Mobilisation, breastfeeding, and quality of recovery after caesarean delivery: a nationwide prospective cohort study in Denmark with secondary analysis on the association with severe pain

BACKGROUND: Severe postoperative pain after caesarean delivery may delay recovery by impeding mobilisation and activities of daily living and may also interfere with feeding and caregiving of the infant. This study aimed to describe maternal recovery after caesarean delivery and investigate the association between severe pain within the first 24 h after surgery and impaired mobilisation, breastfeeding, and overall quality of recovery.

METHODS: This is a planned secondary analysis on a nationwide prospective cohort study across 19 centers in Denmark, with repeated patient-reported outcomes collected throughout the early postoperative hours and days postpartum, analysing recovery outcomes using multivariable regression and multiple imputation for missing data.

RESULTS: Of 583 included patients, 64.6% reported severe pain (numeric rating scale ≥ 7) within the initial 24 h after caesarean delivery. The mean recovery score (ObsQoR-10, range 0-100) was 59.13 ± 13.0 vs. 70.55 ± 12.8 (adjusted difference -11.01, 95% CI -13.40 to -8.62; P < 0.001) in patients with vs. without severe pain, respectively. Severe pain was associated with reduced likelihood of walking independently (86% vs. 94%, adjusted OR 0.43, 95% CI 0.2 to 0.9; P = 0.030), and ability to independently breastfeed (65% vs. 75%, adjusted OR 0.61, 95% CI 0.4 to 0.9; P = 0.037) 24 h after caesarean delivery.

CONCLUSIONS: Severe pain during the first 24 h after caesarean delivery is associated with significant and clinically relevant impaired patient-reported outcome measures of recovery, mobilisation and breastfeeding. These findings support the importance of adequate post-caesarean analgesia for improving maternal recovery.