Resolution of pain after childbirth

Abstract

Background: Chronic pain after surgery occurs in 10-40% of individuals, including 5-20% of women after cesarean delivery in previous reports. Pain and depression 2 months after childbirth are independently associated with more severe acute post-delivery pain. Here we examine other predictors of pain at 2 months and determine the incidence of pain at 6 and 12 months after childbirth.

Methods: Following Institutional Review Board approval, 1228 women were interviewed within 36 h of delivery. Of these, 937 (76%) were successfully contacted by telephone at 2 months, and, if they had pain, at 6 and 12 months after delivery. The primary outcome measure was presence of pain which began at the time of delivery. We also generated a model of severity of acute post-delivery pain and 2 month pain and depression.

Results: Pain which began at the time of delivery was remarkably rare 6 and 12 months later (1.8% and 0.3% [upper 95% confidence limit, 1.2%], respectively). Past history of pain and degree of tissue damage at delivery accounted for 7.0% and 16.7%, respectively, of one aspect in the variability in acute post-delivery pain. Neither of these factors was associated with incidence of pain 2 months later.

Conclusions: Using a definition of new onset pain from delivery, we show a remarkably low incidence of pain 1 yr after childbirth, including those with surgical delivery. Additionally, degree of tissue trauma and history of chronic pain, risk factors for pain 2 months after other surgery, were unimportant to pain 2 months after cesarean or vaginal delivery.

Figures

Figure 1

Participant disposition for both aspects of the data analysis

Figure 2

Pain incidence after delivery, observed or calculated with the pain drop out model. In addition, multiple imputation model results are shown as small dots with their median and 95% confidence intervals. MI = multiple imputation

Figure 3

Predictive model for acute pain after delivery and its application to pain and depression 2 months later. Acute pain after delivery was significantly modeled by each of three factors, patient characteristics, pain history, and tissue damage. These factors failed, however, to result in significant odds ratio (OR) for pain at 2 months (red), although patient characteristics and pain history did significantly affect the OR for depression (blue). *P