title: Postpartum perineal pain in a low episiotomy setting: association with severity of genital trauma, labor care, and birth variables.
abstract: BACKGROUND
  Perineal pain is common after childbirth. We studied the effect of genital tract trauma, labor care, and birth variables on the incidence of pain in a population of healthy women exposed to low rates of episiotomy and operative vaginal delivery.
  
  
  METHODS
  A prospective study of genital trauma at birth and assessment of postpartum perineal pain and analgesic use was conducted in 565 midwifery patients. Perineal pain was assessed using the present pain intensity (PPI) and visual analog scale (VAS) components of the validated short-form McGill pain scale. Multivariate logistic regression examined which patient characteristics or labor care measures were significant determinants of perineal pain and use of analgesic medicines.
  
  
  RESULTS
  At hospital discharge, women with major trauma reported higher VAS pain scores (2.16 +/- 1.61 vs 1.48 +/- 1.40; p < 0.001) and were more likely to use analgesic medicines (76.3 vs 23.7%, p = 0.002) than women with minor or no trauma. By 3 months, average VAS scores were low in each group and not significantly different. Perineal pain at the time of discharge was associated in univariate analysis with higher education level, ethnicity (non-Hispanic white), nulliparity, and longer length of active maternal pushing efforts. In a multivariate model, only trauma group and length of active pushing predicted the pain at hospital discharge. In women with minor or no trauma, only length of the active part of second stage labor had a positive relationship with pain. In women with major trauma, the length of active second stage labor had no independent effect on the level of pain at discharge beyond its effect on the incidence of major trauma.
  
  
  CONCLUSIONS
  Women with spontaneous perineal trauma reported very low rates of postpartum perineal pain. Women with major trauma reported increased perineal pain compared with women who had no or minor trauma; however, by 3 months postpartum this difference was no longer present. In women with minor or no perineal trauma, a longer period of active pushing was associated with increased perineal pain.
authors.affiliation: Department of Family and Community Medicine, University of New Mexico School of Medicine, MSC09 5040, 2400 Tucker NW, Albuquerque, NM 87131, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Leeman
authors.forename: Anne M
authors.initials: AM
authors.lastname: Fullilove
authors.forename: Noelle
authors.initials: N
authors.lastname: Borders
authors.forename: Regina
authors.initials: R
authors.lastname: Manocchio
authors.forename: Leah L
authors.initials: LL
authors.lastname: Albers
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Rogers
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology / Q000209:etiology*; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D004841:Episiotomy / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D015999:Multivariate Analysis; D009516:New Mexico / Q000453:epidemiology; D009721:Nurse Midwives; D010146:Pain / Q000453:epidemiology / Q000209:etiology*; D010147:Pain Measurement; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013536:Suture Techniques; D013997:Time Factors; D014636:Valsalva Maneuver