Perineal pain following childbirth: Prevalence, effects on postnatal recovery and analgesia usage Christine E. East, BApplSc(Nurs), MMedSc, PhD (Senior Lecturer, Senior Clinical Research Fellow) a,b,n , Margaret Sherburn, BApplSc(Physio), M Women’s Hlth, PhD (Manager, Senior Physiotherapist) c , Catherine Nagle, BApplSc(AdvNurs), MPH, PhD (Senior Lecturer, Health, Medicine, Nursing) d , Joanne Said, MBBS, PostGradDipEpid, PhD (Maternal Fetal Medicine Subspecialist, Senior Lecturer) a,b , Della Forster, BHthSc(Nurs), MMid, PhD (Senior Research Fellow) e a Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia b Department of Perinatal Medicine, Royal Women’s Hospital, Melbourne, Victoria, Australia c Physiotherapy Department, Royal Women’s Hospital, Melbourne, Victoria, Australia d Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia e Mother and Child Health Research, La Trobe University, Melbourne, Victoria, Australia article info Article history: Received 11 August 2010 Received in revised form 15 November 2010 Accepted 21 November 2010 Keywords: Perineum Childbirth Episiotomy Analgesia abstract Objective: to establish the prevalence of perineal pain, the effects of pain on postnatal recovery, analgesia used to relieve pain and the perceived effectiveness of such analgesia at the Royal Women’s Hospital, Victoria, Australia. Design, setting and participants: we conducted structured interviews of 215 women in the postnatal ward of a tertiary hospital, within 72 hours of a vaginal birth. Findings: the structured interviews revealed that 90% of women reported some perineal pain, with 37% reporting moderate or severe pain. The degree of perineal trauma predicted women’s ratings of perineal pain on a visual analogue scale, with more severe trauma related to higher pain scores. Over a third of women experienced moderate or severe perineal pain, particularly when walking (33%) or sitting (39%), while 45% noted that pain interfered with their ability to sleep. Women reported moderate or severe perineal pain when they undertook activities involving feeding their infant (12%) or caring for their infant (12%). Women used a range of analgesia, including a combination of ice packs (69%), oral analgesia (75%), narcotic analgesia (4%) and anti-inflammatory suppositories (25%). The majority of women rated these forms of analgesia as effective and identified very few side effects. Key conclusions: following vaginal birth, women commonly reported pain from perineal trauma. This pain affected women’s ability to mobilise and was relieved by a variety of agents. Side effects from analgesia were rare. Implications for practice: the prevalence of perineal pain and the associated impact on women’s recovery from childbirth warrants midwives’ proactive care in offering a range of effective pain relief options to women. Crown Copyright & 2010 Published by Elsevier Ltd. All rights reserved. Introduction Perineal trauma is reported following 63% of vaginal births, resulting from an episiotomy (15%), naturally occurring tears (46%), or laceration+ episiotomy (2%) (Laws and Sullivan, 2009). The combi- nation of spontaneous tears and episiotomy therefore encompasses a large proportion of women who sustain perineal trauma after vaginal birth (Albers et al., 1999; Thompson et al., 2002; Dahlen et al., 2007b). Further sources of trauma include vaginal lacerations and injury to the external genitalia (labia, clitoris, periurethra) and the micro-trauma sustained with a so-called ‘intact’ perineum. A range of practices may impact on the degree of perineal trauma sustained during childbirth. Antenatally, these may include perineal massage, use of perineal dilators and pelvic floor exercises (Beckmann and Garrett, 2006). During labour, the use of water immersion, techniques of pushing during second stage, application of warm packs during second stage and maternal position for birthing may also influence trauma (Dahlen et al., 2007a; Chou et al., 2009). Contents lists available at ScienceDirect journal homepage: www.elsevier.com/midw Midwifery 0266-6138/$ - see front matter Crown Copyright & 2010 Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.midw.2010.11.009 n Corresponding author at: Department of Obstetrics and Gynaecology, University of Melbourne, Christine East, Department of Obstetrics and Gynaecology, Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia. E-mail address: eastc@unimelb.edu.au (C.E. East). Midwifery 28 (2012) 93–97