Original Article POSTPARTUM HEALTH RELATED QUALITY OF LIFE AFTER DIFFERENT MODES OF DELIVERY AMONG WOMEN IN PAKISTAN: THE NEGLECTED LINK FOR BETTER MATERNAL and CHILD HEALTH MADEEHA MALIK 1 , ZIRWA ASIM 2 , AZHAR HUSSAIN 3 1,2 Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan, 3 Received: 12 Jul 2017 Revised and Accepted: 06 Jun 2018 ABSTRACT Objective: The present study was designed to evaluate women postpartum quality of life after different modes of delivery in Pakistan. Methods: A descriptive cross-sectional study design was used. A pre-validated tool SF-36 was self-administered to a sample of 382 women in the postpartum period (6-8 w, 10-12 w, 14-16 w,>9 mo,>15 mo) undergone through elective/emergency cesarean sections or normal vaginal delivery and had delivered a single live child. After data collection, data was cleaned coded and entered in SPSS version 21.0. Descriptive statistics comprising of frequency and percentages was calculated. The non-parametric tests including Mann-Whitney and Kruskal-Walis (p ≥ 0.05) were performed to find out the difference among different variables. Results: Comparison of HRQOL domains by mode of delivery using Mann-Whitney test demonstrated a significant difference (p=0.01) between normal delivery and cesarean section. Women undergoing normal delivery had significantly higher scores as compared to women having cesarean section. Also, a significant difference (p=0.027) among HRQOL scores was observed between working women and house wives and as well who had better socioeconomic status (p=0.018). Conclusion: The results of the present study concluded that postpartum quality of life of most of the women undergoing normal vaginal delivery was better as compared to women undergoing cesarean sections in twin cities of Pakistan. Surgical intervention during cesarean section might lead to consistent postpartum pain, inability to cope with needs of newborn and family which in turn can reduce postpartum quality of life among women. Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan Email: madeehamalik15@gmail.com Keywords: Cesarean sections, Health related quality of life, Normal vaginal delivery, Postpartum period, Women, Pakistan © 2018 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) DOI: http://dx.doi.org/10.22159/ijpps.2018v10i7.21284 INTRODUCTION Cesarean sections have been increasing worldwide and have become a global concern. Cesarean sections should be reserved to treat or prevent fetal and maternal complications, but in reality, this has not been the actual practice [1]. Fear of labor pain and an increased tendency towards cesarean section has been causing a decline in normal vaginal delivery. According to World Health Organization, the reasonable rate of cesarean sections is 10-15%. But this practice is rather above this limit in developing countries and the impact of this inappropriate rise in cesarean section has led to poor postpartum quality of life and depression among women. Doctors frequently had been persuading their patients to accept a scheduled cesarean section for conditions that either did not exist or did not justify the procedure. The reason behind this unethical practice might be money making or inadequate knowledge of gynecologists. Extensive research is required to identify different barriers in promoting maternal infant health, provide information for evidence based practice and to assist women in informed decision making. An association of obesity with cesarean section rate has been reported and women with BMI>30 kg/m2 at 16 w of pregnancy had a high prevalence of cesarean section rate in particular primigravidae women. The risk of instrumental delivery, induced labor and thereby increased cesarean section rate was also reported in obese pregnant women [2]. The postpartum period is a critical time for a woman, her newborn and her family, on a physiological, emotional and social level. Postpartum problems like poor physical and mental health lead to poor postpartum quality of life in women, which has a devastating effect on the health related quality of life of mother, newborn and her family [3, 4]. Cesarean section has been increasing at an alarming rate and causing serious deleterious effects on the infant and maternal postpartum quality of life in Pakistan. A study conducted in Lahore reported 21.07% cesarean section rate, of which 11.33% were elective and 88.67% were emergency cesarean sections. Complications during pregnancy and no antenatal care were the main causes of maternal morbidity and mortality. Other causes of cesarean sections were dystocia, fetal distress and previous cesarean sections [5, 6]. Assessment of postpartum quality of life after different modes of delivery is an unexplored area of research, particularly in Pakistan. To date, there is not even a single study up to our best of knowledge which has explored maternal quality of life during postpartum period in Pakistan. Thus, comprehensive research on assessment of women postpartum quality of life after different modes of deliveries is much required to promote maternal and infant health. Therefore, present study was designed to evaluate women postpartum quality of life after different modes of delivery in Pakistan. MATERIALS AND METHODS A descriptive cross-sectional study design was used to assess the physical functioning, role limitation due to physical problems or role physical, bodily pain, general health, vitality, social functioning, role limitation due to emotional problems or role emotional and emotional well-being among women (fig. 1). National bioethical committee is present for this type of research and it states that only institutional head approval is required for this type of study [7]. Moreover in Pakistan, questionnaire-based studies do not need any endorsement from Ministry of Health. Despite that, prior information was sent to the Ministry of Health, Government of Pakistan for the execution of this research. For data collection approval from MS of the hospitals was taken. Informed International Journal of Pharmacy and Pharmaceutical Sciences ISSN- 0975-1491 Vol 10, Issue 7, 2018