primiparous women. In this retrospective cohort study, 260 medical records of primiparous women who delivered vaginally at Quanzhou First Hospital between January 2022 and June 2025 were analyzed. According to the predefined inclusion and exclusion criteria, 135 women underwent instant perineal cryotherapy constituted the observation group, and the other 125 women that were not given cryotherapy were the controls. Baseline data of mothers and their newborns as well as postpartum outcomes were evaluated at set intervals. The primary outcome was pain intensity at the perineum assessed using visual analog scale (VAS) at 2 hours, 6 hours and 24 hours after delivery. The secondary outcome measures included perineal edema, pelvic floor functionality, wound healing, sleep quality, systemic inflammation, coagulation indices, and sexual function. Cryotherapy was associated with lower perineal pain intensity at all time points (all P < 0.001), with fewer women reporting severe pain or requiring analgesics in the cryotherapy group. Functional pain during sitting, standing, and urination was significantly alleviated, and a greater proportion of participants achieved ≥ 30% pain reduction at 6 and 24 hours postpartum (both P < 0.001). Edema scores, perineal circumference, skin temperature, and subcutaneous thickness decreased more rapidly in the cryotherapy group (all P < 0.001), indicating effective attenuation of tissue swelling. Pelvic floor assessments demonstrated lower resting tone, higher maximal voluntary contraction, greater endurance, and stronger vaginal squeeze pressure in the cryotherapy group (all P < 0.001). Wound healing improved significantly across all REEDA score dimensions. Sleep quality in the cryotherapy group was improved notably, with significantly better PSQI scores, shorter latency, longer duration, and reduced disturbances (all P < 0.001). Furthermore, systemic proinflammation factors (CRP, IL-6, TNF-α) and coagulation parameters (fibrinogen, D-dimer) were also reduced markedly in the cryotherapy group without evidence of deteriorating hemostasis at one week postpartum. Sexual function outcomes, including FSFI total and domain scores, were markedly improved (all P < 0.001). Perineal cryotherapy administered immediately during childbirth significantly reduces the pain, edema, and systemic inflammation and improves the recovery of the pelvic floor and wound healing, sleep patterns, and sexual activity in women whose first birth was by cesarean section, highlighting its value as versatile, relatively safe, and non-pharmacological option to optimize early postpartum recovery.

Episiotomy is a common obstetric procedure often associated with significant postpartum pain and delayed wound healing. Conventional treatments provide limited relief and might not be suitable for all women. Energy-based therapies, including infrared irradiation and low-level laser therapy (LLLT), a non-thermal photo biomodulation technique, have shown potential for enhancing pain relief and tissue recovery, but their effectiveness in post-episiotomy care remains unclear. This study evaluates the efficacy of energy-based treatments on pain reduction and wound healing following episiotomy in postpartum women. A database search was performed using MEDLINE with Ovid and PubMed interfaces, The Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov and Web of Science up to December 2024. Prospective randomized and non-randomized controlled trials were considered for inclusion. No restriction was imposed regarding the year or language of publication. Included studies compared one method of energy-based treatment to placebo, standard of care, no treatment or another intervention. Data were synthesized using RevMan Web (Version 8.14.0) with a random-effects model to account for interstudy heterogeneity. Pooled results were expressed as standardized mean differences (SMDs) with 95% confidence intervals. Evidence certainty was assessed using the GRADE approach. A total of 173 studies were identified through database searches, of which 13 studies were included in the final analysis, encompassing a total of 1377 patients. Analyses were stratified by intervention type: infrared irradiation versus standard care or no treatment (n = 1088), LLLT versus placebo (n = 209) and LLLT versus therapeutic ultrasound (n = 80). Infrared irradiation reduced postpartum pain compared to standard care or no treatment (SMD = -0.50, 95% confidence interval [CI]: -0.98 to -0.02, I2 = 88%, P < 0.01); however, it did not improve healing measures. LLLT showed no improvement in pain reduction (SMD: -0.31, 95% CI: -0.72 to 0.11, I2 = 53%, P = 0.1) or healing (SMD: 0.23, 95% CI: -0.18 to 0.63, I2 = 0%, P = 0.85) compared to placebo. LLLT compared to therapeutic ultrasound did not show advantage in pain or healing and was hindered by very high heterogeneity. Infrared therapy might reduce pain after episiotomy, although its effect on wound healing remains inconclusive. LLLT did not demonstrate significant benefits for pain relief or healing. CRD42024608543; registered December 2024.