Pain intensity and immediate puerperal discomforts

Thais do Amaral Tomasoni Jordana Barbosa Silva Thalita Cristina Wolff Bertotti Jessica Perez Raciele Ivandra Guarda Korelo Rubneide Barreto Silva Gallo About the authors

ABSTRACT

BACKGROUND AND OBJECTIVES:

The immediate puerperium extends until the 10th day after delivery, and this period is characterized by the return of the woman’s body to the pre-pregnancy state. The aims of the study were to identify pain intensity and the major discomforts reported by women in the immediate puerperium period and to analyze the difference in puerperal discomfort according to parity and type of delivery.

METHODS:

The participants included 107 women attended in a public maternity ward. Pain and discomfort were assessed using the semi-structured physical therapy assessment form and pain intensity was measured using the visual analog scale (VAS). Mann-Whitney and Kruskal-Wallis tests were applied to identify differences in discomfort according to the type of parity and delivery.

RESULTS:

Colic pain related to breastfeeding with 4.81±2.52 intensity was reported by 55.14% of mothers in the puerperium, perineal pain with 4,06±2,09 intensity by 30.84%, low back pain with 4.38±2.09 intensity by 28.97%, breast pain with 4.76±2.63 intensity by 23.36% and cesarean related pain with 5.21±2.01 intensity was reported by 17.75% of mothers. No significant differences in pain intensity were found according to parity. However, significant differences were found for perineal pain intensity and cesarean section.

CONCLUSION:

Pain intensity evaluated by the visual analog scale was classified as moderate or light.

Keywords:
Labor pain; Postpartum period; Women’s health

RESUMO

JUSTIFICATIVA E OBJETIVOS:

O puerpério imediato estende-se até o 10º dia após o parto, e este período é caracterizado pelo retorno do corpo da mulher ao estado pré-gravídico. Os objetivos deste estudo foram identificar a intensidade da dor e principais desconfortos relatados pelas mulheres no puerpério imediato e analisar a diferença dos desconfortos puerperais de acordo com a paridade e tipo de parto.

MÉTODOS:

Participaram deste estudo 107 puérperas assistidas em uma maternidade pública. A dor e os desconfortos foram avaliados por meio da ficha de avaliação fisioterapêutica semiestruturada, e a intensidade da dor foi mensurada com a escala analógica visual. Os testes de Mann-Whitney e Kruskal-Wallis foram aplicados para identificar diferenças no desconforto a partir do tipo de parto e paridade.

RESULTADOS:

Dor em cólica relacionada à amamentação de intensidade 4,81±2,52 foi referida por 55,14% das puérperas, dor perineal de intensidade 4,06±2,09 foi referida por 30,84%, lombalgia de intensidade 4,38±2,09 foi referida por 28,97%, dor nas mamas de intensidade 4,76±2,63 foi referida por 23,36% e dor relacionada a cesariana de intensidade 5,21±2,01 por 17,75%. Não foram encontradas diferenças significativas na intensidade da dor de acordo com a paridade. No entanto, foram encontradas diferenças significativas para intensidade da dor perineal e incisão da cesariana.

CONCLUSÃO:

A intensidade da dor avaliada pela escala analógica visual foi classificada como moderada ou leve.

Descritores:
Dor do parto; Período pós-parto; Saúde da mulher

INTRODUCTION

The postpartum period is called puerperium and can be divided into: immediate - from 1st to 10th day, late - from 10th to 45th day and remote - after the 45th day. In this phase, local and systemic changes return the women’s body to its pre-gravidic state11 Rett MT, Bernardes NO, Santos AM, Oliveira MR, Andrade SC. Atendimento de puérperas pela fisioterapia em uma maternidade pública humanizada. Fisioter Pesq. 2008;15(4):361-6.. During the immediate puerperium, some inherent discomforts related to the birth process are present. Pain is the most frequent symptom reported by mothers during this period and can cause limitations on movement, walking and changing of posture in bed22 Sousa L, Pitangui AC, Gomes FA, Nakano AM, Ferreira CH, Mensuração e características de dor após cesárea e sua relação com limitação de atividades. Acta Paul Enferm. 2009;22(6):741-7., beyond complicating the bond between mother and newborn (NB)33 Santana LS, Gallo RB, Marcolin AC, Ferreira CH, Quintana SM. Utilização dos recursos fisioterapêuticos no puerpério: revisão da literatura. Femina. 2011;39(5):245-50..

Due to its multifactorial and complex phenomenon, treatment of pain demands multi professional approach, aiming at better quality of life for women44 Ferreira CH, Beleza AC. Abordagem fisioterapêutica na dor pós-operatória: a eletroestimulação nervosa transcutânea (ENT). Rev Col Bras Cir. 2007;34(2):127-30.. Comprehending and evaluating pain facilitates its profiling, but also brings the physiotherapist closer to the patient, making the professional more aware of the meaning of pain and its repercussions. However, most health professional activities during the puerperium are directed to the NB and are scarce when it comes to the self-care and discomfort reduction for mothers55 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Saúde da Criança: Nutrição Infantil, aleitamento materno e alimentação complementar. Brasília: Caderno de Atenção Básica; 2009..

The Ministry of Health advocates a qualified and humanized attention to women during the puerperium66 Brasil. Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas. Ministério da Saúde; Brasília: 2005. Área Técnica de Saúde da Mulher. Pré-natal e Puerpério: atenção qualificada e humanizada - manual técnico/Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas. 163p. color - (Série A. Normas e Manuais Técnicos) - (Série Direitos Sexuais e Direitos Reprodutivos - Caderno n° 5).. Nonetheless, professional action based on the biomedical model and the ignorance of complaints and real complications during puerperium contribute to the non-conformity between the indicated assistance model and the one found in the health institutions77 Pereira TRC, Souza FG, Beleza ACS. Implications of pain in functional activities in immediate postpartum period according to the mode of delivery and parity: an observational study. Braz J Phys Ther. 2017;21(1):37-43.. On the other hand, there is a growing demand for physiotherapeutic care in Women’s Health, implying an adequate assistance founded in the whole puerperium-gravidic cycle. Its important that the public maternities’ physiotherapists understand the profile of the mothers in the puerperium in order to obtain information that addresses the better approach of the preventive and physiotherapeutic evaluation and intervention11 Rett MT, Bernardes NO, Santos AM, Oliveira MR, Andrade SC. Atendimento de puérperas pela fisioterapia em uma maternidade pública humanizada. Fisioter Pesq. 2008;15(4):361-6.. In addition, the role of the hysiotherapist is considered to assist in improving of assistance directed to puerperal women88 Odunaiya NA, Ilesanmi T, Fawole AO, Oguntibeju OO. Attitude and practices of obstetricians and gynecologists towards involvement of physiotherapists in management of obstetric and gynecologic conditions. Int J Womens Health. 2013;5:109-14., from promotion and prevention to health intervention99 Silva JB, Doi GE, Silva LC, Feltrin MI, Zotz TG, Korelo RI, Gallo RB. Satisfação de puérperas após intervenção fisioterapêutica em educação em saúde. Saúde Pesq. 2019;12(1):141-50..

Therefore, the primary objective of this study was to evaluate the intensity of pain and the main discomforts reported by women in the immediate puerperium. The secondary objective was to evaluate the difference of the puerperal discomforts according to the parity and type of delivery.

METHODS

Cross sectional study with 107 women during the immediate puerperium, through the first 17h from birth, in the period of August 2016 and May 2017.

Mothers with a usual level of risk which were being attended at an accommodation in a public maternity ward and with no cognitive problems were included. The mothers agreed in participating in the study after reading and signing the Free and Informed Consent Term (FICT). According to the 466/2012 Resolution of the National Health Council.

The following participants were excluded: those that asked to be suspended from the research, that didn’t complete the evaluation form or that had missing information in their medical records and those that had puerperal complications.

One of the tools used in this research was a semi-structured questionnaire developed by the researchers in order to profile the sample. This questionnaire is used in physiotherapeutic attendance and contains questions about the personal and obstetric data of the participants. This tool also contains questions related to urinary and intestinal complaints during pregnancy. Next, the participants were questioned about the presence of puerperal discomforts in the superior limbs (SL), lower limbs (LL), torso, cesarean incision and perineal area, apart from the classification of discomforts related to the urogynecological, intestinal and circulatory symptoms. After confirming the presence of pain, the participant was to classify the intensity of pain in the visual analog scale (VAS)1010 Kahl C, Cleland JA. Visual analogue scale, numeric pain rating scale and the McGill pain Questionnaire: an overview of psychometric properties. Phys Ther Rev. 2005;10(2):123-8., which consists in a 10cm ruler, numbered from zero to 10, in which zero is the total absence of pain and 10 the worst imaginable pain. The intensity of pain reported by the participants was classified in light (1-3), moderate (4-6) and intense (7-10).

The study was approved by the Human Research Ethics Committee from the Hospital das Clínicas, according to number 1.674.698, CAAE 56163616.8.0000.0096.

Statistical analysis

The data were processed by the SPSS software, version 21.0. The numeric variables are presented in mean±standard deviation. The descriptive variables were analysed by frequency (n) and percentage (%). To perform the difference analysis, data normality was analyzed by the Kolmogorov-Smirnov test. To analyze the difference in pain intensity according to parity, the Mann-Whitney test was applied. Participants were allocated to two groups: 1) primiparous; and 2) multiparous. For the difference analysis of the type of delivery the Kruskal-Wallis and the Mann-Whitney post-hoc tests were applied. The mothers were allocated in four different groups, according to the type of delivery: a) with intervention (episiotomy and/or forceps); b) grade 1 or 2 laceration; c) cesarean section; d) normal. The significance value was established at p<0.05.

RESULTS

The participants had an mean age of 26±6.44 years old, in its majority multiparous (58.9%), had white skin (60.7%), complete high school (54.2%), paid occupation (56.1%), stable union (43.9%) and the majority had an escort accompanying them during all the labor and immediate postpartum (97.2%).

Mean gestational age in weeks was 39±1.16 with a 95% confidence interval (95%CI) from 39 to 40 weeks, with mean prenatal appointments of 9±3.0 and labor time of 486±334.7 minutes; 95%CI: 3335-638.2). Most puerperal women had vaginal delivery (73.7%); 6.5% had vaginal delivery with episiotomy and/or forceps and one participant had grade 3 laceration after delivery (0.9%). The mean weight of the NBs was 3.19±0.4 kg (95%CI2.99-3.38). The Apgar index was higher than seven in the 1st minute (77.6%) and in the 5th minute (82.2) of NBs. Puerperal women reported discomfort related to breastfeeding and intestine, as well as circulatory, urogynecological and musculoskeletal discomfort (Table 1).

Table 1
Immediate puerperal discomfort reported by puerperal mothers

The average of all discomforts reported by the puerperal mothers and evaluated by the VAS was classified as moderate. In the individual analysis of the VAS, most participants classified cesarean pain, breast pain and back pain as moderate. The intensity of perineal pain and colic pain during breastfeeding was mostly classified as light. Pain considered intense was: colic pain during breastfeeding 18 (16.8%) cesarean section incision, perineal and back pain, 5 (4.7%) and breast pain 4 (3.7%) (Table 2).

Table 2
Prevalence of discomfort in the immediate puerperium reported by study participants

Table 3 presents the average and standard deviation values based on the classification of discomfort intensity by the puerperal mothers and the difference result of pain intensity according to the parity and type of delivery. The pain intensity was superior in women that went through cesarean delivery. In ascending order, the main discomforts found in this study were: cesarean pain, colic pain during breastfeeding, breast pain, back pain and perineal pain. No significant differences were found for the intensity of pain reported by women according to the parity between primiparae and multiparae. Also, no significant differences were found when women were compared according to the type of delivery for the intensity of pain reported in the breasts, colic during breastfeeding and back pain. However, significant differences were found for pain intensity in the cesarean section and perineal pain in women with cesarean and vaginal delivery with episiotomy and/or forceps intervention, vaginal delivery with laceration, and normal delivery.

Table 3
Intensity of pain during the immediate puerperium

It’s worth mentioning that puerperal mothers received routine analgesic drugs every 6 hours during the period of hospitalization, such as paracetamol and dipyrone.

DISCUSSION

During the immediate puerperium, women go through physical, psychological and social alterations. Still in the hospital puerperal women present complaints related to the puerperium, like pain, insecurity and fear. Post-partum complications can affect quality of life and state of health of the puerperal mothers and the NB1111 Cheng CY, Li Q. Integrative review of research on general health status and prevalence of common physical health conditions of women after childbirth. Womens Health Issues. 2008;18(4):267-80.. Therefore, during the puerperium, the multidisciplinary team must be attentive to the elaboration of a care plan that offers the necessary support to women, regarding self-care, transformations related to post-partum and NB care1212 Mazzo MH, Brito RS, Feitosa MM, Lima MS, Silva EC. Percepção das puérperas sobre seu período pós-parto. Investig Enferm. 2018;20(2):1-9..

Pain was classified as moderate for all of the mentioned discomforts after 40h from birth. It’s important to notice that the puerperal mothers were receiving analgesics each 6h, which is part of the hospital routine, and their usage did not seem to resolve the cases of pain.

Pain can be limiting for women, since it can interfere in mobility and performance of daily activities1313 Burti JS, Cruz JP, Silva AC, Moreira IL. Assistência ao puerpério imediato: o papel da fisioterapia. Rev Fac Ciênc Méd Sorocaba. 2016;18(4):193-8.. In this study, the puerperal mothers reported discomforts related to breastfeeding and associated to the intestinal, circulatory, urological and musculoskeletal systems.

In accordance to these data, the study1414 Pereira TR, Montesano FT, Ferreira PD, Minozzi AS, Beleza AC. Existe associação entre os desconfortos no puerpério imediato e a via de parto? Um estudo observacional. ABCS Health Sci. 2017;42(2):80-4. also found high prevalence of discomfort in women during the immediate puerperium. Approximately 73% of patients reported some discomfort, being the cesarean the type of delivery most associated with the presence of discomforts. Another Brazilian study1515 Prado DS, Mendes RB, Gurgel RQ, Barreto IDC, Cipolotti R, Gurgel RQ. The influence of mode of delivery on neonatal and maternal short and long-term outcomes. Rev Saude Publica. 2018;52:95. with puerperal mothers considered pain as a the maternal complication most frequent in the puerperium, with similar numbers, independently of the types of delivery. However, cesarean delivery was associated with a higher risk of maternal complications and feminine sexual dysfunction and presented a negative correlation to the incentive to breastfeeding practices.

In this study, the greatest intensity of pain was attributed to the pain in the cesarean incision, with confidence interval varying from 4.23 to 6.18. No significant differences between pain intensity in women regarding type of delivery were found.

Nonetheless, the pain intensity on the cesarean incision was superior to the related by women who underwent normal delivery or had some sort of complication and/or laceration.

It is known that cesarean rates have increased in many countries, including Brazil, contrary to the World Health Organization (WHO) guidelines for vaginal delivery1616 Chen I, Opiyo N, Tavender E, Mortazhejri S, Rader T, Petkovic J, et al. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev. 2018;28(9):CD005528.,1717 Souza JP, Betran AP, Dumont A, de Mucio B, Gibbs Pickens CM, Deneux-Tharaux C, et al. A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study. BJOG. 2016;123(3):427-36.. Pain after a cesarean section is closely linked to tissue injury due to inflammatory reactions resulting from a traumatic process that can produce pain11 Rett MT, Bernardes NO, Santos AM, Oliveira MR, Andrade SC. Atendimento de puérperas pela fisioterapia em uma maternidade pública humanizada. Fisioter Pesq. 2008;15(4):361-6.. In addition, the abdominal scar resulting from the surgery may impair the action of drainage by the lymphatic system, and restrict movement due to the presence of pain and/or fear, increasing the period of bed stay and favoring the emergence of edemas of the SL1414 Pereira TR, Montesano FT, Ferreira PD, Minozzi AS, Beleza AC. Existe associação entre os desconfortos no puerpério imediato e a via de parto? Um estudo observacional. ABCS Health Sci. 2017;42(2):80-4.. Similar results were found in the study22 Sousa L, Pitangui AC, Gomes FA, Nakano AM, Ferreira CH, Mensuração e características de dor após cesárea e sua relação com limitação de atividades. Acta Paul Enferm. 2009;22(6):741-7., which measured pain in the cesarean section and found a range of 1 to 9 during rest, with a mean pain lower than that found in this study <5.21. However, 75% of study participants reported pain located around the cesarean section incision. Similar to these findings, the study1414 Pereira TR, Montesano FT, Ferreira PD, Minozzi AS, Beleza AC. Existe associação entre os desconfortos no puerpério imediato e a via de parto? Um estudo observacional. ABCS Health Sci. 2017;42(2):80-4. found a higher prevalence of abdominal pain, cervicalgia and edema in women who underwent cesarean section.

Among the discomforts reported by the puerperal mothers, the perineal pain presented a lower mean, but was similar to the result of Brazilian studies in which the mean perineal pain was 4.81818 Francisco AA, Oliveira SM, Santos JO, Silva FM. Avaliação e tratamento da dor perineal no pós-parto vaginal. Acta Paul Enferm. 2011;24(1):94-100. and 4.21919 Pitangui AC, Sousa L, Ferreira CH, Gomes FA, Nakano AM. Mensuração e características da dor perineal em primíparas submetidas à episiotomia. Acta Paul Enferm. 2009;22(1):77-82.. It is also noteworthy that in this study less than 50% of the sample presented perineal pain and of these only 3.6% had episiotomy and 0.9% third degree laceration. In the present study, the highest frequency of complaints was associated with colic pain during breastfeeding, with the discomfort being the second highest pain intensity. This symptom is common during the postpartum period2020 Lelis BDB, Pereira RC, Silva LFI, Leite AM, Dusso MIS, Bernardes NB. Acolhimento puerperal no contexto atribuído às primíparas. Rev Mult Psic. 2019;45(13):287-301., regardless of the route of delivery2121 Wen L, Hilton G, Carvalho B. The impact of breastfeeding on postpartum pain after vaginal and cesarean delivery. J Clin Anesth. 2015;27(1):33-8. and occurs because during breastfeeding there is release of oxytocin, the hormone responsible for milk ejection and for promoting uterine contractions2020 Lelis BDB, Pereira RC, Silva LFI, Leite AM, Dusso MIS, Bernardes NB. Acolhimento puerperal no contexto atribuído às primíparas. Rev Mult Psic. 2019;45(13):287-301.. The prevalence of colic during breastfeeding was 40% in study participants1212 Mazzo MH, Brito RS, Feitosa MM, Lima MS, Silva EC. Percepção das puérperas sobre seu período pós-parto. Investig Enferm. 2018;20(2):1-9. undergoing cesarean section. In the study1313 Burti JS, Cruz JP, Silva AC, Moreira IL. Assistência ao puerpério imediato: o papel da fisioterapia. Rev Fac Ciênc Méd Sorocaba. 2016;18(4):193-8., 15% of women in the immediate puerperium presented this symptom.

Considering the reports of breast pain, 66% of the participants of this study presented breast fissures and reported moderate to intense pain in the area. The percentage of women with such complaint was higher than the data presented in a study with puerperal women 2 and 4 months after delivery2222 Benedett A, Silva IA, Ferraz L, Oliveira P, Fragoso E, Ourique J. A dor e desconforto na prática do aleitamento materno. Cogitare Enferm. 2014;19(1):136-40.. However, similarly to the present study, the intensity of pain reported by puerperal women ranged from moderate to intense to 66.7% of participants2222 Benedett A, Silva IA, Ferraz L, Oliveira P, Fragoso E, Ourique J. A dor e desconforto na prática do aleitamento materno. Cogitare Enferm. 2014;19(1):136-40.. This finding may be related to the deficit of follow-up and guidance of health professionals in the pregnancy and/or puerperal period. The multi professional team should attend the puerperal women based on their social, cultural and ethical context. Difficulties related to breastfeeding can lead to several consequences, such as early weaning, which puts the baby’s health at risk2323 Strapasson MR, Nedel MNB. Puerpério imediato: desvendando o significado da maternidade. Rev Gaúcha Enferm. 2010;31(3):521-8.,2424 Souza MJN, Barnabé AS, Oliveira RS, Ferraz RRN. A importância da orientação à gestante sobre amamentação: fator para diminuição dos processos dolorosos mamários. ConScientiae Saúde. 2009;8(2):245-9..

According to the results of this study, back pain was one of the main discomforts reported by puerperal women. A similar result was found in the study2525 Morari-Cassol EG, Campos Júnior D, Haeffner LSB. Desconforto músculo-esquelético no pós-parto e amamentação. Fisioter Brasil. 2017;9(1):9-16., which highlighted back pain as the main discomfort, being classified with moderate intensity. This discomfort can lead to motor disability and can be reported by women who have recently given birth regardless of the type of delivery1414 Pereira TR, Montesano FT, Ferreira PD, Minozzi AS, Beleza AC. Existe associação entre os desconfortos no puerpério imediato e a via de parto? Um estudo observacional. ABCS Health Sci. 2017;42(2):80-4.. However, the results of the studies22 Sousa L, Pitangui AC, Gomes FA, Nakano AM, Ferreira CH, Mensuração e características de dor após cesárea e sua relação com limitação de atividades. Acta Paul Enferm. 2009;22(6):741-7.,77 Pereira TRC, Souza FG, Beleza ACS. Implications of pain in functional activities in immediate postpartum period according to the mode of delivery and parity: an observational study. Braz J Phys Ther. 2017;21(1):37-43. showed a prevalence of discomfort and functional limitations during daily activities in puerperal women who underwent cesarean delivery. However, it is worth highlighting that changes in the spine resulting from physical changes in pregnancy may contribute to the presence of marked pain in the lumbar region1313 Burti JS, Cruz JP, Silva AC, Moreira IL. Assistência ao puerpério imediato: o papel da fisioterapia. Rev Fac Ciênc Méd Sorocaba. 2016;18(4):193-8.. Therefore, individual physical evaluation by health professionals may direct the resolution of the complaint earlier1414 Pereira TR, Montesano FT, Ferreira PD, Minozzi AS, Beleza AC. Existe associação entre os desconfortos no puerpério imediato e a via de parto? Um estudo observacional. ABCS Health Sci. 2017;42(2):80-4..

Although parity is an influential variable in postpartum recovery and perception of women’s pain2626 Mannion CA, Vinturache AE, McDonald SW, Tough SC. The influence of back pain and urinary incontinence on daily tasks of mothers at 12 months postpartum. PLoS One. 2015;10(6):e0129615., the results of this study do not support this hypothesis, given the absence of significant differences in the analysis of pain intensity reported by primiparous and multiparous women. Thus, the results of this study emphasize the importance of humanized attention of women with or without previous experience with childbirth and postpartum period. Concomitant to this finding, the results of the study77 Pereira TRC, Souza FG, Beleza ACS. Implications of pain in functional activities in immediate postpartum period according to the mode of delivery and parity: an observational study. Braz J Phys Ther. 2017;21(1):37-43. with women during the immediate puerperium did not indicate an association between parity and functional limitations. However, it is worth noting that previous experiences related to childbirth can be modulating for the threshold of pain, and one should consider the subjectivity and individuality of pain experience, since it is based on biological, psychological and environmental responses2626 Mannion CA, Vinturache AE, McDonald SW, Tough SC. The influence of back pain and urinary incontinence on daily tasks of mothers at 12 months postpartum. PLoS One. 2015;10(6):e0129615..

The analysis of data of the present study calls attention to the need of promotion of activities for the puerperal women’s health, since these are scarce and mostly cover only the NB care and not the advising for women’s selfcare55 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Saúde da Criança: Nutrição Infantil, aleitamento materno e alimentação complementar. Brasília: Caderno de Atenção Básica; 2009.. Most postpartum discomfort can be avoided or reduced by early postpartum interventions2727 Rizvi RM, Khan ZS, Khan Z. Diagnosis and management of postpartum urinary retention. Int J Gynecol Obstet. 2005;91(1):71-2.. Even complaints of pain can be reduced after non-pharmacological physiotherapeutic intervention, leading to 100% adherence to treatment1313 Burti JS, Cruz JP, Silva AC, Moreira IL. Assistência ao puerpério imediato: o papel da fisioterapia. Rev Fac Ciênc Méd Sorocaba. 2016;18(4):193-8.. Thus, the importance of interdisciplinary health practices and the promotion of maternal and child care1414 Pereira TR, Montesano FT, Ferreira PD, Minozzi AS, Beleza AC. Existe associação entre os desconfortos no puerpério imediato e a via de parto? Um estudo observacional. ABCS Health Sci. 2017;42(2):80-4. is highlighted. Information and resolution activities during the immediate puerperium are well evaluated by women and could be implemented in the routine maternity services99 Silva JB, Doi GE, Silva LC, Feltrin MI, Zotz TG, Korelo RI, Gallo RB. Satisfação de puérperas após intervenção fisioterapêutica em educação em saúde. Saúde Pesq. 2019;12(1):141-50..

The physiotherapist is a qualified professional who composes multi professional teams and can help in reducing puerperal discomfort through the application of specific physiotherapeutic and non-pharmacological resources1313 Burti JS, Cruz JP, Silva AC, Moreira IL. Assistência ao puerpério imediato: o papel da fisioterapia. Rev Fac Ciênc Méd Sorocaba. 2016;18(4):193-8., such as kinesiotherapy, cryotherapy2828 Francisco AA, de Oliveira SM, Leventhal LC, de Bosco CS. [Cryotherapy after childbirth: the length of application and changes in perineal temperature]. Rev Esc Enferm USP. 2013;47(3):555-61. Portuguese. and electrotherapy2929 Kayman-Kose S, Arioz DT, Toktas H, Koken G, Kanat-Pektas M, Kose M. et al. Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section. J Matern Fetal Neonatal Med. 2014;27(15):1572-5.,3030 Pitangui AC, Araújo RC, Bezerra MJ, Ribeiro CO, Nakano AM. Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial. Braz J Phys Ther. 2014;18(1):72-8., which make up the physiotherapeutic practices aimed at reducing discomfort. In addition, the use of these resources can contribute to reduce women’s hospitalization time, as well as reduce the need for medication methods of analgesia33 Santana LS, Gallo RB, Marcolin AC, Ferreira CH, Quintana SM. Utilização dos recursos fisioterapêuticos no puerpério: revisão da literatura. Femina. 2011;39(5):245-50..

CONCLUSION

The main discomforts reported by puerperal women were related to breastfeeding, in addition to intestinal, circulatory, urological and musculoskeletal discomforts. The pain intensity in the cesarean incision, colic during breastfeeding, breasts, lumbar spine and perineum was classified as moderate. However, these were classified as intense by some puerperal mothers, specially the pain of colic during breastfeeding. There was no difference in the intensity of pain by parity. There were significant differences in the intensity of pain with cesarean section and vaginal delivery with episiotomy and/or forceps, vaginal delivery with laceration and normal delivery.

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Publication Dates

  • Publication in this collection
    17 July 2020
  • Date of issue
    Jul-Sep 2020

History

  • Received
    11 Dec 2019
  • Accepted
    15 May 2020
Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
E-mail: dor@dor.org.br