Persistent Pain Rates Are Similar After C-Section, Vaginal Deliveries

SAN FRANCISCO — Eight weeks after giving birth, about 1 in 10 patients reported persistent delivery-related pain regardless of whether they were delivered vaginally or by cesarean section in a study of 972 U.S. women.

“Previous reports may have overestimated the incidence of persistent pain” after C-section, said Dr. Peter H. Pan, a professor of anesthesiology at Wake Forest University, Winston-Salem, N.C.

There were no significant differences in the severity of pain or its effect on daily activities between the 668 women who delivered vaginally and the 304 who underwent C-section in this multicenter prospective study, he said at the annual meeting of the American Society of Anesthesiologists.

In the vaginal delivery group, 10% reported delivery-related pain at 8 weeks post partum, and 49% of these said the pain affected their daily activities. In the C-section group, 9% had persistent pain 8 weeks after delivery, and 45% of these said it affected their daily activities, reported Dr. Pan and his associates.

Previous studies of persistent pain after delivery either were retrospective or included only small cohorts of women outside the United States. Investigators in one study reported persistent perineal pain 6–24 weeks after vaginal delivery in 4%–7% of women. Researchers in a separate study reported that 18% of women had persistent pain at 3 months post partum and 12% had pain after 10 months.

The current study enrolled women while they were in the hospital for delivery and had them complete a questionnaire and interview to assess preexisting pain syndromes, psychological factors, and sensory perception and sensitivity. The patients were contacted telephonically 8 weeks later to assess the presence of pain related to delivery, its severity and location, its impact on daily living, and the presence of clinical depression. Women reporting delivery-related pain at 8 weeks post partum are being reinterviewed at 6 and 12 months post partum.

Women with third-degree perineal tears or episiotomies were more likely to report persistent pain, but this was not true of women with less severe lacerations, Dr. Pan said. There was no significant difference between primary or repeat C-sections as predictors for persistent pain, statistical analysis suggested.