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Raising awareness about chronic pain and dyspareunia among women: A Swedish survey 8 months after childbirth
Sophiahemmet University.ORCID iD: 0000-0002-9667-4995
2020 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 20, no 3, p. 565-574, article id /j/sjpain.ahead-of-print/sjpain-2019-0163/sjpain-2019-0163.xmlArticle in journal (Refereed) Published
Abstract [en]

Background and aims

Although several studies have been conducted, knowledge about chronic pain and dyspareunia after childbirth is still limited. The aim of this study was to explore the prevalence of chronic pain 8 months after childbirth in a cohort of Swedish women. The characteristics of chronic pain, such as, pain intensity, localization and frequency as well as pain interference with daily activities were examined. An additional aim was to describe the prevalence and intensity of dyspareunia.

Methods

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, to Swedish-speaking women who had given birth to a living child (n = 1,507). The second questionnaire was sent by post 8 months after childbirth. We collected data about demographic and social characteristics, pain presence and its onset, as well as pain intensity, frequency, bodily localization and pain interference with activities of women's daily life. Results In total, 1,171 (77.7%) responded to both questionnaires and were included in the analysis. Eight months after giving birth, totally 16.7% (195/1,171) of the women reported chronic pain related to childbirth. Of these, 9.1% (106/1,171) of women reported chronic pain with onset during pregnancy, 4.5% (53/1,171) experienced chronic pain with onset following labour and 3.1% (36/1,171) of women had both chronic pain with onset during pregnancy and chronic pain with onset following labour (each participant could only appear in one of the groups). Women reported a lower prevalence of chronic pain after vaginal delivery than caesarean section (61/916, 6.7% vs. 28/255, 11%, p = 0.021, OR 1.73, 95% CI 1.1-2.8). Moreover, 19.2% (211/1,098) of women experienced dyspareunia. There was no difference regarding prevalence of dyspareunia and the mode of delivery. Of those women who had a vaginal delivery, 19.5% (167/858) experienced pain during intercourse and the corresponding number for women after caesarean section was 18.3% (44/240) (p = 0.694, OR 0.929, CI 0.6-1.3). Approximately 80% of women with chronic pain, and 60% of women that experienced dyspareunia, rated their worst pain as moderate or severe (NRS 4-10). The corresponding number regarding average chronic pain was between 50 and 70%. More than 35% of the women with chronic pain scored pain interference with daily activities as ≥4 on a 0-10 NRS.

Conclusions

In our study, chronic pain 8 months after childbirth was reported by one in six women and one in five of the women experienced dyspareunia. The intensity of both chronic pain and dyspareunia was reported as moderate to severe in a significant proportion of women and chronic pain interfered considerably with daily activities. Implications There is a need to raise awareness among healthcare providers of this clinical problem as well as to revise and upgrade education regarding pain after childbirth to prevent potential long-term health problems, women's suffering and increased need for health care. The development of strategies for prevention, follow-up and treatment of pain is warranted. More research, including women's experiences of pain as well as intervention studies, are also needed.

Place, publisher, year, edition, pages
2020. Vol. 20, no 3, p. 565-574, article id /j/sjpain.ahead-of-print/sjpain-2019-0163/sjpain-2019-0163.xml
Keywords [en]
childbirth, chronic pain, dyspareunia, labour, pregnancy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:shh:diva-3716DOI: 10.1515/sjpain-2019-0163PubMedID: 32383691OAI: oai:DiVA.org:shh-3716DiVA, id: diva2:1431161
Available from: 2020-05-19 Created: 2020-05-19 Last updated: 2022-12-15Bibliographically approved
In thesis
1. Chronic pain related to childbirth: Prevalence, characteristics, women's experiences about its impact and support from healthcare
Open this publication in new window or tab >>Chronic pain related to childbirth: Prevalence, characteristics, women's experiences about its impact and support from healthcare
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2022. p. 63
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4685 (URN)9789180167789 (ISBN)
Public defence
2022-12-09, Weitnersalen, Sophiahemmet Högskola, Valhallavägen 91, hus R, plan 2, Stockholm, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2022-12-15 Created: 2022-12-15 Last updated: 2022-12-15Bibliographically approved

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