Postoperative pain after cesarean birth affects breastfeeding and infant care.

OBJECTIVE To study women's experience of postoperative pain and pain relief after cesarean birth and factors associated with pain assessment and the birth experience. DESIGN Descriptive patient survey. Data were collected through a questionnaire. The outcome variables were assessments of pain using a Visual Analog Scale and women's birth experience measured on a seven-point Likert scale. SETTING Central Swedish county hospital, maternity unit. PATIENTS/PARTICIPANTS The sample consisted of 60 women undergoing cesarean birth. RESULTS Women reported high levels of experienced pain during the first 24 hours. Seventy-eight percent of the women scored greater than or equal to 4 on the Visual Analog Scale, which can be seen as inadequately treated pain. There was no difference between elective and emergency cesarean births in the levels of pain. In spite of high levels of pain, women were pleased with the pain relief. The risk of a negative birth experience was 80% higher for women undergoing an emergency cesarean birth compared with elective cesarean birth. Postoperative pain negatively affected breastfeeding and infant care. CONCLUSIONS There is a need for individual and adequate pain treatment for women undergoing cesarean birth, as high levels of pain interfere with early infant care and breastfeeding.

[1]  J. Chong,et al.  Single dose diclofenac suppository reduces post-Cesarean PCEA requirements , 2001, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[2]  D. Bick,et al.  Postnatal Care: Evidence and Guidelines for Management , 2002 .

[3]  I. Hildingsson,et al.  A negative birth experience: prevalence and risk factors in a national sample. , 2004, Birth.

[4]  U. Waldenström,et al.  The childbirth experience: a study of 295 new mothers. , 1996, Birth.

[5]  J. Grass,et al.  Patients' versus nurses' assessments of pain and sedation after cesarean section. , 1995, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[6]  J. Monagle,et al.  Oral Medication for Post‐Caesarean Analgesia , 1998, The Australian & New Zealand journal of obstetrics & gynaecology.

[7]  M. Douglas,et al.  Rectal Indomethacin Potentiates Spinal Morphine Analgesia after Caesarean Delivery , 1995, Anaesthesia and Intensive Care.

[8]  T. Lavender,et al.  A prospective study of women's views of factors contributing to a positive birth experience. , 1999, Midwifery.

[9]  B. Fridlund,et al.  Survey of post-operative patients' pain management. , 1997, Journal of nursing management.

[10]  H. Kehlet.  Postoperative Pain Relief: A Look From the Other Side , 1993, Regional Anesthesia & Pain Medicine.

[11]  H. Breivik.  Postoperative pain management: why is it difficult to show that it improves outcome? , 1998, European journal of anaesthesiology.

[12]  G. Lindmark,et al.  Physical symptoms after childbirth: prevalence and associations with self‐rated health , 2005, BJOG : an international journal of obstetrics and gynaecology.

[13]  A. Stubhaug,et al.  Additive analgesic effect of codeine and paracetamol can be detected in strong, but not moderate, pain after Caesarean section , 1996, Acta anaesthesiologica Scandinavica.

[14]  H. Kehlet,et al.  The Value of “Multimodal” or “Balanced Analgesia” in Postoperative Pain Treatment , 1993, Anesthesia and analgesia.

[15]  C. Olofsson,et al.  Diclofenac in the treatment of pain after caesarean delivery. An opioid-saving strategy. , 2000, European journal of obstetrics, gynecology, and reproductive biology.

[16]  M. Rorarius,et al.  Diclofenac and ketoprofen for pain treatment after elective caesarean section. , 1993, British Journal of Anaesthesia.

[17]  I. Lundgren.  Releasing and relieving encounters: experiences of pregnancy and childbirth. , 2004, Scandinavian journal of caring sciences.

[18]  K. Stolte.  A comparison of women's expectations of labor with the actual event. , 1987, Birth.

[19]  Cesarean childbirth and psychosocial outcomes: a meta-analysis. , 1996 .

[20]  A. Williams.  Handbook of pain assessment , 1995 .

[21]  S. Brown,et al.  Satisfaction with care in labor and birth: a survey of 790 Australian women. , 1994, Birth.

[22]  J. Chung,et al.  Postoperative pain management: study of patients' level of pain and satisfaction with health care providers' responsiveness to their reports of pain. , 2003, Nursing & health sciences.

[23]  L. Dahlgren,et al.  Strategies used in post-operative pain assessment and their clinical accuracy. , 2000, Journal of clinical nursing.

[24]  E. Coetzee,et al.  Postoperative Sensitization and Pain After Cesarean Delivery and the Effects of Single IM Doses of Tramadol and Diclofenac Alone and in Combination , 2003, Anesthesia and analgesia.

[25]  K. Rothman.  Epidemiology: An Introduction , 2002 .

[26]  A. Baraka,et al.  Diclofenac and/or Propacetamol for Postoperative Pain Management After Cesarean Delivery in Patients Receiving Patient Controlled Analgesia Morphine , 2000, Regional Anesthesia & Pain Medicine.

[27]  W. Gogarten.  Spinal anaesthesia for obstetrics. , 2003, Best practice & research. Clinical anaesthesiology.

[28]  M. Tunstall,et al.  Postnatal pain: a neglected area , 1993 .

[29]  H. Churchill.  Caesarean birth : experience, practice, and history , 1997 .

[30]  L. Berggren,et al.  Organization of acute pain services: a low-cost model , 1994, Pain.

[31]  B. Lundman,et al.  Postpartum care should provide alternatives to meet parents' need for safety, active participation, and 'bonding'. , 2003, Midwifery.

[32]  I. Hildingsson,et al.  Few women wish to be delivered by caesarean section , 2002, BJOG : an international journal of obstetrics and gynaecology.

[33]  W. Edwards,et al.  Management of Acute Pain: A Practical Guide , 1992 .

[34]  A. Gift,et al.  Visual Analogue Scales: Measurement of Subjective Phenomena , 1989, Nursing research.

[35]  J. Itskovitz‐Eldor,et al.  Oral analgesia in the treatment of post-cesarean pain. , 2000, European journal of obstetrics, gynecology, and reproductive biology.

[36]  M. Reidenberg,et al.  Barriers to better pain control in hospitalized patients. , 1999, Journal of pain and symptom management.

[37]  M. Sjöling,et al.  The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management. , 2003, Patient education and counseling.

[38]  I. Hildingsson,et al.  Women's perspectives on maternity services in Sweden: processes, problems, and solutions. , 2007, Journal of midwifery & women's health.

[39]  U. Waldenström,et al.  Does a traumatic birth experience have an impact on future reproduction? , 2002, BJOG : an international journal of obstetrics and gynaecology.

[40]  A. Santos,et al.  Post-Cesarean Delivery Analgesia , 2005, Anesthesia and analgesia.

[41]  B. Sjöström.  Assessing acute postoperative pain : assessment strategies and quality in relation to clinical experience and professional role , 1995 .

[42]  H. Owen,et al.  Postoperative pain therapy: a survey of patients' expectations and their experiences , 1990, Pain.

[43]  U. Waldenström,et al.  Experience of labor and birth in 1111 women. , 1999, Journal of psychosomatic research.

[44]  E. Svensson,et al.  Lack of interchangeability between visual analogue and verbal rating pain scales: a cross sectional description of pain etiology groups , 2005, BMC medical research methodology.

[45]  U. Waldenström.  Why do some women change their opinion about childbirth over time? , 2004, Birth.