Pain, activity limitations, and functioning among women after vaginal birth and Cesarean section: a cross-sectional studyABSTRACT
Regardless of the mode of delivery, the postpartum period can be accompanied by pain and discomfort. This study aimed to compare pain, activity limitations, mobility, and functioning between women after vaginal birth and Cesarean section. A cross-sectional study was conducted with postpartum women aged 18 years or older. Pain (Numeric Pain Rating Scale), activity limitations, and mobility (timed up and go) were assessed between 12 and 48 hours postpartum, and functioning (WHODAS 2.0 - 12 items) was assessed 30 days later. The Chi-squared test, Fisher’s exact test, and Student’s t-test (α=0.05) were used. A total of 148 women were evaluated (mean age: 28 years); 53.4% (n=79) had a vaginal birth and 46.6% (n=69) had a Cesarean section. C-section was significantly associated with the presence of pain in the following areas: low back (p=0.03), abdomen (p<0.001), and lower limbs (p=0.01). Vaginal birth was associated with perineal pain (p=0.01). C-section was also associated with the presence of pain and limitations in sitting, standing, walking (p<0.001), lying down (p=0.001), and bathing (p=0.02). We conclude that C-sections are associated with a higher frequency of pain in different body regions, greater pain intensity, and greater activity limitations period. Mobility and functioning did not differ significantly between modes of delivery. Early monitoring is necessary to prevent functional limitations.
Keywords:
Postpartum period; Pain; Activities of daily living; Mobility limitation; International Classification of Functioning, Disability and Health
RESUMO
Independentemente do tipo de parto, o período puerperal pode ocorrer com dor e desconforto. Este estudo teve como objetivo comparar dor, limitação de atividades, mobilidade e funcionalidade entre mulheres após parto vaginal e cesáreo. Foi realizado um estudo transversal com puérperas de 18 anos ou mais. A dor (END), limitações de atividade e mobilidade (timed up and go) foram avaliadas entre 12 e 48 horas pós-parto, e funcionalidade (WHODAS 2.0 - 12 itens) 30 dias depois. Foram utilizados o teste qui-quadrado, exato de Fisher e t de Student (α=0,05). Foram avaliadas 148 mulheres (média de idade: 28 anos): 53,4% (n=79) tiveram parto vaginal e 46,6% (n=69) cesárea. Houve associação entre cesárea e presença de dor nas seguintes regiões: lombar (p=0,03), abdômen (p<0,001) e membros inferiores (p=0,01); e parto vaginal com dor perineal (p=0,01). A cesárea esteve associada à presença de dor e limitações para sentar, levantar, caminhar (p<0,001), deitar (p=0,001) e tomar banho (p=0,02). Conclui-se que a cesárea está associada a maior frequência de dor em diferentes regiões, e maior intensidade de dor e limitação para atividades no pós-parto imediato. Mobilidade e a funcionalidade não diferiram entre os tipos de parto. O monitoramento é necessário para evitar limitações.
Descritores:
Período Pós-Parto; Dor; Atividades diárias; Limitação da mobilidade; Classificação Internacional de Funcionalidade, Incapacidade e Saúde
RESUMEN
Independientemente del tipo de parto, el período puerperal puede presentar dolor e incomodidad. Este estudio tuvo como objetivo comparar el dolor, la limitación de actividades, la movilidad y la funcionalidad entre las mujeres después del parto vaginal y por cesárea. Se realizó un estudio transversal con mujeres puérperas, con edad de 18 años o más. El dolor (END), las limitaciones de actividad y movilidad (timed up and go) se evaluaron entre 12 y 48 horas después del parto, y la funcionalidad (WHODAS 2.0 - 12 ítems) 30 días después. Se utilizaron la prueba de chi-cuadrado, la prueba exacta de Fisher y la prueba t de Student (α=0,05). Se evaluaron 148 mujeres (edad media: 28 años): 53,4% (n=79) tuvieron parto vaginal; y 46,6% (n=69) cesárea. Hubo asociación entre cesárea y presencia de dolor en las siguientes regiones: lumbar (p=0,03), abdomen (p<0,001) y miembros inferiores (p=0,01); y parto vaginal con dolor perineal (p=0,01). La cesárea se asoció con la presencia de dolor y limitaciones para sentarse, levantarse, caminar (p<0,001), acostarse (p=0,001) y bañarse (p=0,02). Se concluye que la cesárea se asocia a una mayor frecuencia de dolor en diferentes regiones y a una mayor intensidad de dolor y limitación de actividades en el posparto inmediato. La movilidad y la funcionalidad no difirieron entre los tipos de parto. El monitoreo es necesario para evitar limitaciones.
Palabras clave:
Periodo Posparto; Dolor; Actividades Cotidianas; Limitacion de la Movilidad; Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud
INTRODUCTION
The postpartum period extends from the delivery of the placenta to the completion of uterine involution, which can take up to eight weeks1. This period of regression involves various morphological and physiological adaptations and is therefore chronologically variable. Some conditions, which may be caused or exacerbated by pregnancy and childbirth, may be neglected during this period, and only surface months or years after birth. It is recommended that special care for postpartum women be initiated as soon as possible, as painful conditions can significantly affect recovery time2,3. According to the Informatics Department of the Brazilian Unified Health System (DATASUS), the number of live vaginal births in Brazil in 2022 was 1,072,287, and live Cesarean births were 1,488,4234. Regardless of the mode of delivery, the puerperal period can be accompanied by reports of pain and discomfort. Pain can directly affect a postpartum woman’s activities, such as sitting, standing, walking, and personal care. The functional capacity to perform these activities is an indicator of a faster and more successful recovery after childbirth. According to the International Association for the Study of Pain (IASP), pain is defined as an “unpleasant sensory and emotional experience, associated, or similar to that associated with a real or potential tissue injury.” These complaints sometimes arise from surgical wounds or perineal trauma, depending on the mode of delivery, but they can also be due to labor efforts, physical fatigue, excess weight gained during pregnancy, postural changes, weakness of the abdominal and pelvic floor muscles, prolonged bed rest, and the consequences of anesthesia, when used5,6. Thus, the mode of delivery can also interfere with a woman’s recovery in various ways and contribute to activity limitations3, including reduced mobility7.
Mobility is understood as movement in various forms, including ambulation, transferring from a bed to a chair, and walking, as well as the use of transportation8. Therefore, the early identification of pain and activity limitations-including loss of mobility-is relevant, as these factors contribute to reduced functioning. The International Classification of Functioning, Disability and Health (ICF) characterizes functioning as a term that encompasses all body functions, activities, and social participation. Disability covers negative aspects such as impairments, activity limitations, and restrictions on social participation, interacting with contextual factors9. Furthermore, functioning is considered a third health indicator, complementing morbidity and mortality indicators in monitoring the performance of health strategies, and it serves as a key indicator for rehabilitation10. Currently, the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic instrument capable of measuring levels of functioning and disability11. However, functioning regarding women’s health after childbirth remains poorly understood.
In this context, postpartum pain seems to be a more frequently reported topic, but further studies are needed to explore other factors involved in this period-such as mobility, activity limitations, and functioning-from a biopsychosocial perspective. Although factors contributing to pain and activity limitations in both modes of delivery are known, there is still a need for studies that explore the relationships between modes of delivery and these outcomes. Therefore, we highlight the novelty of this research and justify this investigation to deepen the knowledge surrounding this gap in the literature. This study aimed to compare pain, activity limitations, and mobility in the immediate postpartum period, as well as comparing functioning in the late postpartum period, between women who had vaginal and cesarean births.
METHODOLOGY
This cross-sectional study was conducted in the maternity wards of the Assis Chateaubriand Maternity School (MEAC) at the Federal University of Ceará (UFC), in Fortaleza, Ceará, Brazil, from February to July 2023. Data collection took place in two phases: the first occurred in the wards, and the second was a follow-up contact approximately one month later by telephone. The sample was non-probabilistic, composed of literate women aged 18 years or older in the immediate postpartum period (12-48 hours postpartum), who were not confined to bed and had delivered without clinical complications, infectious diseases, or severe maternal morbidity. The following exclusion criteria were applied: cognitive deficits or auditory dysfunction that hindered understanding the questions; complications during childbirth that persisted in the immediate postpartum period (bleeding, temperature ≥37.8°C, fever, blood pressure ≥140 × 90 mmHg, dizziness, nausea, use of an indwelling urinary catheter); mental disorders; twin births; chronic musculoskeletal pain prior to pregnancy (such as fibromyalgia); and the inability to participate in the study for any personal reason.
Data collection, instruments and procedures
After approval of the study, the researcher was trained, and the instruments were checked to minimize the risk of bias. Recruitment was performed through an active search for participants in the MEAC wards, and screening was conducted using the inclusion criteria checklist. Data collection began by filling out a structured form immediately after the participants signed an informed consent form and their vital signs were checked. Socioeconomic and demographic data were collected, alongside clinical data, such as obstetric history, date and time of delivery, and information on any complications during childbirth and in the immediate postpartum period. Participants were also asked about their use of medication at the time the questionnaire was applied, and medical records were checked to confirm whether the medications were anti-inflammatories or analgesics. Palpation was performed (on the dorsum of the foot and the retromalleolar region) to check for edema, which was recorded on the form. Next, the participants were assessed regarding the presence and intensity of pain (across various locations and during different activities). After completing the form, the women were invited to perform the timed up and go (TUG) test to assess mobility12. Finally, the WHODAS 2.0 - 12 items was applied via telephone call13 approximately one month after the first contact, or via a digital form link (mirroring the original). The digital form was sent as an alternative for participants who could not be reached by phone or who preferred to answer digitally. After a week of attempts via calls (an average of five calls) and messages, any participants who did not return contact were excluded from the functioning analysis stage.
Pain and activity limitations
A structured form was used to ask postpartum women about pain in predetermined locations, such as the lumbar spine, cervical region, abdomen, upper limbs, lower limbs, and perineal region. Following this, they were asked about the pain intensity in each location using the 11-point Numeric Pain Rating Scale (NPRS), ranging from 0 to 1014. The women also reported on the presence of pain when carrying out different activities and subsequently rated the intensity of this pain (NPRS). The activities were related to mobility (sitting, getting up from a sitting position, walking, and lying down), self-care (urinating, defecating, bathing, eating, and sleeping)3, and care for the newborn (changing diapers and breastfeeding). Finally, the participants were asked whether pain limited their performance of these activities. For the comparative analysis between the different modes of delivery, we considered the presence (yes × no) and pain intensity (NPRS) in different locations and activities, as well self-reported activity limitations due to pain (yes × no).
Mobility
Mobility was objectively assessed using the TUG test, which evaluates the time it takes a person (in seconds and milliseconds) to get up from a standardized chair, walk 3m, go around a cone, return, and sit down on the chair again13. The test was performed at a normal, comfortable speed. An adjustment equation based on the postpartum women’s anthropometric data was applied: 8.615 + (age × 0.032) + (BMI × 0.102) − (height × 0.026)15. This equation comes from a multicenter study that established reference values and equations for seven functional tests (in adults aged 20-80 years)15. We used the TUG averages for comparison between the two modes of delivery.
Functioning
Functioning was assessed approximately 30 days after the initial contact (in the late postpartum period), as the WHODAS instrument asks for information regarding the past four weeks. The WHODAS 2.0 12-item instrument was applied via a telephone call or digital form link. This instrument is based on the International Classification of Functioning, Disability and Health (ICF) and is a generic, translated, and validated tool16. The 12-item version of the WHODAS 2.0 is useful for assessments with time constraints and explains 81% of the variance found in the full 36-item version17. The total score is obtained by the simple sum of the values assigned to each of the 12 items: “none” (1), “mild” (2), “moderate” (3), “severe” (4), and “extreme or cannot do” (5), ranging from 12 to 60 points13.
Type of delivery
The form included an item for the mode of delivery, in which the researcher indicated whether the postpartum woman had a cesarean section or a vaginal birth (independent variable). The researcher also recorded whether vaginal births were spontaneous or instrumental (use of forceps, vacuum, or episiotomy), and whether a laceration occurred, including the degree of the laceration (considered for sample characterization).
Next, the following information was considered to characterize the sample: socioeconomic and demographic data (age, contact information, ethnicity/skin color, marital status, education level, paid work, and individual income); as well as obstetric history and clinical data (number of pregnancies, abortions, births, mode of delivery, date and time of delivery, high- or low-risk pregnancy, degree of lacerations, use of medication, and the presence or absence of edema). Edema was verified by inspection and palpation, pressing the thumb for 5 seconds on the dorsum of the foot and the retromalleolar region. The pitting edema test (Godet’s sign) was considered positive when the depression formed on the skin’s surface did not disappear immediately after decompression18. In addition, anthropometric measurements were assessed to estimate BMI.
The sample size estimation was based on an existing study in the literature3. Changes in pain intensity are considered clinically significant when there is a minimum difference of 2 points (SD=3.1) on the 11-point Pain Scale19. Using this parameter and considering the variability of data from previously collected samples-alongside a study power of 80%, a 5% significance level, and an expected sample loss of 10%-the minimum required sample size was 42 women in each group (post-vaginal birth and post-Cesarean section). The sample was expanded (n=148) to guarantee the power of the statistical tests and to enable future analyses with sample stratification.
Data analysis
Data normality was checked using the Kolmogorov-Smirnov test. Absolute and relative frequencies, as well as means and standard deviations, were used for descriptive analysis. Moreover, the Chi-squared or Fisher’s exact tests were used to verify the associations between the mode of delivery (Cesarean section × vaginal) and the presence of pain in different locations (yes × no), as well as the presence of pain and limitations in carrying out daily activities (yes × no). In addition, Student’s t-test was used to compare the mean pain intensity, mobility, and functioning between the different modes of delivery. A 5% significance level was adopted, and SPSS version 20.0 (SPSS, Chicago, IL, USA) was used for all tests.
RESULTS
The sample consisted of 148 women. The mean age was 28.5±6.3 years. Regarding demographics, 69.6% (n=103) identified as Mixed-race, 43.9% (n=65) reported being single, 69.6% (n=103) reported an education level of “Up to complete high school,” and 78.4% (n=116) had paid employment. The mean BMI was 29.9±5.9, with 61.5% of the women falling into the overweight and obese categories. Regarding obstetric history, 71.6% (n=106) reported 1 to 2 pregnancies, and 52.7% (n=78) reported high-risk pregnancies. As for modes of delivery, 53.4% (n=79) had a vaginal birth and 46.6% (n=69) had a Cesarean section (Table 1).
Socioeconomic, demographic and clinical data of the sample of women in the immediate postpartum period after vaginal delivery or cesarean section (n=148)
Table 2 shows the relationship between the mode of delivery and self-reported pain in different body locations. We observed that Cesarean section was significantly associated with the presence of low back pain (p=0.03), abdominal pain (p<0.001), and pain in the lower limbs (p=0.01); meanwhile, vaginal birth was associated exclusively with perineal pain (p=0.01). A statistically significant difference regarding pain intensity between the modes of delivery was found only for the “abdomen” location (MD = −2.91; 95% CI= −3.96 to −1.96), with a lower mean observed in women who had a vaginal birth (data not presented in the table). We found no statistical difference between the groups in pain intensity for the other locations.
Table 3 presents the relationship between the mode of delivery and the self-reported pain during various activities. We observed a significant association between Cesarean section and pain during the following activities: sitting (p<0.001), getting up (p<0.001), walking (p<0.001), lying down (p<0.001), bathing (p<0.001), sleeping (p=0.003), and changing the baby’s diaper (p=0.02). Regarding pain intensity (data not presented in the table), we similarly observed that women who underwent a C-section reported greater pain intensity during the following activities (Figure 1): sitting (MD=−3.49; 95% CI: −4.51 to −2.46), getting up (MD=−3.45; 95% CI = −4.44 to −2.45), walking (MD=−3.71; 95% CI = −4.69 to −2.74), lying down (MD=−3.12; 95% CI: −4.16 to −2.09), bathing (MD=−1.37; 95% CI = −2.04 to −0.70), sleeping (MD=−1.21; 95% CI: −2.00 to −0.41), and changing the baby’s diaper (MD=−0.57; 95% CI: −1.12 to −0.02). Mean differences greater than 2 points were observed for the first four activities mentioned, with statistical power above 90%.
Graphs comparing the means and their 95% confidence intervals (CIs) of pain intensity during activities of daily living between puerperal women who had a vaginal delivery or a C-section
We also observed that the associations were similar regarding activity limitations due to pain (Table 3). There was a significant association between C-section and the presence of limitations in sitting, standing, walking (p<0.001), lying down (p=0.001), and bathing (p=0.02). There was no statistical difference for the other activities.
Table 4 compares mobility (TUG) in the immediate postpartum period and functioning (WHODAS) in the late postpartum between modes of delivery. We observed no statistically significant difference in mobility (p=0.07) or functioning (p=0.67) between the mode of delivery.
DISCUSSION
Our results showed that women who underwent a C-section had a higher frequency of pain in multiple parts of the body (abdomen, lumbar spine and lower limbs) and greater pain intensity, as well as limitations in mobility (such as sitting, getting up, walking and lying down) during the immediate postpartum period. Conversely, vaginal birth was exclusively associated with the presence of perineal pain during this period. However, we did not observe a statistically significant difference between the modes of delivery when analyzing the physical mobility test (TUG) in the immediate postpartum period or overall functioning in the late postpartum period.
We observed that abdominal pain was frequently reported by women in the immediate postpartum period, being significantly more prevalent in those who had a C-section. This finding aligns with previous studies, which attribute the higher prevalence of this pain to the use of anesthesia, reduced peristalsis, and the presence of gas20. Moreover, incision pain after a Cesarean section is commonly reported and can persist for up to two months after birth. Other factors can also influence the high occurrence of abdominal pain in postpartum women, such as the process of uterine involution, abdominal cramps during breastfeeding, and constipation20. Low back pain was also a widely reported postpartum complaint in our study and was strongly associated with C-section. Several conditions may favor the presence of this pain, such as abdominal muscle weakness, pre-existing low back pain during pregnancy, multiparity, and the use of epidural or spinal anesthesia during cesarean births21,22. Furthermore, inadequate postures when caring for the newborn and during breastfeeding also favor the onset of low back pain21. We hypothesize that such inadequate antalgic postures are more common among women who have undergone a cesarean section. According to current evidence, low back and perineal pain affect more than 10% of women after birth2.
The presence of pain in the lower limbs was also more common in women who had a cesarean section. In addition to anesthesia and a greater need for rest, the surgical scar in women who have recently had a cesarean section can impair lymphatic drainage and contribute to the restriction of movement due to pain and/or fear. This leads to prolonged bed rest, which in turn favors the development of lower limb edema23, potentially explaining the increased pain and reduced mobility observed.
Perineal pain was the only type of pain associated exclusively with vaginal birth. This can occur even in women with an intact perineum, although the severity of the pain usually correlates with the degree of tissue trauma. In this mode of delivery, perineal structures undergo adaptations and stretching, which can lead to tissue damage, lacerations, ruptures, and disinsertions. However, these are not factors that should be considered as reasons for performing a Cesarean section24,25. These women should receive targeted care in the immediate postpartum period aimed at preventing further complications.
Women who underwent a C-section reported more pain and limitations in self-care and mobility activities. Recovery after a Cesarean section appears to take longer and is closely related to reduced mobility. In a study conducted in Chicago, authors observed that, within a 24 to 48-hour period after a C-section, women reported a higher frequency of pain during simple activities such as getting in and out of bed, changing posture (standing and sitting), and moving quickly or slowly25.
Evidence suggests that Cesarean deliveries can lead to negative health outcomes, such as higher readmission rates and longer hospital stays24. This is due to the previously discussed issues (anesthesia, surgical wounds, edema, among others), as well as a greater infection risk24, and thus, this type of procedure should only be performed when necessary.
Difficulties in carrying out mobility activities may be related to muscle fatigue, physical symptoms (tiredness or extreme exhaustion), and the cognitive or emotional symptoms, common in the postpartum period2. It is important to highlight that movement in such activities requires the coordinated use of various body segments (mainly the trunk and hips) and the ability to overcome gravity, which increases the muscular demand required to perform them3. Given the timeframe in which these women were evaluated (an average of 27 hours after birth), we believe that women who underwent Cesarean section experience greater pain and functional limitations for the reasons discussed above.
Although women who had a C-section reported more limitations in mobility-related activities, there was no statistical difference in the TUG physical test results. However, we emphasize that there is a limitation for this finding, as only 95 of the 148 participants took the test (56 post-vaginal and 39 post-Cesarean), which may have skewed the results and influenced the lack of difference between the groups. The primary reasons for refusing to perform the test were physical tiredness, abdominal pain, fear of pain at the C-section scar site, and the use of intravenous medication, which made mobility impossible. Therefore, these women would have probably taken longer to complete the test, reflecting poorer mobility. A study by Santos et al.26 conducted in northeastern Brazil observed worse mobility (TUG scores) in women who underwent Cesarean section compared to vaginal birth in the immediate postpartum period26. Similar results were reported in a study from southern Brazil that also used the TUG in the immediate postpartum period8.
The TUG is considered a simple, low-cost functional test that requires few resources and is capable of quantifying functional performance based on mobility skills27. Regardless of the mode of delivery, women who have worse results in the TUG generally have poorer mobility, which may interfere with their daily activities after hospital discharge8 and increase the risk of falls27. Therefore, more studies investigating mobility in this specific population are needed to confirm these results, highlighting that mobility must be consistently evaluated in the immediate postpartum period.
We did not observe any difference between the modes of delivery when evaluating functioning in the late postpartum period. A study by Mayrink et al.28 carried out in southeastern Brazil aimed to understand WHODAS scores among postpartum women without morbidity to suggest a cut-off point for disability screening. The study applied the 12- and 36-item versions of the questionnaire to 128 women (mean age of 28 years) to validate the instrument, observing that the 90th percentile served as the best cutoff point for screening (WHODAS-36: 30.2 points; and WHODAS-12: 30.9 points)28. However, the study did not mention values compared between modes of delivery. In our study, we observed lower mean WHODAS scores in postpartum women of a similar mean age compared to those proposed for screening, regardless of the delivery type, indicating a lower level of disability in this cohort.
Another study conducted with 638 women in Campinas, southeastern Brazil, identified that maternal morbidity negatively impacts functioning (measured by the WHODAS) in the postpartum period, particularly in women with hypertensive disorders and other indirect causes of maternal morbidity29, which were not analyzed in our study. The authors reported that complications during pregnancy, childbirth and the postpartum period can increase WHODAS-36 scores in the long term (up to 5 years after birth), indicating a lasting impact on women’s functioning29.
When applied postpartum to healthy women without specific morbidities, the WHODAS captures the complex factors present in a woman’s life during this stage and their effects on activities of daily living. Among these factors are the physical and emotional changes resulting from the pregnancy-puerperal cycle. This cycle requires broader monitoring regarding health indicators; however, the WHODAS has not been frequently applied to women of reproductive age during pregnancy or the postpartum period29. Information about disability is considered crucial for health assessment, rehabilitation and monitoring the performance of health strategies11. More research is needed to understand the functioning of this population to optimize care for women during this cycle, which involves several physiological adaptations in the body, as well as complex adjustments within the family context.
In 2022, the WHO published a manual on maternal and neonatal care promoting a positive postpartum experience, recommending proactive postpartum pain management30. As part of a multidisciplinary team in maternity wards, specialized physical therapists can expand and improve the care process for postpartum women, such as by implementing non-pharmacological methods for pain relief, stimulating early mobility, and guiding postural adjustments for activities such as caring for newborns and breastfeeding4.
Finally, we can mention some factors as limitations of this study, such as the possibility of bias in the results of the TUG test, since many women refused to undergo the test, with most of the reasons being related to the C-section; the difficulty of contact after 30 days for applying the WHODAS-12, as many participants did not respond to contacts, which limited the functioning evaluation; and the non-use of the WHODAS-36, which makes it impossible to explore the data regarding the domains of this instrument and better understand the functioning in these women.
Although we do not have control over the frequency and dose of pain medication, in our sample there was no statistically significant difference in the use of medication between modes of delivery (p = 0.18). Moreover, even with the use of medication, we observed differences related to pain and to activities between modes of delivery. We recognize the importance of offering non-pharmacological methods for this population, which justifies the early action of physiotherapy seeking to benefit these women. We emphasize the importance of this study due to the novelty of the topic, as well as the need for more research in this population. We suggest that new studies be performed with women in the pregnancy-puerperal cycle using the 36-item version of this instrument in order to expand understanding of functioning, as well as related factors in these periods, and studies which investigate functioning considering the social support received by these women in the postpartum period.
CONCLUSION
In this study, we conclude that Csarean section is associated with a higher frequency of pain in different regions, as well as greater pain intensity and activity limitations in the immediate postpartum period, while perineal pain was associated with vaginal birth. Mobility in the immediate postpartum period and functioning in the late postpartum period were not associated with the mode of delivery. We emphasize the need for early care and monitoring of this population, preventing limitations in their activities.
ACKNOWLEDGMENTS
Maternidade Escola Assis Chateaubriand - MEAC.
DATA AVAILABILITY
The data underlying this study are available in the published article.
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A: Sitting down, B: Standing, C: Walking, D: Lying down, E: Urinating, F: Evacuating, G: Bathing, H: Sleeping, I: Feeding, J: Breastfeeding, K: Changing diapers. NPRS: Numeric Pain Rating Scale.