Declercq, E., Cunningham, D. K., Johnson, C., & Sakala, C. (2008). Birth, 35, 16-24.

As cesarean birth rates continue to rise, more attention is being paid to the consequences associated with different methods of delivery. The purpose of this study was to examine mothers' postpartum experiences with pain associated with vaginal and cesarean deliveries. The analysis was based on data from Listening to Mothers II, a national survey of U.S. mothers conducted in 2006. (For more information about the survey, refer to http://www.childbirthconnection.org/listeningtomothers/). The sample consisted of 1,573 (1,373 online and 200 telephone) English-speaking mothers aged 18 to 45 years who gave birth to a singleton infant in a hospital in 2005. Mothers were asked if they experienced any of eight postpartum difficulties and the extent and duration of the problem. Overall, 79% of mothers who had a cesarean birth reported experiencing pain at the site of cesarean incision in the first 2 months after birth, with 33% describing the problem as major. A painful perineum was frequently reported by women with an assisted vaginal delivery (77% among primiparas and 52% among multiparas), and by primiparas with a spontaneous vaginal delivery (73%, with 28% describing it as major). Mothers with vaginal births were much less likely (10%) to report pain interfering with routine activities in the first 2 months after birth compared with mothers with a cesarean birth (22%). Limitations of the study include potential bias from mothers self-selecting to participate in the survey and reliance on recall about events from up to 12 months earlier. The results emphasize the need for improved management of postpartum pain. Concern about the pain associated with labor has been suggested as a reason for maternal request for cesarean birth. In order to make an informed choice about delivery method, women need to have realistic expectations about the pain associated with both vaginal and cesarean deliveries.

Maureen Heaman