The pain of childbirth may linger for several weeks after vaginal delivery for women, according to a new study.
Researchers say most pregnancy-related pain relief efforts have been focused on labor and delivery or post-cesarean (C-section) pain, but pain in the genital area after a vaginal delivery has not gotten the same attention.
In their study, Canadian researchers found 92 percent of women complained of significant pain in the area between the vulva and anus, known as the perineum, on the day after vaginal delivery. That percentage dropped to 61 percent and 7 percent seven days and six weeks after childbirth, respectively.
The results showed that the frequency and duration of perineal pain were related to the degree of trauma or tearing of the perineum that occurred during childbirth, or use of an episiotomy, a surgical procedure that widens the birth canal.
Despite these complaints of significant pain and dysfunction, researchers say they were disturbed to find that women seldom used prescription or nonprescription pain relievers to treat their perineal pain once discharged from the hospital.
Pain After Vaginal Delivery May Linger
In the study, which appears in the November issue of the American Journal of Obstetrics and Gynecology, researchers tracked post-partum pain in 445 women who delivered babies vaginally at a hospital in Toronto, Canada.
The study showed trauma to the perineum was more common among women who delivered their first child, those who had an episiotomy during vaginal delivery, and those who had an epidural for pain relief during the second stage of labor.
The researchers say that on day one (the day of delivery), the women who reported trauma to the perineal were 30 percent more likely to report perineal pain compared with women without trauma.
Also the percentage of women who reported perineal pain up to one week after childbirth varied among the women depending on the degree of perineal trauma. For example:
—75 percent of women with an intact perineum reported pain one day after childbirth, and 38 percent a week later.
—95 percent of women with 1st or 2nd degree tears in the perineum, involving skin and muscle of the vagina, reported pain one day after delivery, and 60 percent one week later.
—97 percent of women who had an episiotomy reported perineal pain 1 day after childbirth, 71 percent 7 days later.
—100 percent of women who had 3rd or 4th degree tears, an extension of the episiotomy to or through the rectum, reported pain 1 day following vaginal delivery, and 91 percent 7 days later.
—Only 7 percent of women reported perineal pain six weeks after childbirth and the rates did not differ between the different trauma groups.
Non-drug pain relieving therapies, such as sitz baths, ice packs, and wash bottles, were used by about three-fourths of the women on the first day after childbirth, and by day seven about half of the women were still using these therapies for pain relief.
Researchers say the reluctance to use pain relievers to ease their pain may stem from the recommended avoidance of medications during pregnancy, a lack of education about perineal pain, or simply not having enough time as new mothers to treat themselves.
By Jennifer Warner, reviewed by Brunilda Nazario, MD
SOURCE: Macarthur, A. American Journal of Obstetrics and Gynecology, November 2004; vol 191: pp 1199-1204.
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