Experience, impact and expectations: a longitudinal study of postpartum perineal pain

Abstract • Background: o Perineal pain is a prevalent issue whose proper assessment is essential to improving postpartum health outcomes. There is currently no validated tool for assessing postpartum perineal sensation as a unique phenomenon with a range of experiences. This study examines the connection between maternal and birth characteristics and the intensity, description, impact, and management of perineal pain up to three months postpartum. • Methods: o A longitudinal descriptive mixed methods study was conducted including prospective cross-sectional quantitative data obtained from sixty-one participants recruited in a hospital-based postnatal unit within two days postpartum. Background demographic data were collected in a structured questionnaire at recruitment. Pain intensity, nature, normality, relief, impact on daily life, and perineal function data were collected via identical structured questionnaires at the time of recruitment (Q1), 2 weeks (Q2), and 3 months postpartum (Q3). • Results: o Immediately postpartum, mean pain ratings were 3.67 (s.d. +/- 2.53) and higher ratings were associated with induction of labour, multiparity, and instrumental delivery. Intensity decreased over time, average scores being 0.33 at Q3. Perineal pain was not limited to those with perineal trauma. Pain was not the most frequently used word by participants more prevalent were discomfort and swollenness. Multiparas were more likely than primiparas to perceive sensations as normal (92% vs 65%). Impact on daily life and perineal function did not show the pattern of linear decrease over time that was seen with pain intensity. Pain continued to impact daily life and perineal function for a majority of participants at Q3. Areas of life most negatively impacted changed over timeStrong impact of pain on daily life was associated with lower levels of function • Conclusions: o Perineal pain was confirmed to be a prevalent postpartum concern with lasting impact on daily functioning. Diversity in description of perineal sensations may be related to higher rates of reported perineal pain in this study. This research provides a foundation for improving perineal pain assessment, specifically wording used for inquiring about perineal pain. This will improve care in clinical settings. It also opens avenues for future research about expectations, impact, and perception of postpartum pain.