Beyond the pain scores: patient experiences postcaesarean delivery in a low-to-middle income context

BACKGROUND Caesarean delivery rates are increasing globally, and effective postoperative pain management remains important, particularly in low-income and middle-income settings where resource and monitoring constraints may limit access to guideline-recommended multimodal analgesia. This study described pain intensity, selected early recovery markers and peri-operative analgesic practices after caesarean delivery at a tertiary hospital in Cape Town, South Africa. METHODS We conducted a prospective observational cohort study of women undergoing elective or emergency caesarean delivery. After informed consent, participants were interviewed on postoperative days 1 and 2. The primary outcome was pain intensity measured using the Numerical Rating Scale and Wong-Baker Faces Scale. Secondary outcomes were time to first oral intake, mobilisation, urinary catheter removal, self-reported breastfeeding difficulty and peri-operative analgesic practices. RESULTS A total of 387 women were recruited; 309 (80%) underwent emergency and 78 (20%) elective caesarean delivery. Neuraxial anaesthesia was used in 369/387 (95.3%). Pain assessments were performed at 22 ± 7 h on day 1 and 45 ± 7 h on day 2 after surgery. Moderate-to-severe pain during functional activity (NRS >4) was reported by 243/387 (63%) women on day 1 and 140/387 (36%) on day 2. Severe pain (NRS >8) was reported by 79/387 (20%) on day 1 and 28/387 (7%) on day 2. Mean time to first oral intake was 16 ± 10 h, urinary catheter removal 23 ± 9 h and mobilisation 22 ± 9 h. Self-reported difficulty with breastfeeding was reported by 44/387 (12%). Peri-operative analgesic practice was heterogeneous, with frequent use of intrathecal fentanyl, intravenous paracetamol, oral paracetamol, oral tramadol and intramuscular morphine, and less frequent use of intrathecal morphine, NSAIDs and regional techniques. CONCLUSIONS In this cohort, a substantial proportion of women reported moderate-to-severe pain after caesarean delivery, particularly on postoperative day 1, and peri-operative analgesic practices were variable. These findings provide baseline data from a tertiary hospital in a low-income and middle-income setting and support the development of context-appropriate standardised post-caesarean analgesia and recovery pathways.