Chronic pain related to childbirth : prevalence, characteristics, women’s experiences about its impact and support from healthcare

Abstract

Background: Pregnancy and labour often entail pain and tissue damage, which may lead to the development of chronic pain. Globally, chronic pain, defined as pain that persists after three months, is a leading cause of lasting suffering and disability. If pain is not timely diagnosed and adequately treated it can become a chronic condition. However, among healthcare professionals, there seems to be a lack of strategies for its prevention and treatment.

Aim: The aim of this thesis was to describe the prevalence and characteristics of chronic pain related to childbirth. Further aims were to explore women’s experiences of pain and its consequences as well as information and support from healthcare professionals.

Methods: Study I was conducted as a prospective cohort study, Studies II and IV had a qualitative approach, and Study III was a mixed methods study with a sequential explanatory design. In Study I, as well as in the first, quantitative part of Study III, data were obtained through two self-administered questionnaires and the patient record system, Obstetrix. The first questionnaire was distributed on the maternity ward, 24–36 h after labour between April and December 2015. The second questionnaire was sent by post eight months after childbirth. Data from 1,171 women, who answered the second questionnaire, were analysed using descriptive statistics. Studies II and IV as well as the second, qualitative part of Study III, had a qualitative approach and included 20 individual semi-structured interviews. Participants in these studies consisted of the same sample, recruited among women who had reported chronic pain related to pregnancy and/or labour in Study I. The interviews were conducted between June and November 2016, recorded and transcribed verbatim. The data were processed and analysed using inductive content analysis.

Results: The results of Study I showed that 17% of the women reported chronic pain related to childbirth. Approximately 80% rated their worst pain as moderate or severe and more than 40% of the women experienced pain constantly or daily. Dyspareunia related to childbirth was reported by 19% of the women, with approximately 60% experiencing their worst pain during intercourse as moderate or severe. Study II revealed that women constantly struggled with the pain and its consequences. Chronic pain had a negative impact on several aspects of women’s lives, including physical and social activities, psychological well-being, self-image, as well as their roles as partners and mothers. The results of Study III revealed that the majority of the women did not receive information about risks of developing chronic pain related to childbirth. They did not have knowledge about when and where to seek help, and half of them did not consult healthcare professionals. The lack of information also led to women feeling unprepared for the pain causing emotional distress. In addition, as Study IV revealed, when women turned to healthcare, they did not receive the attention, recognition, and support they needed. They reported not being listened to, not taken seriously, or believed by healthcare professionals and their pain was not assessed, diagnosed, or treated. The women felt abandoned after childbirth and forced to manage the condition on their own. There was an overall desire for more support and continuity regarding care as well as better knowledge among healthcare professionals.

Conclusions: Chronic pain eight months after childbirth was reported by one in six women and one in five experienced dyspareunia. Approximately 80% of the women rated their worst pain as moderate or severe, and more than 40% experienced pain constantly or daily. The pain and its consequences had a negative impact on several aspects of women’s lives. In addition, women did not receive adequate information or support from healthcare. In consequence, they did not seek help or when they did, their pain was not recognised, treated, or resolved. Living with pain as well as the lack of adequate information and support from healthcare may also lead to emotional distress. Together this may contribute to women’s suffering as well as an increased risk of development and maintenance of chronic pain. This thesis indicates a need to review the content and quality of current postpartum maternal care concerning pain assessment and management, as well as to develop standards and guidelines for prevention and treatment of pain persisting after pregnancy or labour.