Physical and psychological recovery after vaginal childbirth with and without epidural analgesia

1. There was a steady increase in daily step counts, improvement in health-related quality of life scores, and a decrease in fatigue scores in the postpartum period.

2. There was no significant difference in daily step counts between women who used neuraxial labor analgesia and those who did not. 

Evidence Rating Level: 1 (Excellent)

Early mobilization plays a vital role in enhanced recovery after surgery (ERAS), reducing thromboembolism and complications while improving physical recovery and pain relief. These benefits extend to postpartum patients, aiding in their physical and psychological recovery while caring for newborns. This study aims to evaluate postpartum recovery, utilizing activity trackers, questionnaires, and diaries, with a focus on identifying factors influencing recovery and the impact of neuraxial labor analgesia. 300 women anticipating a vaginal delivery were enrolled in the study, with 95 having a vaginal delivery without neuraxial analgesia (NCB group), and 116 opting for neuraxial labor analgesia (EPL group). At the 1-month postpartum visit, the EPL group reported slightly higher pain scores (median [interquartile range] 1 [0,6] versus 3 [0,12.5]; P=0.01), but demonstrated no other significant differences in pain scores at other time points. Both groups showed consistent increases in adjusted daily step counts, with no significant differences. Receiving neuraxial labor analgesia was not associated with increased or decreased odds of achieving adequate ambulation, defined as >3500 steps between 48 and 72 hours postpartum. Health-related quality of life scores, as measured by the validated EuroQol 5 Dimension 5 Level questionnaire  (EQ-5D-5L), were lowest on postpartum day 1, gradually returning to pre-pregnancy levels by one month postpartum. Multidimensional Fatigue Inventory  (MFI) scores increased during hospitalization compared to the antenatal period but improved by one month postpartum. Overall, these findings suggest epidural analgesia did not lead to poorer postpartum recovery outcomes. 

Click to read the study in PLOSONE

Image: PD

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