Symptoms of Discomfort and Problems Associated with Mode of Delivery During the Puerperium: An Observational Study

Int J Environ Res Public Health. 2019 Nov 18;16(22):4564. doi: 10.3390/ijerph16224564.


Despite abundant literature on antenatal and delivery care received by pregnant women, there is a wide knowledge gap on the prevalence of symptoms of discomfort or problems during the postpartum period and their relationship with the mode of delivery. This cross-sectional study, carried out with 3324 participants in Spain in 2017, aimed to investigate the association between the mode of delivery and self-reported postpartum symptoms of discomfort and maternal problems during the puerperium. An ad hoc online questionnaire was used to collect data on socio-demographic and obstetric variables, symptoms of discomfort, and maternal problems during the puerperium. The crude odds ratios (OR) and adjusted OR (aOR) and their 95% confidence intervals (95%CI) were calculated using binary logistic regression. In total, 3324 women participated. Compared to a normal vaginal delivery, having a cesarean section was associated with increased odds of an infected surgical wound (aOR: 11.62, 95%CI: 6.77-19.95), feeling sad (aOR: 1.31, 23 95%CI: 1.03-1.68), and symptoms of post-traumatic stress (aOR: 4.64, 95%CI: 2.94-7.32). Instrumental delivery vs. normal vaginal delivery was a risk factor for constipation (aOR: 1.35 95%CI: 25 1.10-1.66), hemorrhoids (aOR: 1.28, 95%CI: 1.04-1.57), urinary incontinence (aOR: 1.30, 95%CI: 26 1.05-1.61), and fecal incontinence (aOR: 1.94, 95%CI: 1.29-2.92) during the puerperium. Women who gave delivery via cesarean section or instrumental delivery had higher incidences of infection and psychological alterations than those who had a normal vaginal delivery. Identifying women at risk of giving birth by cesarean section and informing them about subsequent symptoms of discomfort and maternal problems during the puerperium must be included in pregnancy health program policies and protocols to allow women to make informed decisions regarding their birthing plan.

Keywords: birthing plan; discomfort; health problems; maternal problems; mode of delivery; policy; puerperium; self-perceived health.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Cesarean Section / adverse effects
  • Cross-Sectional Studies
  • Delivery, Obstetric / adverse effects*
  • Delivery, Obstetric / methods
  • Fecal Incontinence / epidemiology
  • Fecal Incontinence / etiology
  • Female
  • Humans
  • Incidence
  • Logistic Models
  • Odds Ratio
  • Parturition
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postpartum Period*
  • Pregnancy
  • Prevalence
  • Risk Factors
  • Spain / epidemiology
  • Surveys and Questionnaires
  • Urinary Incontinence / epidemiology
  • Urinary Incontinence / etiology