Minimizing postpartum pain: a review of research pertaining to perineal care in childbearing women

Pain and stress after vaginal delivery: characteristics at hospital discharge and associations with parity

The objective of this study was to characterise pre-discharge maternal pain and stress severity after vaginal delivery and associations with parity. This is a descriptive analysis with 148 women in the early post-partum period (84 primiparae and 64 secondiparae) after vaginal delivery. Pain and stress were measured by McGill Pain Questionnaire (MGPQ) and by the Psychological Stress Measure (PSM). Vaginal delivery in primiparae women was associated with MGPQ, significantly higher pain scores. Sensorial, affective and mixed pain descriptive categories were also significantly higher. Pain location involved lower abdomen, vagina and perianal area. In addition, their PSM showed a significantly higher 'Sense of effort and confusion' subscale scores. In conclusion, this study provides important information on the quality of care implications of hospital-to-home discharge practices in puerperae after vaginal delivery, a critical time characterised by qualitatively and quantitatively high pain and stress in primiparae.Impact statementWhat is already known on this subject? Pain and fatigue are the most common problems reported by women in the early postpartum period.What the results of this study add? Primiparae who delivered vaginally presented at the time of hospital-to-home discharge significantly higher pain and stress, as compared to secondiparae. Pain involved lower abdomen, vagina and perianal area, whereas the stress was quantitatively higher in the 'sense of effort and confusion'.What the implications are of these findings for clinical practice and/or further research? Awareness of problematic pain and stress associations with parity may offer the opportunity to better support puerperae to develop maternal orientation and adjust to motherhood.

Feasibility of a Smartphone website to support antenatal Perineal massage in pregnant women

Background

In Japan, 85% of pregnant women do not practice antenatal perineal massage. Therefore, we developed a smartphone website to support the practice of antenatal perineal massage. The purpose of the present study was to evaluate the feasibility of our smartphone website.

Methods

Pregnant women were recruited at five hospitals or clinics in Tokyo, Japan. Participants assigned to the smartphone website group (n = 74) were asked to register on the smartphone website. After completing registration, they could login and use all the contents of the website. After giving birth, participants completed a 5-item questionnaire evaluating the acceptability of the smartphone website. Participants assigned to the leaflet group (n = 71) received a leaflet on antenatal perineal massage and completed a similar 4-item questionnaire evaluating the leaflet. Data were collected from April 2014 to November 2014. Data analysis was performed using chi-square and t-tests to analyze responses to close-ended questions, and content analysis was conducted to analyze responses of open-ended questions.

Results

In the smartphone website group, 9 women (12.2%) did not register on the smartphone website. Approximately 80% of the women who responded indicated that the smartphone site was easy to understand and useful for practicing antenatal perineal massage. In the smartphone website group, the reply rate for reporting the frequency of massage was 43.6%. Although the ratings and frequency at which the material was accessed tended to be higher in the smartphone website group than in the leaflet group, there were no significant differences.

Conclusions

Most pregnant women in the smartphone website group provided a favorable evaluation for the smartphone website. However, some participants had suggestions for improvement, which need to be incorporated in a revised version of the website. Therefore, the present study’s results demonstrate the feasibility of a smartphone website to support the practice of antenatal perineal massage, and they may aid in the development of similar web-based educational material for pregnant women.

Trial registration

This trial was registered with the UMIN Clinical Trials Registry (UMIN000013979) on May 16, 2014.

Randomised controlled trial using smartphone website vs leaflet to support antenatal perineal massage practice for pregnant women

BACKGROUND

In Japan, the rate of pregnant women who practice antenatal perineal massage was only 15.1%.

AIM

The aim of this study was to develop and evaluate a smartphone website and a leaflet to support antenatal perineal massage practice for primiparous women.

METHODS

In a randomised control trial, 161 primiparous women were randomly assigned to a smartphone website group (n=81) or a leaflet group (n=80). Data analysis were by per protocol analysis and intention to treat analysis.

FINDINGS

Of the 161 women participants, 47 in the smartphone website group and 49 in the leaflet group completed all questionnaires. Primary outcome was continuance rate (three times a week over a three week period) of antenatal perineal massage practice. The rates by a per protocol analysis were 51.1% in the smartphone website group and 51.0% in the leaflet group, respectively. There was no significant difference between the groups. Moreover, the rates by an intention to treat analysis were 29.6% in the smartphone website group and 31.3% in the leaflet group, respectively. There was also no significant difference between the groups. There were no significant differences in the evaluation of perineal massage, childbirth self-efficacy, satisfaction with efforts towards childbirth, and perineal outcomes following childbirth which were measured as secondary outcomes between the groups.

CONCLUSION

There was no significant difference in continuance rate of antenatal perineal massage practice between those using a smartphone website and those with a leaflet, however, the rate was better than no instructions.

A comparative study on relieving post-episiotomy pain with diclofenac and indomethacin suppositories or placebo

In this study, we compare the prophylactic efficacy of a diclofenac suppository and an indomethacin suppository on decreasing post-episiotomy pain. A total of 90 women with 2nd-degree episiotomy were assigned to receive a single dose of diclofenac suppository (30), indomethacin suppository (30) or placebo (30), according to randomised blocks. The pain was assessed at 1, 2, 4, 6 and 12 hours after receiving analgesia, using the two methods of pain score and visual analogue. This study showed that in the group given diclofenac or indomethacin, at all the assessed hours, the pain measured was considerably less than in the suppository-free group (p < 0.05). Comparing the diclofenac and indomethacin groups, there were only significant differences in the 4 and 12 hour measurements: the diclofenac was more effective than the indomethacin (4th hour), but due to a shorter half-life, the diclofenac group in the 12th hour had more pain (p < 0.05). Diclofenac suppository is recommended at 4-hour intervals for all patients, without internal disorders, to decrease episiotomy pain.

Randomized controlled trial of early skin-to-skin contact: effects on the mother and the newborn

OBJECTIVE

To estimate the influence of skin-to-skin care on the thermal regulation of the infant and the rate of breastfeeding at different points of time. We also aim to establish whether skin-to-skin contact reduces maternal pain during episiotomy repair and decreases the time to expel the placenta.

METHODS

A randomized control study was performed with 137 patients in each branch of the study. Differences between the study groups were analysed with the unpaired t-test, Fisher test or chi-square test as appropriate.

RESULTS

Greater thermal stability in the skin-to-skin care group was found where an average temperature rise of 0.07°C was observed. Mothers in the skin-to-skin care group exclusively breastfed more frequently at discharge. Mean time to expel the placenta was lesser in the skin-to-skin care group.

CONCLUSION

This study shows that skin-to-skin care implies better thermal regulation and a better proportion of exclusive breastfeeding at hospital discharge.

Mensuração e características da dor perineal em primíparas submetidas à episiotomia

OBJETIVO: Mensurar e caracterizar a percepção dolorosa das puérperas primíparas submetidas à episiotomia. MÉTODOS: Trata-se de uma pesquisa descritiva com abordagem quantitativa, realizada com 40 puérperas primíparas submetidas ao parto normal com episiotomia. Para mensuração da dor foi utilizada a escala de categoria numérica e para caracterização a versão brasileira do questionário McGill - Br-MPQ. RESULTADOS: Os valores encontrados na avaliação da dor foram de média 4,2 e os descritores que melhor caracterizaram a dor foram: dolorida; que repuxa; incômoda; chata; ardida; pica como uma agulhada; latejante; em pressão. CONCLUSÃO: A intensidade da dor perineal foi considerada como moderada pelas puérperas. Na caracterização da queixa dolorosa os descritores mais citados foram da dimensão sensorial. Este estudo possibilitou observar a necessidade do reconhecimento dos aspectos qualitativos e quantitativos da dor na prática clinica obstétrica.

Case report: labial fusion postpartum and clinical management of labial lacerations

Lacerations of the external genitalia of various degrees are a common occurrence in the childbirth process. Evidence-based management of minor lacerations of the vulva has yet to emerge in the scientific literature. Spontaneous approximation of minor lacerations of the labia may uncommonly result in distorted anatomical healing, with resultant dyspareunia, among other distressing symptoms. Management of this occurrence, including pharmacologic and surgical strategies, is presented in this case study discussion.