Postpartum Pain Research Articles

Maternal psychosocial factors associated with postpartum pain

The experience of pain is shaped by a host of psychological, cultural, and social factors. Although pain is the most common postpartum complaint, data on its relationship with psychosocial factors and postpartum pain are limited. This study aimed to examine the relationship between self-reported postpartum pain scores and patient-level psychosocial factors, including relationship status, pregnancy intendedness, employment, education, and psychiatric diagnosis. This was a secondary analysis of data from a prospective observational study of postpartum patients at 1 institution (May 2017 to July 2019) who used an oral opioid at least once during their postpartum hospitalization. Enrolled participants completed a survey, which included questions regarding their social situation (including relationship status), psychiatric diagnoses, and perceptions of their pain control during their postpartum hospitalization. The primary outcome was self-reported overall pain during the postpartum hospitalization (score of 0-100). Multivariable analyses accounted for age, body mass index, nulliparity, and mode of delivery. In this cohort of 494 postpartum patients, most patients (84.0%) underwent cesarean delivery, and 41.3% of patients were nulliparous. In a pain score of 0 to 100, participants reported a median pain score of 47. On bivariable analyses, there was no significant difference in pain score between patients with and without an unplanned pregnancy or a psychiatric diagnosis. Patients who were unpartnered, those without a college education, and those who were unemployed reported significantly higher pain scores (57.5 vs 44.8 [P<.01], 52.6 vs 44.6 [P<.01], and 53.6 vs 44.6 [P<.01], respectively). In multivariable analyses, patients who were unpartnered and unemployed reported significantly higher adjusted pain scores than patients who were partnered and employed (adjusted beta coefficients: 7.93 [95% confidence interval, 2.29-13.57] vs 6.67 [95% confidence interval, 2.28-11.05]). Psychosocial factors, such as relationship and employment statuses, which are indicators of social support, are associated with the experience of pain postpartum. These findings suggest that addressing social support, such as via enhanced support from the health care team, warrants exploration as a nonpharmacologic means of improving the postpartum pain experience.

Obstetric pain management for pregnant women with opioid use disorder: A qualitative and quantitative comparison of patient and provider perspectives (QUEST study).

Patients with opioid use disorder (OUD) may experience inadequate pain management especially during childbirth. This study assessed and compared patient and provider perspectives on analgesia during and after delivery in women with OUD. Prospective cohort, mixed method design including semi-structured interviews and structured surveys with pregnant or recently pregnant patients (n = 17) and provider (n = 15) groups. Prenatal clinics and hospital postpartum units. Patients were pregnant women with OUD currently treated with methadone (n = 1) or buprenorphine (n = 16). Providers were obstetricians (n = 5), obstetric nurses (n = 5) and anesthesiologists (n = 5). Validated questionnaires were completed by both groups; patient interviews were conducted during the third trimester and at 5 days post-delivery. Patient topics included pain management preferences, analgesia satisfaction and attitudes toward pain. Provider topics included labor and postpartum pain management perspectives. Interviews were independently coded and qualitatively analyzed for major themes. Five major themes emerged from patient interviews: (1) neuraxial blockade was endorsed for labor pain; (2) otherwise, limited pain control options were perceived; (3) no consensus around use of opioids for pain; (4) non-opioid options should be available; and (5) provider communication and health-care system issues act as barriers to adequate pain management. Provider perspective themes included the following: (1) unique challenges in pain management for patients with OUD; (2) confusion on how to plan for and make perinatal adjustments to medication for OUD; (3) discrepant views on use of opioids for pain management; (4) endorsement of non-pharmacological and non-opioid options; and (5) need for improved provider collaboration in developing pain management plans. Patients with opioid use disorder and health-care providers prioritize pain management during and after childbirth, but have discrepant views on use of opioids and other pain management options. Inadequate care coordination and discrepancies in opinions need to be addressed both within care teams and between patients and providers. Clinicians would benefit from better evidence to guide clinical care of patients with OUD for patient-centered pain management.

Inequities in Inpatient Obstetrics Pain Management and Evaluation: Age, Race, Mental Health, and Obesity.

To evaluate disparities of pain management among patients giving birth in inpatient Obstetrics units based on age, race, BMI, and mental health diagnoses. A retrospective cohort study was performed and included all individuals giving birth at a tertiary-care institution in 2019. Patient-reported pain scores, and inpatient narcotic administration and dosing for pain control were collected. Models were adjusted for race, age, BMI, and diagnoses of anxiety, depression, opioid use disorder, and/or schizophrenia. 4788 Individuals met the inclusion criteria. A higher proportion of African American patients reported severe pain (n = 233/607, 38.4%) and received narcotics (n = 653/1141, 57.2%) compared to patients of other races. Despite controlling for several possible confounders, African American patients (OR 1.55, 95% CI 1.08-2.22), patients with increased BMI (OR 1.02, 95% CI 1.01-1.03), and patients with a mental health diagnosis (OR 2.33, 95% CI 1.32-4.12) were more likely to have worse pain at rest. Older patients were more likely to be administered narcotics (n = 447/757, 59.0%) compared to younger patients (patients aged 18-26: n = 577/1257, 52.3%; patients aged 27-35: n = 1451/2774, 52.3%; p < 0.001), despite younger patients being more likely to have severe pain (OR 1.50; 95% CI 1.20-1.86; p = 0.001). Patients who are Non-Hispanic African American and patients with obesity and mental health diagnoses experience inequities in postpartum pain management. Pain is complex and multifactorial and can be impacted by cultural, social, environmental factors and more. Further studies on factors that influence pain perception and management in inpatient obstetrics units are needed.

Depressive symptoms and sleep disturbances in late pregnancy: Associations with experience of induction of labor with a catheter

ObjectiveDepressive symptoms and sleep disturbances have been found to be associated with negative labor experiences, particularly an increased level of pain. However, the associations between maternal depressive symptoms and sleep disturbances and the experience of induction of labor (IOL) remain unknown. In this study, we evaluated these associations with balloon catheter IOL. Study designA prospective study was conducted on 106 women with planned IOL. Depressive symptoms were evaluated with The Edinburg Postnatal Depression Scale (EPDS) and sleep disturbances with the Basic Nordic Sleep Questionnaire (BNSQ) at the beginning of IOL. The IOL experience was investigated both during the IOL and postpartum with the same nine visual analogue scale (VAS) questions. ResultsRegarding sleep disturbances, during the IOL, women with worse general sleep quality were less satisfied (P = 0.019), less relaxed (P = 0.008), experienced more pain in general (P = 0.002) and reported higher contraction frequency (P = 0.003). Furthermore, women who experienced difficulties falling asleep were less relaxed (P = 0.009), reported more general pain (P < 0.001) and contraction pain (P = 0.005), while those with more daytime sleepiness reported less contraction pain (P = 0.033). In postpartum, women with worse general sleep quality reported more general pain (P = 0.003), while women with longer sleep duration and those with higher sleep loss reported more anxiety (P = 0.009 and P = 0.024, respectively). Additionally, women who woke up too early in the morning were less satisfied (P = 0.042), less relaxed (P = 0.004) and reported more general pain (P = 0.018). However, those who experienced more frequent nocturnal awakenings reported being more relaxed (P = 0.014) and having less general pain (P = 0.033). Higher depressive symptoms were associated with a higher frequency of contractions during IOL (P = 0.030), but with less general pain in postpartum (P = 0.027). ConclusionsWomen with sleep disturbances during pregnancy were more likely to report more negative experiences during the IOL. Specifically, they reported more pain, feeling less relaxed and they were less satisfied with IOL. Conversely, the association between depressive symptoms and the experience of IOL seemed weaker. Thus, the quality of sleep of pregnant women is important for a better experience of IOL.

Association between history of childbirth and chronic, functionally significant back pain in later life

BackgroundBack pain is more prevalent among women than men. The association with sex could be related to pregnancy and childbirth, unique female conditions. This association has not been thoroughly evaluated.MethodsUsing a retrospective cohort design, we evaluated the relationship between history of childbirth on the prevalence and severity of functionally consequential back pain in 1069 women from a tertiary care pain management clinic. Interactions among preexisting, acute peripartum, and subsequent back pain were evaluated as secondary outcomes among the parous women using logistic and linear regression as appropriate.ResultsThe women who had given birth had a higher risk for functionally significant back pain compared to women who had not given birth (85% vs 77%, p < 0.001, Risk Ratio 1.11 [1.04-1.17]). The association was preserved after correction for age, weight, and race. Back pain was also more slightly severe (Numerical Rating Score for Pain 7[5-8] vs 6[5-7] out of 10, p = 0.002). Women who recalled severe, acute postpartum back pain had a higher prevalence of current debilitating back pain (89% vs 75%, Risk Ratio 1.19 (1.08-1.31), p = 0.001). Twenty-eight percent of acute postpartum back pain never resolved and 40% reported incomplete resolution.ConclusionsA history of pregnancy and childbirth is a risk factor for chronic functionally significant back pain in women. Severe acute postpartum back pain is a risk factor for future disability suggesting that the peripartum period may provide an important opportunity for intervention. Early recognition and management may mitigate future disability.Trial registrationThe study was registered with clinicaltrials.gov as “Association Between Chronic Headache and Back Pain with Childbirth” (NCT04091321) on 16/09/2019 before it was initiated.

Biases in the management of postpartum pain: a qualitative analysis of clinicians’ perspectives

Biases in the management of postpartum pain: a qualitative analysis of clinicians’ perspectives

Perspectives on clinicians’ roles and postpartum pain management: a qualitative analysis

Pain is a common postpartum complaint, yet data suggest that approaches to postpartum pain management vary widely. Given the goal of improving quality and equity in postpartum pain management, we aimed to examine whether and how clinicians’ perspectives on postpartum pain management differed by clinician roles.

Effect of TENS Treatment Mode for Labor Pain and its Influence on Perinatal Women

This study is to observe the analgesic effect of TENS and its influence on postpartum stress hormone. The patients were randomly divided into three groups: comfortable care+TENS group, comfortable care+PCA group, comfortable care+false TENS group. 1. One hour after operation before analgesia. VAS score of postpartum pain was performed at 7 time points (before analgesia, 5 min after analgesia, 15 min after analgesia, 30 min after analgesia, 60 5min after analgesia, 24 h after analgesia, 48 h after analgesia); The VAS score of comfortable care+TENS group decreased significantly compared with that of sham TENS group after 30 minutes of analgesia (P&lt;0.05); There was no significant difference in VAS between comfort care+TENS group and comfort care+PCA group 30 minutes after analgesia (P&gt;0.05).

Prenatal and Childbirth Risk Factors of Postpartum Pain and Depression: A Machine Learning Approach.

About 74.91% of U.S. mothers experience postpartum pain at 6 to 10 weeks postpartum, and one in seven U.S. mothers suffer from postpartum depression. We used machine learning to explore physical, psychological, and social factors during pregnancy and childbirth and identify the most important predictors of postpartum pain and depression. Data were from the Listening To Mothers III survey (2012), a national representative sample of postpartum mothers. We randomly split the dataset into a training set (N = 1467) and a test set (N = 723). The final models included 34 risk factors identified from previous literature. Postpartum pain was measured as "to what extent the pain interferes with mothers' daily life". PHQ2 scores measured depression. We used the random forest model, an aggregate of many regression trees, to accommodate potential nonlinear/interaction effects. In the test data set, our models explained 15.8% of the variance in pain and 27.1% of the variance in depression. The model's strongest predictors for postpartum pain were Cesarean delivery, holding back while communicating with providers, non-use of pain relief medications, and perceived discrimination. For depression scores, the model's strongest predictors included needing help for depression during pregnancy, perceived discrimination, holding back, gestational diabetes, and pain. Mental and physical health are intertwined and should be considered integratively in the perinatal period. Besides, practitioners should also be aware of the importance of patient-provider-relationship, which both independently and interact with other risk factors to predict postpartum health.

Assessment of In-Hospital Pain Control after Childbirth and Its Correlation with Anxiety in the Postpartum Period: A Cross-Sectional Study at a Single Center in the USA

Anxiety is common during the antepartum, intrapartum, and postpartum period. While the relationship between obstetric pain and depression is well characterized, there are few publications examining the relationship between obstetric pain and anxiety. Our objective was to characterize the association, if any, between postpartum pain and anxiety. This was a survey-based cross-sectional study. The general anxiety disorder (GAD)-7 and American Pain Society patient outcome questionnaire (APS-POQ) were completed by 64 postpartum participants at hospital discharge. Associations between anxiety and pain control were assessed. Participants with moderate to severe scores (greater or equal to 10) on the GAD-7 had more maximum pain scores (0 to 10 scale) in the severe range (greater or equal to 7) in the first (p = 0.049) and second (p = 0.010) 24 h periods after delivery and were more likely to have spent more time in severe pain within these time frames (p = 0.007 and p = 0.010, respectively). Similar relationships were observed when classifying anxiety ordinally. In conclusion, higher postpartum pain scores were associated with greater anxiety in the postpartum period.

Restrictive v/s Routine episiotomy in Primigravida

Introduction: Episiotomy is the surgical enlargement of the vaginal orifice by an incision on the perineum during the last part of the second stage of labour or delivery. Episiotomy is the most common surgical procedure experienced by women. In near past there were many studies pointed out its disadvantages like more post-delivery pain, wound complications and dyspareunia. So, this study was done to compare use of restrictive episiotomy and routine episiotomy in primigravidae undergoing vaginal birth. Aims and objectives: To assess the effects of restrictive use of episiotomy in comparison with routine episiotomy in primigravida during vaginal birth in terms of - (1) No. of episiotomies can be avoided (2) Perineal tear (3) Blood loss (4) Hematoma &amp; Healing complications (5) Faecal &amp; urinary incontinence (6) Dyspareunia. Material and methods: This study was descriptive analytic study conducted in the Department of Obstetrics and Gynecology, Surat municipal institute of medical education and research (SMIMER), Surat from January 2017 to June 2019 with sample size of 148 patients. Results: This study included total 148 patients, where 74 were selected randomly in each group. In Restrictive Episiotomy group, out of 74 patients, Episiotomy was required in 18 (24.32%) patients. Thus, Episiotomy was avoided in 56 (75.68%) patients. Mean duration of second stage of labour in Routine Episiotomy group was 31.88 ± 5.37min and in Restrictive Episiotomy group it was 32.35 ± 3.73min, which was suggestive of no statistically significant difference. (p value = 0.5375). Total 4.05% patients in Routine group and 13.51% patients in Restrictive group suffered from anterior vaginal tear which was statistically significant (p value = 0.021). There were 2 cases (18%) of 2nd degree perineal tear in routine episiotomy group which were 8(40%) in restrictive episiotomy group. The difference was statistically assessed by Chi-square and found to be significant (p value=0.2399). Not a single case of 3rd &amp; 4th degree perineal tear in either group. In Routine Episiotomy group, suturing was done in 100% patients. While restricted episiotomy group only 44.59% needed suturing which was statistically significant (p value:&lt;0.0001). Average blood loss in Routine group was 341.89 ± 49.33ml and in Restrictive group was 301.01 ± 52.41ml. So, there was significantly higher blood loss in Routine Episiotomy group. (p value= 0.000002). Complications rate in the form of episiotomy wound gap and hematoma was higher in routine group in 5.41% patients as compared to 1.35% patients in Restrictive group. Postpartum perineal pain at 1 week (14 v/s 5) and 2 weeks (5 v/s 1) was significantly higher in routine group as compared to the restrictive group. Postpartum perineal pain at 1 week and 2 weeks was significantly higher in routine group as compared to the restrictive group. Conclusion: In conclusion on the basis of our study, the immediate outcomes of routine episiotomy are no better than the restrictive use of episiotomy. Indeed, routine use is harmful to the degree that some proportion of women who would have had lesser injury instead had a surgical incision. The routine use of episiotomy has higher incidence of peripartum blood loss, requirement of suturing, postpartum perineal pain and healing complications. The policy of restrictive use of episiotomy is not associated with any third and fourth degree perineal tear or adverse neonatal outcomes.

DEEP RELAXATION TECHNIQUES TO REDUCE MIDDLE-LEVEL ANXIETY IN THE FIRST GESTATIONAL MOTHER IN THE TAKING-IN PHASE

Background: The postpartum period begins when the placenta is born and ends when the uterus returns to its normal state. During the postpartum period, physiological and psychological adaptations occur in the mother. One of the psychological conditions that can appear in postpartum mothers is anxiety. The process of pregnancy, childbirth, and the puerperium may cause anxiety, especially in primiparous mothers. Anxiety not treated immediately can lead to postpartum depression or baby blues syndrome. Objective: This research aims to apply nursing care, including assessment, diagnosis, intervention based on evidence-based practice, implementation, and evaluation of nursing Methods: The research method used interviews with patients and families and nurses' direct observations in the Visual Analog Scale for Anxiety (VAS-A) to measure anxiety levels. This research design was a case study with primiparous postpartum mothers who were given nursing intervention. Results: The patient experienced nursing problems of moderate level of anxiety, postpartum pain, knowledge deficit, and risk of infection. The primary intervention given to the patient is to provide non-pharmacological therapy using deep breathing relaxation techniques to reduce the patient's level of anxiety. Conclusion: Based on the results of nursing interventions given, it is explained that there is a decrease in the level of anxiety in patients. Thus, the patient's treatment plan was stopped and continued with self-care at home according to the recommendations given.

Women’s beliefs of pain after childbirth: Critical insight for promoting behavioral strategies to regulate pain and reduce risks for maternal mortality

ObjectivePromoting behavioral strategies to better regulate pain and decrease the use of prescription pain medications immediately after childbirth is an attractive approach to reduce risks for adverse outcomes associated with the maternal mortality crisis. This study aimed to understand women’s beliefs and experiences about pain management to identify important insights for promoting behavioral strategies to control postpartum pain. Methods: N = 32 postpartum women participated in a semi-structured interview about beliefs/experiences with managing postpartum pain. Higher- and lower-order themes were coded; descriptive statistics were used to summarize results. Results: Major trends emerging from the data were: (1) most women used a combination of medications (e.g., oxycodone and acetaminophen) and behavioral strategies (e.g., physical activity) in the hospital (94 %) and at discharge (83 %); (2) some women reported disadvantages like negative side effects of medications and fatigue from physical activity; and (3) some women reported they would have preferred to receive more evidence-based education on behavioral strategies during prenatal visits. Conclusion: Our findings showed that most women were prescribed medications while in the hospital and at discharge, and used non-prescription, behavioral strategies. Practical Implications: Future research is needed to test behavioral strategies in randomized clinical trials and clinical care settings to identify impact on reducing adverse maternal health outcomes.

Associations between postpartum pain type, pain intensity and opioid use in patients with and without opioid use disorder: a cross-sectional study

BackgroundPain is a multidimensional construct. The purpose of this cross-sectional, single-centre study was to evaluate the relationship between postpartum pain type with pain intensity and opioid use in people with and without opioid use disorder (OUD). MethodsPostpartum pain type was coded from McGill Pain Questionnaire and Patient-Reported Outcome Measurement Information System (PROMIS) inventories in people with or without OUD after childbirth in a 4-month period. The co-primary outcomes were pain intensity (0–10 scale) and total inpatient oxycodone (mg). Multivariable linear mixed-effects models assessed between- and within-person relationships for pain type (primary predictor) and outcomes. ResultsThere were 44 522 unique pain scores and types from 2610 people. Pain types were associated with pain intensity (P<0.001). Between-person comparisons showed affective pain was associated with a small but higher total oxycodone dose (difference 1.04 mg compared with no affective pain, P<0.001). Among people with OUD, within-person comparisons showed that the presence of affective pain resulted in pain scores 1 point higher than when affective pain was not present (P=0.002); between-person comparisons showed that people with affective pain had pain scores 6 points higher (P=0.048). Within-person and between-person comparisons among OUD showed that nociceptive/neuropathic pain was associated with a higher total oxycodone dose (1.6 and 11.4 mg, respectively). ConclusionsPostpartum pain type was associated with pain intensity and opioid use. Further research is required to address the multiple dimensions of postpartum pain in people with and without OUD to improve treatment of postpartum pain.

8442 Isthmocele Repair in Unusual Presentations

<h3>Study Objective</h3> To demonstrate unusual clinical presentations and surgical management of isthmocele. <h3>Design</h3> Surgical video. Two cases are presented of women with unusual presentations undergoing isthmocele repair. One video demonstrates a robot-assisted and hysteroscopic repair, while the other is a laparoscopic and hysteroscopic repair. <h3>Setting</h3> Academic tertiary care hospital. <h3>Patients or Participants</h3> A 30-year-old G1P1and a 33-year-old G1P1 were referred to a minimally invasive gynecologic surgeon for pelvic pain and abnormal uterine bleeding. <h3>Interventions</h3> The first patient was referred for evaluation of dysmenorrhea and dyspareunia. She had a known history of an emergent cesarean delivery. MRI demonstrated findings concerns for isthmocele. She underwent a hysteroscopy, robotic-assisted excision of endometriosis and isthmocele repair. The second patient was referred 3 months after her delivery for abnormal uterine bleeding. She presented with persistent abnormal uterine bleeding. Her cesarean was complicated by a left extension and postoperative hemorrhage leading to IR coiling of her left uterine artery and a take-back exploratory laparotomy for hemoperitoneum. MRI report described myometrial blood products continuous with the endometrial lining. She underwent a concomitant hysteroscopy and laparoscopic isthmocele repair. Given the left lateral location of her defect near the uterine insertion of the uterine artery, the left uterine artery was clipped at its origin during the surgery as a precautionary measure. The clip was later removed upon completion of the repair. During her surgery, an endometrioma was noted to overly the c-section scar defect. Both patients had full recoveries and were cleared for pregnancy 6 months after the repair. <h3>Measurements and Main Results</h3> Office hysteroscopy after both the procedures demonstrated no further appreciable defects. <h3>Conclusion</h3> Isthmocele presentations vary. Isthmoceles should remain high on a differential when working up a patient with post-partum pelvic pain and abnormal bleeding. Concomitant use of hysteroscopy during laparoscopic or robotic repair of isthmocele is recommended.

PENERAPAN KOMPRES DINGIN (ICE GEL) TERHADAP PENURUNAN NYERI LUKA EPISIOTOMI PADA PASIEN POST PARTUM DI RSUD Dr. SOESELO KABUPATEN TEGAL

This study aims to determine the application of cold compress (ice gel) to reduce episiotomy wound pain in post partum patients at RSUD Dr. Soeselo Tegal Regency. This research method is a descriptive method with the research design being a case study. The results of the case study study with cold compress therapy (ice gel) had a significant influence in reducing the scale of pain in post partum patients with episiotomy wound pain. There was a decrease in the pain scale of the two respondents, namely the level of the pain scale before being given cold compress therapy (ice gel) in patient 1 pain scale 6 and patient 2 pain scale 7, after being given cold compress therapy (ice gel) for 3 days to both patients the pain scale dropped to 2. The application of cold compress (ice gel) is recommended to be done 3 times a day for 3 days with a duration of 5-10 minutes at a temperature of 15o C to reduce pain. In conclusion, cold compress therapy (ice gel) can reduce episiotomy wound pain in post partum patients.Keywords : Pain, Episiotomy, Cold Compress.

Associations between postpartum pain, mood, and maternal–infant attachment and parenting outcomes

Pain and depression are interrelated, and worse postpartum pain has been associated with postpartum depression. It remains unclear whether improved pain and mood after delivery can also improve maternal parenting. Few studies have examined relationships between postpartum pain and negative mood (anxiety or depression) or their effects on parent–infant relationship outcomes. The purpose of this study was to explore the relationships between postpartum pain, mood, parent–infant attachment, parenting self-efficacy, and infant development. This was a prospective longitudinal observational pilot study of nulliparous women enrolled at the third trimester and presenting for labor and delivery at term gestation. Baseline third trimester assessments included validated inventories of pain (the brief pain inventory, BPI), depression (the Edinburgh postnatal depression screen, EPDS), anxiety (the state trait anxiety inventory, STAI), multidimensional scale of perceived social support (perceived social support scale, MSPSS) and perceived stress scale (PSS). Demographic and labor characteristics were recorded. At 6 weeks and 3 months postpartum, self-reported assessments included EPDS, STAI, BPI, maternal parent infant attachment scale (MPAS), and perceived maternal parenting self-efficacy (PMP-SE). Child development outcomes were assessed at 6 weeks and 3 months using the Ages and Stages Questionnaire (ASQ). Univariable linear regression assessed the relationships between pain and parenting outcomes (MPAS and PMP-SE), including potential interactions between pain and mood for parenting outcomes. Generalized linear modeling was used to explore the relationships between postpartum pain, parenting outcomes, and child development outcomes. Of 187 subjects, 87 had complete data on parent–infant attachment and parenting self-efficacy data at 3 months. Lower "pain right now" scores (BPI) on postpartum day 1 was associated with higher maternal–infant attachment (MPAS) at 6 weeks postpartum (Estimate − 1.8, 95% CI − 3.4 to − 0.2, P < 0.03) but not at 3 months (Estimate 0.23 95% CI − 1.1 to 1.6, P = 0.7). Higher depression (EPDS) scores at 6 weeks were also associated with lower MPAS scores at 6 weeks (Estimate − 1.24, 95% CI − 2.07 to − 0.40, P = 0.004). However, there was no evidence that the relationship between pain and MPAS varied by depression score at 6 weeks (P = 0.42). Pain scores at baseline, six weeks, or three months did not correlate with parenting outcomes (MPAS, PMP-SE) at six weeks or three months. Results of the generalized linear modeling revealed relationships between pain, age, anxiety (STAI), and depression (EPDS) predictors, and the outcomes of parenting (MPAS, PMP-SE) and gross motor and personal–social (ASQ) aspects of infant development. There is a pattern of association between worse postpartum pain, anxiety, and depression with worse parenting outcomes. Depression and pain may also affect infant development, but future work is required to replicate and characterize these potential relationships.

Variations in Postpartum Opioid Prescribing Practices among Obstetrician-Gynecologists.

There have been many efforts to combat the United States opioid crisis that has been occurring for the past two decades, specifically with postpartum patients that often were prescribed opioids. Prior studies described how accounting for usage of inpatient opioids on the day prior to discharge had an impact on how much discharge opioids were prescribed on the day of discharge. These studies provided a guideline to use the inpatient opioid amount from the day before discharge to determine discharge opioid quantity and minimize how much was being prescribed. In July 2018, the American College of Obstetrics and Gynecologists (ACOG) published Committee Opinion 742, guidelines for obstetricians-gynecologists about post-partum pain management. Prescription pain medications (including opioids, if necessary) require a shared decision-making approach between the physician and patient to determine the medication type and quantity. This study aimed to determine if there were differences in prescribing practices based on the specific post-operative day that opioid prescriptions were written, and if there were differences in the prescribing practices for cesarean deliveries following the publication of ACOG Committee Opinion 742. This retrospective chart review included patients who had a live cesarean birth at one rural Midwest facility anytime between July 1, 2017 and February 28, 2021. This study excluded those with chorioamnionitis and those discharged after more than four days. Opioid amounts were converted to oral morphine milligram equivalents (MME) for comparison, and total MME was calculated for each prescription. Patients were stratified into two groups based on the day that their discharge opioid medication prescriptions were written (i.e., a day prior to discharge or the day of discharge). Patients were also stratified based on date of delivery, before or after the publication of ACOG Committee Opinion 742. Of 411 cesarean patients, 93.9% (n = 386) had opioids prescribed at discharge, 86% (n = 330) of whom received a prescription written on the day of discharge. There was no difference in the quantity of MMEs, doses per day, or dosage from discharge prescriptions between those written on the day of discharge and those written on a prior day. Patients whose deliveries occurred after the publication of ACOG Committee Opinion 742 (63.9%, n = 263) received discharge prescriptions with fewer average MMEs (159.53 ± 61.64) than those whose deliveries occurred before the publication (36%, n = 148; 187.35 ± 53.42; χ2 (1, N = 411) = 17.71; p < 0.001), and they were prescribed fewer doses per day. After cesarean sections, the specific post-operative day did not seem to impact the prescribing trends as there were no differences in MMEs, doses per day, or dosage between prescriptions that were written on the day of discharge and before the day of discharge. Patients whose deliveries occurred after the publication of ACOG Committee Opinion 742 received discharge prescriptions with fewer MMEs, fewer doses per day, and the same dosage than those whose deliveries occurred before the publication, reflecting the overall national trend of decreasing prescription opioids over these years.

Association of pain, analgesic, psychological, and socioeconomic factors with sub-acute pain after childbirth: A prospective cohort study

Study objectiveTo determine if acute postpartum pain, psychological distress, socioeconomic factors, and labor analgesia were associated with sub-acute pain after childbirth (SAPC; pain starting after childbirth and lasting between four weeks to three months). DesignProspective cohort study, from pre-conception to post-partum three months. SettingSingapore's major public maternity institution. PatientsWe included women planning to conceive within a year. We excluded women who were pregnant, taking chemotherapy or psychotropic medications, had diabetes mellitus, received assisted fertility interventions or contraception, did not conceive after 12 months, with multiple pregnancies, or who developed obstetric complications. InterventionsNone. MeasurementsWe investigated the relationship between average pain score during the three days after childbirth (primary exposure) and incidence of SAPC at postpartum three months (primary outcome). Secondarily, psychological distress at pre-conception (Beck Depression Inventory (BDI), Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), General Health Questionnaire-12 (GHQ-12), Life Experiences Survey (LES)) and second trimester of pregnancy (BDI, EPDS, STAI, PSS, Pregnancy Experience Scale (PES)) were assessed. Baseline maternal and socioeconomic characteristics, labor analgesia, maternal and neonatal outcomes were also collected accordingly. Main resultsOf 317 women who met the study criteria, 30 (9.5%) developed SAPC. Higher average pain score during the three days after childbirth (adjusted odds ratio (aOR) 1.46, 95% CI 1.17 to 1.82, p = 0.001), use of meperidine for labor analgesia (aOR 4.23, 95% CI 1.03 to 17.43, p = 0.046), higher pre-conception GHQ-12 score (aOR 1.14, 95% CI 1.03 to 1.27, p = 0.013), and lack of employment with income during pregnancy (aOR 9.62, 95% CI 3.07 to 30.30, p < 0.001) were independently associated with SAPC, with area under the curve (AUC) of 0.837. ConclusionsHigher acute postpartum pain scores, use of meperidine for labor analgesia, poorer pre-conception general psychological health, and lack of employment with income during pregnancy are associated with SAPC.

Inflammatory Bowel Disease and Pregnancy

Inflammatory Bowel Disease and Pregnancy