The Symptom Experience of Postpartum Pain after Cesarean Birth

The Symptom Experience of Postpartum Pain after Cesarean Birth Emily G. Chin, Ph.D. Department of Women, Children, and Family Health Science University of Illinois at Chicago Chicago, Illinois 2012 Dissertation Chairperson: Dr. Catherine Vincent Pain is a common experience after all births, particularly after cesarean birth, where pain has been reported as more intense and longer lasting when compared to vaginal birth. Postpartum pain has detrimental implications for both the infant and mother by interfering with infant care, breastfeeding exclusivity, and maternal sleep. This study was guided by the University of California at San Francisco (UCSF) symptom management theory, focusing on the symptom experience components of perception, evaluation, and response. The study aim was to comprehensively describe the symptom experience of postpartum pain after cesarean birth, reflecting the 4 dimensions (sensory, affective, cognitive, and behavioral) and 2 types (nociceptive and neuropathic) of pain. In this concurrent mixed-methods study, thirty participants scheduled for a cesarean birth at an academic medical center were recruited. Data were collected at 24 to 48 hours after birth and at 6 weeks postpartum. Through the PAINReportIt (computerized McGill Pain Questionnaire) and an open ended interviews, participants described their pain in terms of the 3 symptom experience components, 4 pain dimensions, and words reflective of the 2 pain types. Regarding pain symptom experience, participants perceived the change in sensation, evaluated the impact on their lives, and responded with behavioral changes. For pain dimensions, participants reported mild pain intensity; on a 0-10 scale, at 24 to 48 hours mean pain score was 2.75 (+/- 1.8) and at 6 weeks 1.1 (+/- 2.4). In spite of these mild pain scores, most participants described their pain as aching, cramping, tender, and sore; for many, these descriptions persisted at 6 weeks. Most participants expected their pain and were satisfied with their pain level. Pain affected participants’ actions such as lifting and affected their roles with partners and children. Participants selected pain descriptors associated with nociceptive (e.g., cramping, tender, and sore) and neuropathic (e.g., aching) pain at both visits. The symptom experience of pain is multidimensional, individual, and complex. The symptom management theory provided a valuable framework and PAINReportIt and interview comprehensive measures to describe this phenomenon.