Caesarean section (CS) birth is associated with pain and reduced mobility that impacts a woman’s ability to breastfeed and care for her newborn infant. Post-CS pain, difficulties in mobilising and medication side effects pose challenges to picking up the infant and breastfeeding; these factors may contribute to lower rates of exclusive or any breastfeeding after CS birth. Anaesthetic type, postpartum pain levels and use of analgesia differ between women after CS. A better understanding of post-CS pain and analgesia use is needed to optimise maternal comfort and safety of the breastfeeding dyad in the postpartum period. We analysed an existing dataset of
n = 824 online anonymous survey responses from Australian women who gave birth via CS within the previous 12 months [
1]. Participants provided details of their CS birth and breastfeeding experiences, pain ratings (range 0–10) in the hours and days after birth and in the first two weeks after discharge and post-discharge analgesia use. The aim of this secondary analysis was to determine early postpartum maternal pain scores and analgesia use after CS birth. We also explored associations between biopsychosocial factors, pain scores and post-discharge analgesia use.
Descriptive statistics were used to summarise postpartum pain ratings and analgesia use in the first two weeks after hospital discharge. Linear mixed model and linear regression tested for associations between biopsychosocial factors and pain scores over time, and pain in the first two weeks after discharge, respectively. Logistic regression models were used to investigate associations with opioid consumption and the duration of non-opioid analgesia use after discharge. Median (Q1, Q3) pain scores were 3 (1, 6) in the early hours and 6 (4, 8) in the first few days after birth, and 5 (3, 7) in the first two weeks after discharge. Participants who had a non-elective lower uterine segment CS (NELUSCS) reported higher pain scores in the first few days after birth (β = 0.40; 95% CI 0.01, 0.79; p = 0.043) and in the first two weeks after discharge (β = 0.67; 95% CI 0.28, 1.07; p < 0.001) when compared to those who had an elective lower uterine segment CS (ELUSCS). Unmet birth expectations (β = 0.60; 95% CI 0.15, 1.06; p = 0.010) and birth trauma (β = 0.55; 95% CI 0.09, 1.00; p = 0.020) were also associated with higher pain scores in the first two weeks after discharge in the marginal model; however, NELUSCS was no longer significant (β = –0.06; 95% CI −0.52, 0.40; p = 0.79). CS birth at a private hospital was associated with lower pain scores in the first two weeks after discharge (β = −0.76; 95% CI −1.11, −0.41; p < 0.001). Most participants used paracetamol (95.8%) and NSAIDs (81.9%), while over half used at least one type of opioid analgesia in the first two weeks after discharge (ELUSCS: 62.3%, NELUSCS: 65.4%). Higher early postpartum pain ratings were associated with greater odds of opioid use after discharge (OR = 1.15; 95% CI 1.06, 1.23; p < 0.001), and an interaction effect was observed between CS type and hospital setting, with NELUSCS at private hospitals associated with increased odds of opioid consumption after discharge (OR = 2.48; 95% CI 1.25, 5.01; p < 0.001). NELUSCS was associated with a longer duration of paracetamol consumption after discharge (OR = 1.38, 95% CI 1.07, 1.80, p = 0.015).
Postpartum pain and analgesia use is higher after NELUSCS birth, indicating the need for the refinement of enhanced recovery after caesarean (ERAC) protocols to improve maternal and breastfeeding outcomes after an unplanned CS birth. Furthermore, psychosocial factors may explain differences in postpartum pain and warrant further investigation. The optimisation of pain management may include using interventions before and after CS birth, with the additional benefit of reducing opioid consumption in line with recommended opioid stewardship practices to minimise risks to the breastfeeding dyad.
Author Contributions
Conceptualization, S.L.P., S.G.A., S.A.P. and D.T.G.; methodology, S.L.P., P.V. and J.E.H.; software, J.L.M.; formal analysis, J.E.H., C.T.L. and P.V.; investigation, S.G.A., J.E.H. and S.L.P.; resources, D.T.G.; data curation, J.L.M.; writing—original draft preparation, J.E.H.; writing—review and editing, P.V., S.G.A., J.L.M., D.T.G. and S.L.P.; supervision, D.T.G. and S.L.P.; project administration, J.L.M.; funding acquisition, D.T.G. All authors have read and agreed to the published version of the manuscript.
Funding
This research was funded by an unrestricted research grant from Medela AG (Switzerland). The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki. The study was approved by the Human Research Ethics Committee at the University of Western Australia (2022/ET000174) and conducted in accordance with the relevant guidelines and regulations.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
Restrictions apply to the availability of some, or all data generated or analysed during this study. The corresponding author will on request detail the restrictions and any conditions under which access to some data may be provided.
Acknowledgments
We thank all of the participants for their help with this research.
Conflicts of Interest
D.T.G. declares past participation in the Scientific Advisory Board of Medela S.G.A., J.L.M., C.T.L., D.T.G. and S.L.P. are supported by an unrestricted research grant from Medela AG, administered by the University of Western Australia. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. All other authors declare no conflicts of interest.
Reference
- Perrella, S.L.; Abelha, S.G.; Vlaskovsky, P.; McEachran, J.L.; Prosser, S.A.; Geddes, D.T. Australian Women’s Experiences of Establishing Breastfeeding after Caesarean Birth. Int. J. Environ. Res. Public Health 2024, 21, 296. [Google Scholar] [CrossRef]
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