Parity and Postpartum Problems
by Anne Eglash MD, IBCLC, FABM
This week’s CQW is based on a recently published survey done in Spain among 1503 primiparous (first time) mothers, and 1487 multiparous (had previous children) mothers, to determine how parity is related to postpartum problems, including lactation. The authors state that most studies on parity evaluate the effect of parity on prenatal and intrapartum factors, but not on postpartum problems.
The mothers, most of whom were highly educated, participated in an online questionnaire. 24.8% of the primiparous mothers experienced an instrumented delivery vs 11.2% of multiparous mothers. 30.5% of primiparous mothers had a cesarean birth vs 18.4% in the multiparous group.
- Primiparous mothers were more likely to perform skin-to-skin as compared to multiparous mothers.
- Primiparous mothers were twice as likely to artificially feed at discharge compared to multiparous mothers.
- Primiparous mothers were nearly 30% more likely to complain of breast pain than multiparous mothers.
- Primiparous mothers were more than twice as likely to have lactation problems as compared to multiparous mother.
- Primiparous mothers were more likely to suffer from postpartum depression and anxiety than multiparous mothers.
See the Answer
Parity is associated with the incidence of problems in pregnancy, delivery and the puerperium. The influence of parity in the postpartum period has been poorly studied and the results are incongruous. The objective of this study was to identify the association between parity and the existence of distinct discomfort and problems during the postpartum period. Cross-sectional study with puerperal women in Spain. Data was collected on demographic and obstetric variables and maternal manifestations of discomfort and problems during the postpartum period. An ad hoc online questionnaire was used. Crude odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated by conditional logistic regression. 1503 primiparous and 1487 multiparous participated in the study. 53.4% (803) of the primiparous women affirmed to have feelings of sadness, as opposed to 36.2% (539) of multiparous women (aOR: 1.60; 95% CI: 1.35–1.89). 48.3% (726) of primiparous had lactation problems vs 24.7% (367) of multiparous (aOR: 2.46; 95% CI: 2.05–2.94). 37.2% (559) of primiparous reported anxiety, while the percentage in multiparous was 25.7% (382) (aOR: 1.34; 95% CI: 1.12–1.61). 22.2% (333) of primiparous had depressive symptoms, and 11.6% (172) of multiparous (aOR: 1.65; CI 95%: 1.31–2.06). Faecal incontinence was more present in primiparous than in multiparous, 6.5% (97) and 3.3% (49) respectively (aOR: 1.60; 95% CI: 1.07–2.38). Parity is associated with the presence of certain problems in the postpartum period. Thus, primiparous are more likely to have lactation problems, depressive symptoms, anxiety, sadness, and faecal incontinence.
In this study, multiparous women were more likely to provide skin to skin compared to primiparous mothers. This study validates what I see clinically. In my breastfeeding medicine clinic, the majority of mothers presenting with breastfeeding problems are primiparous. And, in my family medicine practice, newborn visits with multiparous mothers are shorter and less complicated than those with primiparous mothers. If we add to these findings that primiparous women are more likely to experience a delay in lactogenesis II (milk increasing postpartum), it is highly important that we advocate for primiparous dyads to be seen within 24 hours after hospital discharge, and to have close follow-up by breastfeeding-knowledgeable providers and other supporters, until they are smooth sailing. Any less support sustains current risks of insufficient infant weight gain, maternal complications (such as loss of milk supply and breast infections), as well as premature weaning, all of which need improvement.