a retrospective study on persistent pain after childbirth in the netherlands

Rianne C Bijl,1,2 Liv M Freeman,2 Philomeen TM Weijenborg,3 Johanna M Middeldorp,2 Albert Dahan,1 Eveline LA van Dorp1 1Department of Anesthesiology, 2Department of Obstetrics, 3Department of Gynecology, Leiden University Medical Center, Leiden, The NetherlandsAbstract: Reported prevalence rates of persistent postpartum pain (PPP) range from less than 1% to almost 20%. The aim of this study was to examine the prevalence of PPP in a Dutch cohort and to evaluate a possible causal role for specific risk factors on the development of chronic pain after childbirth. A questionnaire was sent to 960 postpartum women approximately 2 years after delivery. Primary outcome was pain that arose from childbirth at follow-up, and secondary outcomes included quality of life (QoL) and Hospital Anxiety and Depression Scale scores. Tested risk factors included mode of labor analgesia, history of negative effect, history of chronic pain, delivery route, parity, and ethnicity. A total of 495 (51.6%) women participated. At a mean time of 2.3 postpartum years, 7.3% of women reported any pain and 6.1% reported significant pain related to the delivery. Compared to spontaneous delivery, cesarean delivery provided protection against persistent pain (odds ratio, 0.12; 95% CI, 0.01–0.63, P<0.05). None of the other risk factors, including remifentanil use for labor pain, were of influence on the prevalence of persistent pain. Women with PPP experienced greater negative effects and had lower QoL scores compared to women without pain. In this cohort of Dutch patients, PPP is a serious problem with a great impact on the physical and mental health of women. Keywords: chronic pain after childbirth, chronic pain, partus, labor analgesia, remifentanil, epidural analgesia, risk factors