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Am J Perinatol
DOI: 10.1055/a-2573-9156
Short Communication

Clinician Perspectives on the Assessment and Management of Postpartum Pain

Tazim Merchant
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2   Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
,
Julia D. DiTosto
3   Department of Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
,
Elizabeth Soyemi
4   Division of Biology and Medicine, Brown University, Providence, Rhode Island
,
Lynn M. Yee
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Nevert Badreldin
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
5   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
› Author Affiliations Funding This work was supported by the Friends of Prentice, and by the Eunice Kennedy Shriver NICHD (grant no.: 1R03HD112103–01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Abstract

Objective

Postpartum pain management practices have significant variation and are known to be influenced by nonclinical factors. We aimed to examine factors that contribute to clinicians' assessment and management of postpartum pain, including the role of opioids.

Study Design

We conducted a qualitative study of obstetric clinicians providing postpartum care at a single, large, tertiary care center (November 2021–June 2022). Attending and trainee OB/GYN physicians and advanced practice providers (APPs) completed in-depth interviews using a semistructured interview guide. Purposive sampling was employed to ensure a representative sample of each clinician type was included. Participants were asked about factors that influence postpartum pain management. Data were analyzed using the constant comparative method.

Results

Of 46 participants, 48% were attending physicians, 32% trainee physicians, and 20% APPs. The analysis demonstrated three key themes related to postpartum assessment and management: influencing factors (knowledge or experiences that influence practice), objective findings, and the role of counseling. While clinicians reported guidelines and patient satisfaction as major influencing factors, several also shared the inherent conflict that may arise between them. Objective findings, specifically the impact of pain on patients achieving functional goals, also influenced clinician decision-making. Conversely, many participants reported the limited utility of the numeric pain scale as an objective metric. Additionally, the role of counseling in shared decision-making and providing anticipatory guidance was emphasized. Finally, clinicians had a range of opinions on the role of opioids in pain management, but many spoke to the value of opioids as second-line treatment and the impact of the opioid epidemic on prescribing practices.

Conclusion

The factors that influence clinicians' assessment and management of postpartum pain are occasionally in conflict. Furthermore, objective measures, such as the numeric pain scale, have significant limitations.

Key Points

  • Guidelines and patient satisfaction influence care.

  • Guidelines and patient satisfaction can conflict.

  • The numeric pain scale has significant limitations.

  • Opioids are valuable as second-line pain treatment.

Keywords

pain management - pain assessment - opioid epidemic - postpartum


Publication History

Received: 05 November 2024

Accepted: 01 April 2025

Accepted Manuscript online:
03 April 2025

Article published online:
30 April 2025

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