Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20240007-en
Brazilian Journal of Pain
Artigo Original

The pain reported by postpartum women in rooming-in according to the mode of delivery

Dor relatada por puérperas no alojamento conjunto segundo a via de nascimento

Mariana Nunes Miranda Carasek da Rocha; Roxana Knobel; Yasmin Lima Gouveia Arruda; Vitor Leonardo Nandi; Jessica Goedert Pereira; Manuela Beatriz Velho

http://dx.doi.org/10.5935/2595-0118.20240007-en BrJP, vol.7, e20240007, 2024
PDF English
PDF Português
SciELO
Downloads: 0
Views: 39

Abstract

BACKGROUND AND OBJECTIVES: Pain is the most frequently reported symptom in the immediate puerperium. The aim of this study was to quantify pain levels and sociodemographic, obstetric, and care characteristics associated with severe pain and inadequate analgesia according to the mode of delivery.
METHODS: Observational, descriptive, cross-sectional study conducted between October and December 2020, with a sample of 229 postpartum women considered eligible (baby born alive, weighing > 500 g and/or gestational age > 22 weeks) to answer the study questionnaire.
RESULTS: The mean reported pain was 5.34 by Visual Analogue Scale (VAS) and there was a difference (p<0.001) between modes of delivery. Cesarean section was associated with severe pain (p=0.006) and pain above eight on the VAS (p=0.02). Vaginal delivery was associated with the perception of inadequate analgesia (p=0.04). Severe pain reported was associated with the admission of the baby to the ICU (p=0.01) and cases of postpartum hemorrhage (p=0.002). Among women who gave birth vaginally, there was an association between severe pain and instrumental delivery (p=0.05). Reported severe pain was associated with difficulties in self-care (p<0.001) and care of the newborn (p= 0.02), sensation of weakness (p<0.001), and fainting (p=0.002). The perception of inadequate analgesia was associated with vaginal birth (p=0.04) end non-white skin color (p=0,03).
CONCLUSION: The average reported pain was moderate. Intense pain and the perception of inadequate analgesia were associated with instrumental delivery, newborns being referred to the NICU, postpartum hemorrhage, and non-white skin color.

Keywords

Cesarean section, Cross-sectional study, Postpartum period, Vaginal delivery.

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor é o sintoma mais frequentemente relatado no puerpério imediato. O objetivo deste estudo foi quantificar os níveis de dor e as características sociodemográficas, obstétricas e da assistência associadas à dor intensa e à percepção de analgesia inadequada segundo a via de nascimento. 
MÉTODOS: Estudo observacional, descritivo, transversal, conduzido entre outubro e dezembro de 2020, com uma amostra de 229 puérperas consideradas elegíveis (nativivos com peso > 500g e/ou idade gestacional > 22 semanas) para responder ao questionário do estudo.
RESULTADOS: A média de dor relatada foi 5,3 pela Escala Analógica Visual (EAV) e houve diferença (p<0,001) entre as vias de nascimento. A cesariana apresentou associação com dor intensa referida (p=0,006) e dor acima de oito pela EAV (p=0,02). O parto vaginal obteve associação com percepção de analgesia inadequada (p=0,04). Entre as mulheres que referiram dor intensa, houve associação com recém-nascido encaminhado à unidade de terapia intensiva neonatal (UTIN) (p=0,01) e nos casos de hemorragia pós-parto (p=0,002). Entre as mulheres que tiveram parto vaginal, também houve associação entre dor intensa e o parto instrumental (p=0,05). Dor intensa referida teve associação com dificuldades para o autocuidado (p<0,001) e do recém-nascido (p=0,02), sensação de fraqueza (p<0,001) e de desmaio (p= 0,002). A percepção de analgesia inadequada esteve associada a parto vaginal (p=0,04) e cor da pele não branca (p=0,03).
CONCLUSÃO: A média de dor relatada foi moderada. Dor intensa e percepção de analgesia inadequada estiveram associadas com parto instrumental, recém-nascido encaminhado à UTIN, hemorragia pós-parto e cor de pele não branca. 

Palavras-chave

Cesariana, Dor, Estudo transversal, Parto normal, Período pós-parto

Referências

1 Tomasoni TA, Silva JB, Bertotti TC, Perez J, Korelo RI, Gallo RB. Pain intensity and immediate puerperal discomforts. BrJP. 2020;3(3):217-21.

2 Guerra BO, Lobato G, Nakamura-Pereira M, Rezende-Filho J. Puerpério. In: Rezende-Filho J, Braga A, Junior JA, Nakamura-Pereira M, Amorim M, Nomura R, eds. Rezende Obstetrícia. Guanabara Koogan; 2022. 255-63p.

3 DeSantana JM, Perissinotti DMN, Oliveira Junior JO, Correia LMF, Oliveira CM, Fonseca PR. Revised definition of pain after four decades. BrJP. 2020;3(3):197-8.

4 Dutra LR, Araújo AM, Micussi MT. Non-pharmacological therapies for postpartum analgesia: a systematic review. BrJP. 2019;2(1):72-80.

5 Deussen AR, Ashwood P, Martis R, Stewart F, Grzeskowiak LE. Relief of pain due to uterine cramping/involution after birth. Cochrane Database Syst Rev. 2020;(10):CD004908.

6 Wuytack F, Smith V, Cleary BJ. Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period. Cochrane Database Syst Rev. 2021;2021(1):CD011352.

7 Silva AM, Santos LM, Cerqueira EA, Carvalho ES, Xavier AS. Characterization of pain resulting from perineal trauma in women with vaginal delivery. BrJP. 2018;1(2):158-62.

8 He S, Jiang H, Qian X, Garner P. Women’s experience of episiotomy: a qualitative study from China. BMJ Open. 2020;10(7):e033354.

9 Brito APA, Caldeira CF, Salvetti MG. Prevalence, characteristics, and impact of pain during the postpartum period. Rev Esc Enferm USP. 2021;55:e03691.

10 Silva KTV, Gervasio MDG, Cuenca AMB. Lei do acompanhante na mídia: a pandemia e suas implicações nos direitos do parto. Saúde e Soc. 2023;32:e220540pt.

11 Paixão GPN, Campos LM, Carneiro JB, Fraga CDS. A solidão materna diante das novas orientações em tempos de SARS-COV-2: um recorte brasileiro. Rev Gaúcha Enferm. 2021;42:e20200165.

12 Alderete G, Ferreira H, França AFO, Contiero AP, Zilly A, Silva RMM. Repercussões da pandemia da COVID-19 na atenção à mulher no trabalho de parto e parto: estudo transversal. Cogitare Enferm. 2023;28:e86841.

13 Morden MV, Ferris EJE, Furtmann J. The socioemotional impact of the COVID-19 pandemic on pregnant and postpartum people: a qualitative study. CMAJ Open. 2023;11(4):E716-E724.

14 Srinidhi R, D’lima SK, Shahanaz, Mateti UV, Sonkusare S. Assessment of pain and maternal complications after normal vaginal delivery. J Obstet Gynaecol. 2022;42(5):989-93.

15 Makeen M, Farrell LM, LaSorda KR, et al. Associations between postpartum pain, mood, and maternal-infant attachment and parenting outcomes. Sci Rep. 2022;12(1):17814.

16 Babazade R, Vadhera RB, Krishnamurthy P, Varma A, Doulatram G, Saade GR, Turan A. Acute postcesarean pain is associated with in-hospital exclusive breastfeeding, length of stay and post-partum depression. J Clin Anesth. 2020;62:109697.

17 Badreldin N, Grobman WA, Yee LM. Racial disparities in postpartum pain management. Obstet Gynecol. 2019;134(6):1147-53.

18 Conselho Nacional de Saúde (Brasil). Resolução n 466, de 12 de dezembro de 2012. Published online December 12, 2012. https://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf

19 Nunes JT, Gomes KRO, Rodrigues MTP, Mascarenhas MDM. Qualidade da assistência pré-natal no Brasil: revisão de artigos publicados de 2005 a 2015. Cad Saúde Colet. 2016;24(2):252-61.

20 Fahey JO. Best practices in management of postpartum pain. J Perinat Neonatal Nurs. 2017;31(2):126-36.

21 Mascarello KC, Matijasevich A, Santos IS, Silveira MF. Complicações puerperais precoces e tardias associadas à via de parto em uma coorte no Brasil. Rev Bras Epidemiol. 2018;21:e180010.

22 Silva GM, Freitas AL, Paula Júnior NF, Giuliani CD. Percepções dos profissionais de enfermagem sobre a dor de pacientes grandes queimados. Eletronic J Collect Health. 2023;23(4):1-12.

23 Martínez-Galiano JM, Delgado-Rodríguez M, Rodríguez-Almagro J, Hernández-Martínez A. symptoms of discomfort and problems associated with mode of delivery during the puerperium: an observational study. Int J Environ Res Public Health. 2019;16(22):4564.

24 Almeida RAAS, Carvalho RHSBF, Lamy ZC, Alves MTSSB, Poty NARC, Thomaz EBAF. Do pré-natal ao puerpério: mudanças nos serviços de saúde obstétricos durante a pandemia da covid-19. Texto Contexto Enferm. 2023;31:e20220206.

25 Stochero HM, Antunes CS, Smeha LN, et al. Percepções de gestantes e puérperas no contexto de pandemia da covid-19. Av En Enferm. 2022;40(Suppl 1):11-22.

26 Mathias AE, Pitangui AC, Vasconcelos AM, Silva SS, Rodrigues PS, Dias TG. Perineal pain measurement in the immediate vaginal postpartum period. Rev Dor. 2015;16(4):267-71.

27 Carter J, Bick D, Gallacher D, Chang Y. Mode of birth and development of maternal postnatal post-traumatic stress disorder: a mixed-methods systematic review and meta-analysis. Birth Berkeley Calif. 2022;49(4):616-27.

28 Gallos ID, Williams HM, Price MJ, Merriel A, Gee H, Lissauer D, Moorthy V, Tobias A, Deeks JJ, Widmer M, Tunçalp Ö, Gülmezoglu AM, Hofmeyr GJ, Coomarasamy A. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev. 2018 Apr 25;4(4):CD011689.

29 Leal MDC, Gama SGND, Pereira APE, Pacheco VE, Carmo CND, Santos RV. The color of pain: racial iniquities in prenatal care and childbirth in Brazil. Cad Saude Publica. 2017;33Suppl 1(Suppl 1):e00078816.

30 Blumenstock AK, Mauter D. Schmerzassessment unter Geburt : Welche Assessmentinstrumente stellen den Geburtsschmerz unter der physiologischen Geburt nachvollziehbar dar? Schmerz. 2023;37(4):250-6.
 

Submetido em:
18/08/2023

Aceito em:
22/11/2023

66607a78a953957e3c6a4783 brjp Articles
2595-3192 (Eletrônico) 2595-0118 (Impresso)
BrJP ©2024 Todos os direitos reservados.

BrJP

Share this page
Page Sections