What Matters to Mothers: A Qualitative Exploration of Pain and Recovery After Cesarean Section

Background: Fast recovery after cesarean section is vital since the mother not only has to take care of herself but also the newborn. Recovery scores are useful tools to measure and compare recovery; however, standardized questionnaires may miss in-depth patient experiences. What is important to women in the postoperative period after cesarean section can vary in different populations, making it crucial to understand the specific needs of one's own population. This study aims to explore what matters most to Danish mothers during the early phase of recovery following elective cesarean section.

Methods: Qualitative design: Adult, Danish-speaking women undergoing elective cesarean section under spinal anesthesia were included in three Danish hospitals. Semi-structured interviews focusing on women's experiences of recovery, pain, and mobilization both in hospital and after discharge were conducted for 4-7 days following their cesarean section. Baseline characteristics and maternal outcomes were collected from patient files. The interviews were recorded, transcribed verbatim, and analyzed using manifest content analysis.

Results: In total, 25 women were interviewed a median of 6 days post cesarean section (IQR 5-8). Three themes emerged: "Experience of being a cesarean section patient," "I'm doing good - and better than expected," and "Challenges when going home." The cesarean section itself was described as a disturbing experience. The initial days post-cesarean section were described as very painful, but hereafter, many patients expressed surprise at their rapid recovery. None used opioids after discharge. Post-discharge, having a partner's support, especially with other children to care for, was helpful, and moving from lying to sitting position and getting out of bed were noted as particularly painful. Many women requested more information and specific rehabilitation programs.

Conclusions: In this qualitative study of Danish women 4-7 days after elective cesarean sections, the women described the initial days as very painful but felt that they recovered rather quickly thereafter. The study indicated a need for enhanced communication, especially regarding the experience of surgery, pain after cesarean section, and physical rehabilitation plans.

Editorial Comment: In this qualitative, explorative study, participants were interviewed by telephone 4-7 days following their elective cesarean section. The focus was the women's experience of recovery, pain, and mobilization, both in hospital and when going home. The findings identified a need for more information about the perioperative course, as most participants were surprised and unprepared both for the pain from other areas than the scar and for the surgery experience being unpleasant, and many requested physical rehabilitation plans.