Discussion
nausea, low back pain, labor pain, blood loss, tearing, pain, depression, nausea, vomiting, trauma
PREMENSTRUAL SYNDROME (PMS), BLOOD LOSS, CONTRACTION, DILATION, RESPIRATORY DEPRESSION, SHOULDER DYSTOCIA
In this study, we found that labor pain intensity as assessed via A-LPQ total score was not associated with acute postpartum pain. However, greater A-LPQ subscale on birthing pain, increased blood loss during delivery, presence of shoulder dystocia, and use of pethidine for labor analgesia were independently associated with high acute postpartum pain in women who underwent labor process. In addition, “sometimes” having nausea during menstruation before current pregnancy was also found to be independently associated with reduced risk of high acute postpartum pain.In the primary aim of the study, we found no association between overall labor pain intensity and acute postpartum pain; but looking into specific birthing pain revealed a significant association with high acute postpartum pain at 0 to 24 h after delivery. This may attribute to the timing of A-LPQ administration, where participants were given the choice to complete the A-LPQ at any time point after they experienced labor pain. The use of different labor analgesia and the retrospective completion of A-LPQ may further contribute to a subjective recollection of pain experience emotions and psychological state that could reduce the true representation of labor experience. In addition, other physiological domains (back pain/long haul, uterine contraction) did not show significant association with acute postpartum pain. It is notable that uterine contraction and low back pain are typically present during the first stage of labor, whereas perineal pain usually exists at the later second stage of labor [The association factors on presence of shoulder dystocia and increased blood loss during delivery may imply presence of perineal trauma or complicated birth experience in those having high acute postpartum pain. As one of the most common sources of postpartum pain, perineal pain typically arises from the stretching and tearing of perineal tissues (perineal trauma) during the period from complete cervical dilation to the delivery [We also identified the use of pethidine for labor analgesia as one of the association factors of high acute postpartum pain. Intramuscular pethidine is a commonly used opioid for labor pain relief; yet many studies have reported concerns regarding its use including the various side effects on nausea, vomiting, sedation, and respiratory depression [As part of the primary study assessment for perinatal mental health, we investigated the factors that could be associated with postpartum depression, which included symptoms in premenstrual syndrome (PMS) which has been reported to have positive association with postpartum depression [It was previously reported that pain catastrophizing may predict labor pain intensity and anticipation, leading to a greater risk of acute and persistent perineal postpartum pain and poorer postpartum maternal recovery and adjustment [This study should consider several limitations. First, this study was conducted in a single maternity institution that offers treatment to predominantly English-speaking Asian population. A systematic review showed that Asians could have lower pain thresholds and different perceptions towards pain as compared with other populations, e.g., non-Hispanic whites, hence limiting the extrapolation of the study findings to other populations [