Postnatal perineal pain after vaginal delivery in comprehensive and specialised hospitals in Amhara regional state, Ethiopia, April to June, 2023

Postnatal perineal pain after vaginal delivery in comprehensive and specialised hospitals in Amhara regional state, Ethiopia, April to June, 2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Postnatal perineal pain after vaginal delivery in comprehensive and specialised hospitals in Amhara regional state, Ethiopia, April to June, 2023 Hassen Ahmed Yimam, Tadesse Belayneh Melkie, Abatneh Feleke Agengehu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4598238/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Millions of women suffer from perineal trauma during childbirth which is the most common cause of postnatal compliant that lasts for hours, days, weeks, or even months. It is the most common source of postnatal morbidity. Hypothesis: There is not clinically significant postnatal perineal pain after vaginal deliveries Objective: The objective of this study was to determine postnatal perineal pain and associated factors among women who had vaginal deliveries. Methods: A multicentre prospective follow-up study was conducted, including a total of 374 women who delivered vaginally at comprehensive specialised hospitals in the Amhara Regional State, Ethiopia, from April 1 to June 30, 2023. Simple random sampling techniques were used to select the samples. Descriptive statistics and logistic regression were performed to determine the incidence of moderate to severe perineal pain, and the association was presented as an odds ratio with a 95% confidence interval. All p-values less than 0.05 were considered statistically significant. Results: The final data analysis includes 356 women out of 374 with a 95% response rate. The incidence of moderate to severe pain was 213 (59.8%) [95%, CI =54.8-65.4], 126 (35.4%) [95%, CI =30.6-39.9], and 30 (8.4%) [95%, CI =5.6-11.8] at days one, three and seven respectively. On postnatal day one, higher level of education [AOR =3.62, 95%, CI (0.99-13.08)], primiparity [AOR =3.22, 95%, CI=1.91-5.42)], episiotomy [AOR =11.90, 95%, CI=5.98-23.75)], and instrumental delivery [AOR =4.54, 95%, CI=1.593-12.91)] were significantly associated with postnatal perineal pain. On the 3rd postnatal day, primiparous [AOR =2.66, 95 %, CI=1.57-4.50)], first degree tear [AOR =7.98,95%,CI=3.06-20.77)], 2nd degree tear [AOR =12.48,95%, CI=4.9031.79)], and 3rd to 4th degree tear [AOR =10.13,95%,CI=3.013-34.04)] were again significantly associated with postnatal perineal pain. On the seventh postnatal day, Episiotomy [AOR =9.76, 95%, CI=2.19-43.54)], 2nd degree tear [AOR =5.51, 95%, CI=1.024-29.618)], and 3rd -4th degree tear [AOR =8.75,95%, CI=1.325-7.822)] were also had a significant association with postnatal perineal pain.. Conclusion: The incidence of moderate to severe postnatal perineal pain remains high. Based on this result, we recommend health care providers consider and act accordingly to prevent and treat postnatal perineal pain. postnatal perineal pain vaginal delivery degree of tear episiotomy Figures Figure 1 INTRODUCTION Pain, as defined by the revised International Association for the Study of Pain, is "an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage" ( 1 ). Perineal pain has been recognised as a frequent issue in women's complaints during the postnatal period following vaginal delivery ( 2 , 3 ). Postnatal perineal pain is the most common debilitating condition that limits the mother's mobility impacting women's lives, yet this is the most neglected period for providing quality care ( 4 – 6 ). Pain is a major problem affecting millions of women throughout the world ( 7 ). Postnatal perineal pain may affect more than 88% of women and is one of the worst effects from the first postnatal day to six weeks ( 2 , 8 – 10 ). Moderate to severe perineal pain is one of the consequences of perineal injuries caused by childbirth ( 11 ). It can also have a significant impact on a woman's physical and psychological well-being including interference with daily activities whether the woman encountered perineal trauma or not ( 12 – 16 ). It is very common after childbirth and can seriously impair a mother's ability to bond with her newborn and perform simple everyday activities ( 7 , 12 , 17 , 18 ). Around 80% of women worldwide are exposed to perineal trauma. Of these, 70% of wounds need to be sutured, which is known to increase perineal pain ( 19 , 20 ). The incidence of persistent postnatal pain varies depending on the delivery method, research population, and study design ( 21 ). The most likely causes of post-natal perineal pain in women include perineal laceration, perineal tear, forceps or vacuum delivery, and surgical episiotomy ( 12 , 22 , 23 ). Women's primiparous and instrumental delivery were the factors associated with the use of surgical episiotomies ( 24 ). The severity of post-natal perineal pain caused by perineal traumas are commonly underestimated ( 21 , 25 ). Evidence demonstrates that in the healthcare setting, there are few and mostly overlooked treatments to alleviate perineal pain ( 3 ). Obstetric anaesthesia has concentrated on the management of labour and delivery pain, but post-natal perineal pain has not yet received the same attention ( 26 , 27 ). A critical narrative analysis of level one evidence reveals an overall lack of high-quality, focused studies to direct the treatment of postnatal perineal pain secondary to perineal tear ( 28 ). Post natal perineal pain negatively affects a woman's ability to perform her daily activities. However, it is underestimated, and most women don't mention it as they think it's just a natural part of the delivery process ( 29 , 30 ). Pain-free immediate postnatal periods may encourage an early return to normal daily activity ( 30 , 31 ). In a prospective study, 92% of women reported perineal pain. Compared to intact perineum, more women report perineal pain after tears. At five days, a complicated episiotomy exacerbated more perineal pain than a second to third degree tear ( 32 ). In a study on 233 participants, 73% of women complained pain during daily living activities, 47% during micturition, and 19.% during defecation ( 17 ). The incidence of significant postnatal perineal pain scores greater than three was 41.1% on day one, and 8.7% on day two in the post-natal period. The contributing factors were instrumental delivers and duration of the second stage of labour (> 30 min). However, there is was no statistically significant difference in newborn birth weight or degree of perineal trauma on postnatal pain scores ( 33 ). According to a cross-sectional study, the mean pain severity score was 4.8 ± 1.9. Only maternal age (OR = 1.08) and episiotomy (OR = 3.80) remained independent predictors of perineal pain ( 29 ). STUDY METHODS A multi-center follow-up study was deployed on 374 women at randomly selected comprehensive and specialist hospitals in Amhara Regional State, Ethiopia, from April 1, 2022, to June 30, 2022. The sample size was calculated using the single population proportion calculation based on previous study done in Nigeria, with a confidence level of 95%, a degree of freedom 5%, and a non-response rate of 10%, making a sample size of 374 study participants. The calculated sample size was proportionally allocated among the randomly selected institutions. Ethical approval was obtained from ethical review committee of the College of Medicine and Health Sciences, University of Gondar. Study participants were selected using a simple random sampling technique. After we got verbal and written consent, we used a lottery method to select the participants by using coded envelopes. All parturient in the fertile age group who gave birth by unassisted or assisted vaginal delivery were candidates for participation. Those women who had pre-existing pain, abdominal cramp, a history of haemorrhoid and pelvic pain, and women who had no functional telephone during the data collection period were excluded from the study. Interviewer-administered sumi-structured questionnaire was used to collect data. Three female midwifery professionals were recruited. Training was given to data collectors before data collection, and the data collector discussed the pain assessment tool and collected data on days one, three, and seven in the postnatal period. Independent variables were extracted from the women’s chart (partograph summary sheet) documented by the healthcare provider except for educational level. The data collector has taken the first information, based on a structured questionnaire. Data collectors used Numerical rating scale(NRS) as a pain assessment tool ranging from 0 to 10, and pain score of NRS ≥ 3, was considered as clinically significant on any of following up time whereas pain score of NRS < 3 was considered as controlled pain or no pain (42, 55). Data were checked, cleaned, and coded, entered into Epi Data Software version 4.6.05, and exported to the Statistical Package for the Social Sciences (SPSS) version 26 program for analysis. Descriptive statistics were performed, and data were presented in frequencies and percentages. The mean and standard deviation were calculated, and tables and figures were used to present the data. Chi-square assumptions were checked. Binary logistic regression was used for the analysis of relationships between each independent and dependent variable. Multicollinearity was checked, and the variance inflation factor was 1.03. Model fitness was checked using the Hosmer-Lemeshow test P-value < 0.2 would be selected and included in multivariable analysis to control potential confounding factors. Crude and adjusted odds ratios with 95% confidence intervals were reported to measure the strength of the association. And also, those variables with a p-value < 0.05 were considered to have significant associations with moderate to severe post-natal perineal pain. The numerical rating scale is a valid and reliable pain assessment tool with numbers assigned from 0 to 10 to represent the severity of pain: 0 = no pain, 1–3 = mild pain, 4–6 = moderate pain, and 7–10 = severe pain. It is the most preferred scale for patient self-reporting of pain due to its simplicity, and easier to understand for most people ( 34 ). On the first day, perineal pain was assessed at 6 hours after vaginal delivery in the hospital, and then, data were collated by telephone interview on the third and seventh days. Women were asked only about perineal pain that existed on the day of the interview. Finally, a yes or no question was used to measure how much pain interfered with their ability to sit comfortably, urinate, walk, and sleep. ( 22 , 35 ). Each data collection quality, clarity, and completeness were closely checked by the supervisor. RESULTS 7.1 Socio-demographic and Obstetric Characteristics of the Study Participants Among 374 eligible women, a total of 356 were included in the final data analysis with a 95% response rate. Eighteen (5%) parturient were excluded from the analysis due to missing data. The mean age was 26.83 ± 4.96; 171 were primiparous, and 158 were multiparous women. One hundred fourteen (32.0%) women gave birth by SVD with an intact perineum; 108 (30.3%) had an episiotomy; 21 (5.9%), had forceps or vacuum delivery; and the other 113 (31.8%) had SVD with perineal tears ( Table 1 ). Table 1 Socio-demographic and Obstetric characteristics of the women in the comprehensive specialized hospitals, Amhara regional state, Ethi opia April 1 to June 30, 2023 (n = 356). Variable Category Frequency Percent (%) Reproductive age 15–24 134 37.65% 25–34 186 52.1% 35–49 36 10.1% Educational status Cannot read and write 21 5.9% Can read and write 59 16.6% Primary school 89 25.0% Secondary school 67 18.8% Diploma 65 18.3% Degree and above 55 15.4% Residence Urban 236 66.3% Rural 120 33.7% Parity Primiparous 171 48.0% Multiparous 185 52.00% Duration of 2nd stage labor < 30 minutes 58 16.3% ≥ 30 minutes 298 83.7% Mode of delivery Intact perineum 114 32.0% Episiotomy 108 30.3% Vacuum or forceps 21 5.9% Degree of perineal tear First degree 44 12.4% Second degree 51 14.3% Third &fourth degree 18 5.1% The material used for repair Chromic catgut 201 56.5% Vicryl 23 6.5% Newborn weight < 3000 gram 155 43.5% ≥ 3000 gram 201 56.5% 7.2. Incidence of moderate to severe postnatal perineal pain In our study, the overall incidence of moderate to severe postnatal perineal pain was 213 (59.8%) [95%, CI = 54.8–65.4] at day one, 126 (35.4%), 95%, CI = 30.6–39.9] at day three, and 30 (8.4%, 95%, CI = 5.6–11.8] at day seven, respectively (Fig. 1). 7.3 Incidence of postoperative perineal pain with independent variables The result of the present study shows that 30.7% of parturient with intact perineum complained moderate or severe postnatal perineal pain on day one and 17.6% of primiparous participants with episiotomies had moderate or severe perineal pain on day seven(Table 2 ). Table 2 Incidence of moderate to severe perineal pain on days one, three, seven with independent variables at comprehensive and specialised hospitals, Amhara regional state of Ethiopia, from April 1 to June 30, 2023 (n = 356). Variables Day 1 Day 3 Day 7 Frequency % Frequency % Frequency % Intact perineum 35 30.7% 8 47.0% 2 1.8% Episiotomy 90 83.3% 63 58.3% 19 17.6% Forceps or vacuum 13 61.9% 2 9.5% 1 4.8% First-degree tear 33 75.05% 19 43.2% 3 6.8% Seconds degree tear 29 56,9% 25 49.0% 5 9.8% 3rd -4th degree tear 13 72.2% 9 50.0% 3 16.7% Primiparas 126 73.7% 80 46.8% 21 12.3% Multiparous 87 47.0% 46 24.9% 12 6.5% 7.4. Interference of postnatal perineal pain in daily living activity The results of our study show that pain affected daily activities on days one, three, and seven and revealed that women who reported perineal pain decreased their levels of daily activity when sitting, urinating, walking, sleeping, and taking care of young children, especially in those who had experienced perineal trauma(Table 3 ). Table 3 ፡ Frequency of post-natal perineal pain interfering with daily activity life (yes/no) in comprehensive and specialised hospitals, Amhara Region, Ethiopia, from April 1 to June 30, 2023 (n = 356). Interference of postnatal perineal pain in daily living activity Day 1 Day3 Day 7 Yes No Yes No Yes No Activity Frequency (%) Frequency (%) Frequency (%) Frequency (%) Frequency(%) Frequency(%) Sitting 318 (89.3%) 38 (10.7) 221 (62.1%) 135 (37.9%) 90 (25.3%) 266 (74.7%) Urination 246 (69.1%) 110 (30.%) 183 (51.4%) 173 (48.6%) 54 (15.2%) 302 (84.8%) Walking 229 (64.3%) 127 (35.7%) 157 (44.1%) 199 (55.9%) 51 (14.3%) 305 (85.7% Sleeping 127 (35.7%) 229 (64.3%) 81 (22.8%) 275 (77.2%) 17 (4.8%) 339 (95.2%) Baby Care 242 (68.0%) 114 (32.0%) 168 (47.2%) 188 (52.8) 51 (14.3%) 305 (85.7%) 7.5. Factorassociatedwith moderate to severe postnatal perineal pain During bivariable logistic analysis, maternal age, residency, educational status, parity, mode of delivery such as spontaneous delivery, episiotomy, instrumental delivery, and degree of perineal tear (1st, 2nd, 3rd or 4th ), met the threshold (p-value < 0.2) to fit multivariate analysis. However, after controlling the potential confounding factors using multivariable logistic regression analysis, we found that the odds of having higher education were 3.6 times (AOR = 3.615, 95% CI = 0.99–13.08) more likely to experience moderate to severe perineal pain on day one when compared to those who cannot read and write. Primiparous women more likely experienced moderate to severe post-natal perineal pain three times (AOR = 3.22 = 95%, CI = 1.91–5.42) on day one, 2.6 times (AOR = 2.66, 95% CI = 1.57–4.50) on day three as compared to multiparous women. Women who underwent episiotomies develop moderate to severe perineal pain 11.9 times (AOR = 11.90 = 95% CI = 5.98–23.75) on day one, 18.17times (AOR = 18.176 95%, CI = 7.90-41.81) on day three, 9.7 times (AOR = 9.76,95% CI = 2.19–43.54) on days seven, and instrumental delivery 4.5 times (AOR = 4.54, 95% CI = 1.593–12.91, P < 0.005) on day one, when compared to intact perineum, respectively ( Table 4 ). Table 4 Bivariable and Multivariable Binary Logistic Regression analysis factors associated with moderate to severe postnatal perineal pain on days one, day three, and day seven in comprehensive and specialised hospitals, Amhara Region, Ethiopia, from April 1 to June 30, 2023 (n = 356). Post-natal perineal pain on day one Variable Overall perineal pain NRS < 3-n (%) ≥ 3 n (%) COR (95%CI) AOR (95%CI) P-value Educational status Can’t read &write 14 (66.7%) 7 (33.3%) References. References. Can read and write 32 (54.2%) 27 (45.8%) 1.69 (0.65–4.78) 0.899 (0.259–3.12) 0.866 Primary school 38 (42.7%) 51 (57.3%) 2.68 (0.99–7.35) * 1.581 (0.475–5.26) 0.455 Secondary school 25 (37.3%) 42 (62.7%) 3.36 (3.36–9.46) * 2.175 (0.636–7.45) 0.215 Diploma 18 (27.7%) 47 (72.3%) 5.22 (1.25–15.04) ** 3.248 (0.931–11.36) 0.065 Degree& above 16 (29.1%) 39 (70.9%) 4.86 (1.81–14.32) ** 3.615 (0.999–13.08) < 0.05 Parity Multiparous 98 (53.0%) 87 (47.0%) References. References. Primiparous 45 (26.3%) 126 (73.7%) 3.154 (2.018–4.93)** 3.22 (1.913–5.42) < 0.001 Mode of delivery Intact perineum 79 (69.3%) 35 (30.7%) References. References. Episiotomy 18 (16.7%) 90 (83.3%) 11.36 (5.9221.49) ** 11.90 (5.98–23.75) < 0.001 Vacuum/force 8 (38.1%) 13 (61.9%) 3.67 (1.395 9.64** 4.54 (1.593–12.91) < 0.005 Degree of perineal tear 1 st− degree tear 11(25.0%) 33 (75.0%) 6.77 3.07–14.92) ** 5.620 (2.42–13.19) < 0.001 2 nd− degree tear 22 (43.1%) 29 (56.9%) 2.98(1.504–5.89) ** 2.95 (1.413–6.16) < 0.004 3rd /4 th− degree tear 5 (27.8%) 13 (72.2%) 5.87(1.94–17.73) ** 4.66 (1.40-15.497) < 0.012 Post-natal perineal pain on day three Parity Multiparous 139(75.1%) 46 (24.9%) References. References. Primiparous 91(53.2%) 80 (46.8%) 2.656 (1.696–4.161) 2.66 (1.57–4.50) < 0.001 Mode of delivering Intact perineum 106(93.0%) 8 (7.0%) References. References. Episiotomy 45(41.7%) 63 (58.3%) 18.55(8.23–41.87) ** 18.176(7.90-41.81) < 0.001 Vacuum/forceps 19(90.5%) 2(9.5%) 1.395(0.275–7.08) 1.345(0.258-7.012) < 0.725 Degree of perineal tear 1 st− degree tear 25(56.8%) 19(43.2%) 10.07(3.96–25.62) ** 7.975(3.06–20.77) < 0.001 2 nd− degree tear 26(51.0%) 25(49.0%) 12.74(5.16–31.47) ** 12.48(4.90-31.79) < 0.001 3rd /4 th− degree tear 9(50.0%) 9(50.0%) 13.25(4.11–42.71) ** 10.13(3.013–34.04) < 0.001 Post-natal perineal pain on day seven Parity Multiparous 173(93.5%) 12(6.5%) Primiparous 150(87.7%) 21(12.3%) 0.408(0.186–0.894) * 0.454(0.20-1.022) 0.056 Mode of delivering Intact perineum 112(98.2%) 2(1.8%) References. References. Episiotomy 89(82.4%) 19(17.6%) 11.96(2.72–2.695) ** 9.760(2.19–43.54) < 0.003 Vacuum/forceps 20(95.2%) 1(4.8%) 2.80(0.242–32.355) 2.68(0.230–31.18) < 0.431 Degree of perineal tear 1 st− degree tear 41(93.2%) 3(6.8%) 4.098(0.66–25.41) 3.313(0.53–20.84) < 0.202 2 nd− degree tear 46(90.2%) 5(9.8%) 6.087(1.14–32.51) 5.51(1.024–29.618 < 0.047 3rd or 4 th− degree tear 15(83.3%) 3(16.7%) 11.20(1.729–72.57) 8.754(1.32-57.822) < 0.024 Abbreviation: COR- crude odd ratio, AOR-Adjusted Odd ratio, CI-confidence interval. 1 st -first degree tear, 2 nd - seconds degrees tears, 3 rd - third-degree tear, 4 th - fourth-degree tear. Notes: **-statistically significant p<.0.001, *-significant p<0.05. First-degree perineal tears after vaginal delivery increased a woman's chances of having moderate to severe perineal pain by 5.6 times (AOR = 5.62, 95% CI = 2.42–13.19) on day one and 7.9 times (AOR = 7.90, 95% CI = 3.018–20.701) on day three (Table 2 ). Besides, second-degree perineal tears increase the odds of having moderate to severe perineal pain by 2.9 times (AOR = 2.99, 95% CI = 1.42–6.32) on day one, 12.8 times (AOR = 12.8, 95% CI = 4.62–30.25) on day three, and 5.9 times (AOR = 5.99, 95% CI = 1.08–33.19) on day seven. Women with third to fourth-degree perineal tears also had an increased chance of feeling moderate to severe postpartum perineal pain 4.78 times (AOR = 4.870, 95% CI = 1.4–16.4) on day one, 10.21 times (AOR = 10.21, 95% CI = 3.018–34.5) on day three, and 8.37 times (AOR = 8.37, 95% CI = 1.218–57.51) on day seven when compared to intact perineum (Table 2 ). DISCUSSION Women throughout the world have been experiencing perineal pain as a result of continuous perineal trauma following delivery. This study aimed to assess the incidence, severity, and associated factors of postnatal perineal pain after vaginal delivery. Our results show that postnatal perineal pain occurs commonly in the first two days (day one and day three) and that higher perineal injuries were associated with more moderate-to-severe perineal pain. The incidence of moderate to severe post-natal perineal pain in our study was 59.8% (95% CI = 54.8–65.4) on day one, 35.4% (95% CI = 30.6–39.9) on day three, and 8.4% (95%, CI = 5.6–11.8) on day seven. The incidence was 30.7%, 7.0%, and 1.8% in intact perineum on days one, three, and seven, respectively; in episiotomy, it was 83.3%, 58.3%, 17.6%; for instrumental delivery, was 61.9%, 9.5%, 4.8%; first degree tears were 75.0%, 43.2%, 6.8%; second-degree tears were 56.9%, 49.0%, 9.8%; and third-and fourth-degree tears were 72.2%, on days one, three, and seven respectively. However, these results are lower than the prospective study done in Nigeria, with intact perineum (38%, 27.7%), episiotomy (86.8%, 69.1%), and first or second degree tear (71%, 50%) on days one and three, respectively ( 36 ). A cohort study conducted in Canada found that the incidence of postnatal perineal pain was 75% and 38% in intact perineum, 97% and 71% in episiotomies, 95% and 60% first or second degree tears, and 100% and 91% third or fourth degree tears on days one and seven, respectively ( 37 ). The difference may be due to differences in sample size, the study area, study design, and population differences. We found that having a university degree increased the probability of having moderate to severe perineal pain on day one by 3.6 times compared to not being able to read and write. But there was no statistical significance on the 3rd or 7th days. The possible reason may be basic demographic covariates; a residence is all associated significantly with higher reporting of pain. This result supported a study done in the USA, on the education and pain among adults ( 38 ), and in France, by NRS assessment tool on days 1,4 and 8, predictive factors of post-surgical pain results show that high school diploma level report more pain than other groups( 39 ) .but, one study discrepancy from our results of the study conducted the impact of educational status on postoperative pain perception (Red Cross Athens General Hospital, Greece, pain assessment tool NRS), to compared lower education up to junior school and high school up university, lower education ( junior school) more pain than higher education in the post-operative the 2nd ,3rd ,4th and 6th day due to different reason low understanding of preoperative information, level of anxiety to ( 40 ). So, health care providers should provide non-pharmacological treatments to relieve pain in women, like awareness creation and reassuring the parturient, and they might be informed of these modifying factors as they are directly involved in their pain management. In this study, primiparous women who had vaginal deliveries 3.2 times on day one and 2.6 times on day three had a significant association with moderate to severe postnatal perineal pain as compared to those with a multiparous woman. Possible reasons: some postnatal perineal pain following vaginal delivery in primiparous women is associated with high pain scores ( 41 ), perineum exposure to tears, surgical episiotomy, and instrumental delivery. This finding was supported by the studies done in Brazil ( 42 , 43 ) and Turkey ( 44 ). Besides this, other studies conclude that post-natal perineal pain is significantly associated with primiparous women at the time of hospital–home discharge ( 26 , 33 , 41 , 45 , 46 ). Therefore, it may be possible to support and be aware of the problematic ways that pain and stress are related to parity, such as the management of anxiety including meditation, relaxation therapy, and individualization of privacy. Understanding the causes will shed light on the several modifiable factors by which social factors cause distress. In women who had undergone delivery with surgical episiotomy, the odds of having moderate to severe perineal pain were 11.9 times on day one, 18.17 times on day three, and 10.5 times on day seven, when compared to those women with an intact perineum. This may be because episiotomy increased the risk for perineal pain and delayed wound healing until the third-week postpartum period ( 44 ), welling, the collection of blood in the perineal tissue, the increased risk of infection, and perineal scars. These results supported research done in the USA, Brazil, Turkey, and Sweden ( 42 , 44 , 47 – 49 ). In light of the above-mentioned facts, increase awareness of restricted episiotomies, conduct in-service training programmes, and encourage medical professionals to risk-stratify labouring women, manage according to their experience of perineal pain, and give the best possible care, like labor epidural analgesia. In our study, we found that women who experienced perineal tears during childbirth were more likely to have moderate to severe painful postnatal periods. The likelihood of having pain on patients with first degree perineal tears was 5.6 times on day one, 7-fold on day three, but not statistically significant on day seven. On the other hand, the likelihood of having pain on second − degree tear was 2.95 times on day one, 12.48-fold on day three, and 3.3 times on day seven. And also, the likely of having pain with the third or fourth-degree perineal tear was 4.66 times on day one, 10.1 times on day three, and 8.7 times on day seven, as compared with that of SVD with an intact perineum. The scientific reason for postnatal perineal pain after encountering a perineal tear is usually perineal oedema, which heals in 4–6 weeks, with poor wound care and scar formation. This result is higher than the studies conducted in Brazil ( 46 ) and Canada ( 26 ). Hence, healthcare providers should take preventative steps to provide women with a choice of appropriate pain treatment options due to the frequency of perineal pain and the scientific evidence for procedures that can prevent perineal trauma, such as the restricted use of episiotomies. For participants who underwent delivery assisted with a vacuum or forceps, the odds of having moderate to severe perineal pain was 4.54-fold on day one, but on days three and seven, were not statistically significant when compared to those with an intact perineum. Possible reasons may be lower genital tract lacerations (such as a deep laceration of the vaginal sulcus), vulvar or vaginal hematomas, haemorrhage, local infection, and hematoma, cervical laceration, and vaginal laceration ( 50 ). However, compared to a study conducted in Thailand on day one, our findings are higher than on day one ( 33 ). The reason may be due to the sample size and the difference on the setup. Another study from New York conclude that instrumental delivery was significantly associated with personal discomfort or perineal pain ( 50 ). Similar to research conducted in Thailand and Brazil ( 33 , 42 ), our results showed that the first, third, and seventh-day post-natal perineal pain was not statistically significantly associated with bivariable and multiple logistic regression analysis, variables like the mother's age, the newborn's weight, or the suturing material. A Cochrane database systematic review reported that catgut sutures resulted in more pain experiences as compared to synthetic sutures ( 51 ). Strength and Limitations of the study Our study had several strengths we used primary data, and conducted a follow-up study and the first study in our country. Limitations of the study Because primary pain is a subjective response that is self-reported using a questionnaire, it was not assessed using an objective tool. Women have difficulty remembering the details of their pain, and medications may have been mentioned during the period of data collection. For those who couldn't read or write, measuring pain with a numerical rating scale was difficult. Conclusion and Recommendation Conclusion : According to this study, a considerable percentage of women feel moderate to severe postpartum perineal pain. Being primiparous, having an episiotomy, and having a perineal tear were all revealed to be significant risk factors for the incidence of moderate to severe postnatal perineal pain. The result should inevitably inspire reflection on medical professionals' efforts to avoid and decrease perineal trauma. In addition, the same study under consideration may have important ramifications for post-natal pain management, the quality of care, and current practices of discharge following vaginal delivery. Recommendation To researchers: Scholars urge high-level, ongoing research to be conducted in this area because postnatal perineal pain is a prominent problem, particularly for women when exposed to perineal trauma and the prolonged impact of postnatal pain on mothers. To clinicians : Based on this result, we recommend health care providers consider and act accordingly to treat the pain, especially obstetricians, midwives, and anaesthetists should be able to provide prompt and helpful support for the relief of pain into consideration, and pain management practice following vaginal delivery, and prepared guidelines. Programmer : The programmer and policymaker need to emphasise on postnatal follow-up care. Declarations Funding declaration The research was funded by the University of Gondar. Author Contribution Hassen Ahmed Yimam worte the main manuscript text. Henos Enyew Ashagrie Edited the final version of the manuscript. Tadesse Belayneh Melkie and Abatneh Feleke Agegnehu reviwed the manuscript. Data Availability The data can be obtained from the corresponding author up on request References Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-82. Morais Í, Lemos A, Katz L, Melo LFRd, Maciel MM, Amorim MMRd. Perineal pain management with cryotherapy after vaginal delivery: a randomized clinical trial. Revista brasileira de ginecologia e obstetricia. 2016;38:325-32. Fahey JO. Best Practices in Management of Postpartum Pain. The Journal of perinatal & neonatal nursing. 2017;31(2):126-36. Organization WH. Postnatal Care for Mothers and Newborns: Highlights from the World Health Organization 2013 Guidelines. In. 2015; 25. 2019. World Health O. Postnatal care for mothers and newborns: Highlights from the World Health Organization 2013 Guidelines.[Accessed on: 01 Ekim 2016]. Avaible from: http://www who int/maternal_child_adolescent/publications/WHO-MCA-PNC-2014-Briefer_A4 pdf. East CE, Sherburn M, Nagle C, Said J, Forster D. Perineal pain following childbirth: prevalence, effects on postnatal recovery and analgesia usage. Midwifery. 2012;28(1):93-7. Hedayati H, Parsons J, Crowther CA. Topically applied anaesthetics for treating perineal pain after childbirth. Cochrane Database of Systematic Reviews. 2005(2). East CE, Sherburn M, Nagle C, Said J, Forster D. Perineal pain following childbirth: Prevalence, effects on postnatal recovery and analgesia usage. Midwifery. 2012;28(1):93-7. Persico G, Vergani P, Cestaro C, Grandolfo M, Nespoli A. Assessment of postpartum perineal pain after vaginal delivery: prevalence, severity and determinants. A prospective observational study. Minerva Ginecol. 2013;65(6):669-78. 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Techniques to reduce perineal pain during spontaneous vaginal delivery and perineal suturing: a UK survey of midwifery practice. Midwifery. 2005;21(2):154-60. White C, Atchan DM. Postpartum management of perineal injury - A critical narrative review of level 1 evidence. Midwifery. 2022;112:103410. Amorim Francisco A, Junqueira Vasconcellos de Oliveira SM, Barbosa da Silva FM, Bick D, Gonzalez Riesco ML. Women's experiences of perineal pain during the immediate postnatal period: A cross-sectional study in Brazil. Midwifery. 2011;27(6):e254-e9. Imarengiaye CO, Andet AB. Postpartum perineal pain among Nigerian women. West African journal of medicine. 2008;27(3):148-51. Butwick AJ, Wong CA, Lee HC, Blumenfeld YJ, Guo N. Association between Neuraxial Labor Analgesia and Neonatal Morbidity after Operative Vaginal DeliveryA Retrospective Cross-sectional Study. Anesthesiology. 2021;134(1):52-60. Andrews V, Thakar R, Sultan AH, Jones PW. Evaluation of postpartum perineal pain and dyspareunia--a prospective study. European journal of obstetrics, gynecology, and reproductive biology. 2008;137(2):152-6. Watanatitan J, Armarttasn S, Manusirivithaya S. Incidence and factors associated with postpartum perineal pain in primipara. Thai Journal of Obstetrics and Gynaecology. 2009:139-44. Breivik H, Borchgrevink P-C, Allen S-M, Rosseland L-A, Romundstad L, Breivik Hals E, et al. Assessment of pain. BJA: British Journal of Anaesthesia. 2008;101(1):17-24. Bech RD, Lauritsen J, Ovesen O, Overgaard S. The Verbal Rating Scale Is Reliable for Assessment of Postoperative Pain in Hip Fracture Patients. Pain Research and Treatment. 2015;2015:676212. Imarengiaye C, Andet A. Postpartum perineal pain among Nigerian women. West African journal of medicine. 2008;27(3):148-51. Macarthur AJ, Macarthur C. Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study. Am J Obstet Gynecol. 2004;191(4):1199-204. Zajacova A, Rogers RG, Grodsky E, Grol-Prokopczyk H. The Relationship Between Education and Pain Among Adults Aged 30-49 in the United States. The journal of pain. 2020;21(11-12):1270-80. Lloret-Linares C. Predictive factors of chronic post-surgical pain at 6 months following knee replacement: influence of postoperative pain trajectory and genetics. Pain physician. 2016;19:E729-E41. Lanitis S, Mimigianni C, Raptis D, Sourtse G, Sgourakis G, Karaliotas C. The impact of educational status on the postoperative perception of pain. The Korean journal of pain. 2015;28(4):265-74. Zanardo V, Parotto M, Manghina V, Giliberti L, Volpe F, Severino L, et al. Pain and stress after vaginal delivery: characteristics at hospital discharge and associations with parity. Journal of Obstetrics and Gynaecology. 2020;40(6):808-12. Mathias AERdA, Pitangui ACR, Vasconcelos AMA, Silva SS, Rodrigues PdS, Dias TG. Perineal pain measurement in the immediate vaginal postpartum period. Revista Dor. 2015;16:267-71. Francisco AA, Kinjo MH, Bosco CdS, Silva RLd, Mendes EdPB, Oliveira SMJV. Associação entre trauma perineal e dor em primíparas. Revista da Escola de Enfermagem da USP. 2014;48:39-44. Karaçam Z, Ekmen H, Çalişır H, Şeker S. Prevalence of episiotomy in primiparas, related conditions, and effects of episiotomy on suture materials used, perineal pain, wound healing 3 weeks postpartum, in Turkey: a prospective follow-up study. Iranian journal of nursing and midwifery research. 2013;18(3):237. Zanardo V, Parotto M, Manghina V, Giliberti L, Volpe F, Severino L, et al. Pain and stress after vaginal delivery: characteristics at hospital discharge and associations with parity. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2020;40(6):808-12. Francisco AA, Kinjo MH, Bosco CdS, Silva RLd, Mendes EdPB, Oliveira SMJV. Association between perineal trauma and pain in primiparous women. Revista da Escola de Enfermagem da USP. 2014;48:39-44. Declercq E, Cunningham DK, Johnson C, Sakala C. Mothers’ reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey. Birth. 2008;35(1):16-24. Åhlund S, Rådestad I, Zwedberg S, Lindgren H. Perineal pain the first year after childbirth and uptake of post-partum check-up-A Swedish cohort study. Midwifery. 2019;78:85-90. Moradi M, Niazi A, Mazloomi E, Mousavi SF, Lopez V. Effect of lavender on episiotomy wound healing and pain relief: a systematic review. Evidence Based Care Journal. 2020;10(1):61-9. Mikolajczyk RT, Zhang J, Troendle J, Chan L. Risk factors for birth canal lacerations in primiparous women. American journal of perinatology. 2008;25(05):259-64. Kettle C, Dowswell T, Ismail KMK. Absorbable suture materials for primary repair of episiotomy and second degree tears. Cochrane Database of Systematic Reviews. 2010(6). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4598238","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318283816,"identity":"2a3cb693-193b-4a7c-8ae8-b21f8bfd3b7d","order_by":0,"name":"Hassen Ahmed Yimam","email":"","orcid":"","institution":"Boru General Hospital, Amhara Regional State","correspondingAuthor":false,"prefix":"","firstName":"Hassen","middleName":"Ahmed","lastName":"Yimam","suffix":""},{"id":318283817,"identity":"83f1f993-b6e5-492d-88f4-c02a5189b4f7","order_by":1,"name":"Tadesse Belayneh Melkie","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Tadesse","middleName":"Belayneh","lastName":"Melkie","suffix":""},{"id":318283818,"identity":"dcab6c36-5052-4236-ae45-725bf5af2b7d","order_by":2,"name":"Abatneh Feleke Agengehu","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Abatneh","middleName":"Feleke","lastName":"Agengehu","suffix":""},{"id":318283819,"identity":"a5c7d917-b447-4747-979f-5f3b9fc6616f","order_by":3,"name":"Henos Ashagrie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACAyjNw8beAOJaEK9Fho/nAIgrQbwWGzmJBBBNhBZz9t5jEh93HOZhk3x+dcOPAgkG/vbuBLxaLHvOpUnOPAPUIp1TdrMH6DCJM2c34HfYjRwzad42sJa0GzxALQYSuQS03H9jJv0XpEXyTNrNP0RpucFjJs0I0iLBfuw2cbacyTG27G1L52HjyWG7LWMgwUPYL8fPGN742WZtL99+/NnNN39s5Pjbe/FrAQIWYFw0A2kecBzxEFIOAswfGBjqgDT7A2JUj4JRMApGwQgEADYDQ+OupkltAAAAAElFTkSuQmCC","orcid":"","institution":"University of Gondar","correspondingAuthor":true,"prefix":"","firstName":"Henos","middleName":"","lastName":"Ashagrie","suffix":""}],"badges":[],"createdAt":"2024-06-18 07:52:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4598238/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4598238/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60020299,"identity":"890fb8be-7918-4c76-91d2-24df2dfd8ed3","added_by":"auto","created_at":"2024-07-10 15:41:02","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":71480,"visible":true,"origin":"","legend":"\u003cp\u003eScheme presentation of sampling procedure from each of three comprehensive and specialized hospitals in the Amhara region, Ethiopia April -01-june30.2023.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4598238/v1/1b6d28eedf345b85713cd404.jpg"},{"id":76260841,"identity":"7b57cc24-ae18-4a74-9362-5633bbb3e4a5","added_by":"auto","created_at":"2025-02-14 06:17:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1261554,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4598238/v1/42faeea2-6591-4fa5-8a62-6632c903b64d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Postnatal perineal pain after vaginal delivery in comprehensive and specialised hospitals in Amhara regional state, Ethiopia, April to June, 2023","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePain, as defined by the revised International Association for the Study of Pain, is \"an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage\" (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Perineal pain has been recognised as a frequent issue in women's complaints during the postnatal period following vaginal delivery (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Postnatal perineal pain is the most common debilitating condition that limits the mother's mobility impacting women's lives, yet this is the most neglected period for providing quality care (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePain is a major problem affecting millions of women throughout the world (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Postnatal perineal pain may affect more than 88% of women and is one of the worst effects from the first postnatal day to six weeks (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Moderate to severe perineal pain is one of the consequences of perineal injuries caused by childbirth (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). It can also have a significant impact on a woman's physical and psychological well-being including interference with daily activities whether the woman encountered perineal trauma or not (\u003cspan additionalcitationids=\"CR13 CR14 CR15\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). It is very common after childbirth and can seriously impair a mother's ability to bond with her newborn and perform simple everyday activities (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAround 80% of women worldwide are exposed to perineal trauma. Of these, 70% of wounds need to be sutured, which is known to increase perineal pain (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The incidence of persistent postnatal pain varies depending on the delivery method, research population, and study design (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe most likely causes of post-natal perineal pain in women include perineal laceration, perineal tear, forceps or vacuum delivery, and surgical episiotomy (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Women's primiparous and instrumental delivery were the factors associated with the use of surgical episiotomies (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The severity of post-natal perineal pain caused by perineal traumas are commonly underestimated (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEvidence demonstrates that in the healthcare setting, there are few and mostly overlooked treatments to alleviate perineal pain (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Obstetric anaesthesia has concentrated on the management of labour and delivery pain, but post-natal perineal pain has not yet received the same attention (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). A critical narrative analysis of level one evidence reveals an overall lack of high-quality, focused studies to direct the treatment of postnatal perineal pain secondary to perineal tear (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Post natal perineal pain negatively affects a woman's ability to perform her daily activities. However, it is underestimated, and most women don't mention it as they think it's just a natural part of the delivery process (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Pain-free immediate postnatal periods may encourage an early return to normal daily activity (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In a prospective study, 92% of women reported perineal pain. Compared to intact perineum, more women report perineal pain after tears. At five days, a complicated episiotomy exacerbated more perineal pain than a second to third degree tear (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a study on 233 participants, 73% of women complained pain during daily living activities, 47% during micturition, and 19.% during defecation (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The incidence of significant postnatal perineal pain scores greater than three was 41.1% on day one, and 8.7% on day two in the post-natal period. The contributing factors were instrumental delivers and duration of the second stage of labour (\u0026gt;\u0026thinsp;30 min). However, there is was no statistically significant difference in newborn birth weight or degree of perineal trauma on postnatal pain scores (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to a cross-sectional study, the mean pain severity score was 4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9. Only maternal age (OR\u0026thinsp;=\u0026thinsp;1.08) and episiotomy (OR\u0026thinsp;=\u0026thinsp;3.80) remained independent predictors of perineal pain (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e"},{"header":"STUDY METHODS","content":"\u003cp\u003e A multi-center follow-up study was deployed on 374 women at randomly selected comprehensive and specialist hospitals in Amhara Regional State, Ethiopia, from April 1, 2022, to June 30, 2022. The sample size was calculated using the single population proportion calculation based on previous study done in Nigeria, with a confidence level of 95%, a degree of freedom 5%, and a non-response rate of 10%, making a sample size of 374 study participants. The calculated sample size was proportionally allocated among the randomly selected institutions.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from ethical review committee of the College of Medicine and Health Sciences, University of Gondar. Study participants were selected using a simple random sampling technique. After we got verbal and written consent, we used a lottery method to select the participants by using coded envelopes. All parturient in the fertile age group who gave birth by unassisted or assisted vaginal delivery were candidates for participation. Those women who had pre-existing pain, abdominal cramp, a history of haemorrhoid and pelvic pain, and women who had no functional telephone during the data collection period were excluded from the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eInterviewer-administered sumi-structured questionnaire was used to collect data. Three female midwifery professionals were recruited. Training was given to data collectors before data collection, and the data collector discussed the pain assessment tool and collected data on days one, three, and seven in the postnatal period. Independent variables were extracted from the women\u0026rsquo;s chart (partograph summary sheet) documented by the healthcare provider except for educational level. The data collector has taken the first information, based on a structured questionnaire.\u003c/p\u003e \u003cp\u003eData collectors used Numerical rating scale(NRS) as a pain assessment tool ranging from 0 to 10, and pain score of NRS\u0026thinsp;\u0026ge;\u0026thinsp;3, was considered as clinically significant on any of following up time whereas pain score of NRS\u0026thinsp;\u0026lt;\u0026thinsp;3 was considered as controlled pain or no pain (42, 55).\u003c/p\u003e \u003cp\u003eData were checked, cleaned, and coded, entered into Epi Data Software version 4.6.05, and exported to the Statistical Package for the Social Sciences (SPSS) version 26 program for analysis. Descriptive statistics were performed, and data were presented in frequencies and percentages. The mean and standard deviation were calculated, and tables and figures were used to present the data. Chi-square assumptions were checked. Binary logistic regression was used for the analysis of relationships between each independent and dependent variable. Multicollinearity was checked, and the variance inflation factor was 1.03. Model fitness was checked using the Hosmer-Lemeshow test P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 would be selected and included in multivariable analysis to control potential confounding factors. Crude and adjusted odds ratios with 95% confidence intervals were reported to measure the strength of the association. And also, those variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered to have significant associations with moderate to severe post-natal perineal pain.\u003c/p\u003e \u003cp\u003eThe numerical rating scale is a valid and reliable pain assessment tool with numbers assigned from 0 to 10 to represent the severity of pain: 0\u0026thinsp;=\u0026thinsp;no pain, 1\u0026ndash;3\u0026thinsp;=\u0026thinsp;mild pain, 4\u0026ndash;6\u0026thinsp;=\u0026thinsp;moderate pain, and 7\u0026ndash;10\u0026thinsp;=\u0026thinsp;severe pain. It is the most preferred scale for patient self-reporting of pain due to its simplicity, and easier to understand for most people (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). On the first day, perineal pain was assessed at 6 hours after vaginal delivery in the hospital, and then, data were collated by telephone interview on the third and seventh days. Women were asked only about perineal pain that existed on the day of the interview. Finally, a yes or no question was used to measure how much pain interfered with their ability to sit comfortably, urinate, walk, and sleep. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Each data collection quality, clarity, and completeness were closely checked by the supervisor.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e7.1 Socio-demographic and Obstetric Characteristics of the Study Participants\u003c/h2\u003e \u003cp\u003eAmong 374 eligible women, a total of 356 were included in the final data analysis with a 95% response rate. Eighteen (5%) parturient were excluded from the analysis due to missing data. The mean age was 26.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96; 171 were primiparous, and 158 were multiparous women. One hundred fourteen (32.0%) women gave birth by SVD with an intact perineum; 108 (30.3%) had an episiotomy; 21 (5.9%), had forceps or vacuum delivery; and the other 113 (31.8%) had SVD with perineal tears \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic and Obstetric characteristics of the women in the comprehensive specialized hospitals, Amhara regional state, Ethi\u003cb\u003eopia April 1 to June 30, 2023\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;356).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eReproductive age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.65%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCannot read and write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCan read and write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDegree and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of 2nd stage labor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntact perineum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEpisiotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVacuum or forceps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDegree of perineal tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird \u0026amp;fourth degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eThe material used for repair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChromic catgut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVicryl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNewborn weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3000 gram\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3000 gram\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e7.2. Incidence of moderate to severe postnatal perineal pain\u003c/h2\u003e \u003cp\u003eIn our study, the overall incidence of moderate to severe postnatal perineal pain was 213 (59.8%) [95%, CI\u0026thinsp;=\u0026thinsp;54.8\u0026ndash;65.4] at day one, 126 (35.4%), 95%, CI\u0026thinsp;=\u0026thinsp;30.6\u0026ndash;39.9] at day three, and 30 (8.4%, 95%, CI\u0026thinsp;=\u0026thinsp;5.6\u0026ndash;11.8] at day seven, respectively \u003cb\u003e(Fig.\u0026nbsp;1).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e7.3 Incidence of postoperative perineal pain with independent variables\u003c/h2\u003e \u003cp\u003eThe result of the present study shows that 30.7% of parturient with intact perineum complained moderate or severe postnatal perineal pain on day one and 17.6% of primiparous participants with episiotomies had moderate or severe perineal pain on day seven(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIncidence of moderate to severe perineal pain on days one, three, seven with independent variables at comprehensive and specialised hospitals, Amhara regional state of Ethiopia, from April 1 to June 30, 2023 (n\u0026thinsp;=\u0026thinsp;356).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDay 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDay 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDay 7\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntact perineum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpisiotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForceps or vacuum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst-degree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeconds degree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56,9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd -4th degree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimiparas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e7.4. Interference of postnatal perineal pain in daily living activity\u003c/h2\u003e \u003cp\u003eThe results of our study show that pain affected daily activities on days one, three, and seven and revealed that women who reported perineal pain decreased their levels of daily activity when sitting, urinating, walking, sleeping, and taking care of young children, especially in those who had experienced perineal trauma(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e፡ Frequency of post-natal perineal pain interfering with daily activity life (yes/no) in comprehensive and specialised hospitals, Amhara Region, Ethiopia, from April 1 to June 30, 2023 (n\u0026thinsp;=\u0026thinsp;356).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eInterference of postnatal perineal pain in daily living activity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDay 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDay3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDay 7\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFrequency(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFrequency(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSitting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e318 (89.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e221 (62.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e135 (37.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e266 (74.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e246 (69.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110 (30.%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e183 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e173 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e302 (84.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWalking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e229 (64.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (35.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e157 (44.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e199 (55.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e305 (85.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleeping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127 (35.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229 (64.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81 (22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e275 (77.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e339 (95.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaby Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e242 (68.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (32.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e168 (47.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e188 (52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e305 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e7.5. Factorassociatedwith moderate to severe postnatal perineal pain\u003c/h2\u003e \u003cp\u003eDuring bivariable logistic analysis, maternal age, residency, educational status, parity, mode of delivery such as spontaneous delivery, episiotomy, instrumental delivery, and degree of perineal tear (1st, 2nd, 3rd or 4th ), met the threshold (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2) to fit multivariate analysis.\u003c/p\u003e \u003cp\u003eHowever, after controlling the potential confounding factors using multivariable logistic regression analysis, we found that the odds of having higher education were 3.6 times (AOR\u0026thinsp;=\u0026thinsp;3.615, 95% CI\u0026thinsp;=\u0026thinsp;0.99\u0026ndash;13.08) more likely to experience moderate to severe perineal pain on day one when compared to those who cannot read and write.\u003c/p\u003e \u003cp\u003ePrimiparous women more likely experienced moderate to severe post-natal perineal pain three times (AOR\u0026thinsp;=\u0026thinsp;3.22\u0026thinsp;=\u0026thinsp;95%, CI\u0026thinsp;=\u0026thinsp;1.91\u0026ndash;5.42) on day one, 2.6 times (AOR\u0026thinsp;=\u0026thinsp;2.66, 95% CI\u0026thinsp;=\u0026thinsp;1.57\u0026ndash;4.50) on day three as compared to multiparous women. Women who underwent episiotomies develop moderate to severe perineal pain 11.9 times (AOR\u0026thinsp;=\u0026thinsp;11.90\u0026thinsp;=\u0026thinsp;95% CI\u0026thinsp;=\u0026thinsp;5.98\u0026ndash;23.75) on day one, 18.17times (AOR\u0026thinsp;=\u0026thinsp;18.176 95%, CI\u0026thinsp;=\u0026thinsp;7.90-41.81) on day three, 9.7 times (AOR\u0026thinsp;=\u0026thinsp;9.76,95% CI\u0026thinsp;=\u0026thinsp;2.19\u0026ndash;43.54) on days seven, and instrumental delivery 4.5 times (AOR\u0026thinsp;=\u0026thinsp;4.54, 95% CI\u0026thinsp;=\u0026thinsp;1.593\u0026ndash;12.91, P\u0026thinsp;\u0026lt;\u0026thinsp;0.005) on day one, when compared to intact perineum, respectively \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariable and Multivariable Binary Logistic Regression analysis factors associated with moderate to severe postnatal perineal pain on days one, day three, and day seven in comprehensive and specialised hospitals, Amhara Region, Ethiopia, from April 1 to June 30, 2023 (n\u0026thinsp;=\u0026thinsp;356).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003ePost-natal perineal pain on day one\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eOverall perineal pain NRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3-n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCOR (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAOR (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"5\" nameend=\"c2\" namest=\"c1\" rowspan=\"6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eCan\u0026rsquo;t read \u0026amp;write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eCan read and write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (54.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27 (45.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.69 (0.65\u0026ndash;4.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.899 (0.259\u0026ndash;3.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38 (42.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e51 (57.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.68 (0.99\u0026ndash;7.35) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.581 (0.475\u0026ndash;5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.455\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (37.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42 (62.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.36 (3.36\u0026ndash;9.46) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.175 (0.636\u0026ndash;7.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47 (72.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.22 (1.25\u0026ndash;15.04) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.248 (0.931\u0026ndash;11.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eDegree\u0026amp; above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e39 (70.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.86 (1.81\u0026ndash;14.32) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.615 (0.999\u0026ndash;13.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMultiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98 (53.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e87 (47.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrimiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e126 (73.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.154 (2.018\u0026ndash;4.93)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.22 (1.913\u0026ndash;5.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntact perineum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e79 (69.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e35 (30.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpisiotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.36 (5.9221.49) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11.90 (5.98\u0026ndash;23.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVacuum/force\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.67 (1.395 9.64**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.54 (1.593\u0026ndash;12.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDegree of perineal tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"2\" nameend=\"c3\" namest=\"c1\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1\u003csup\u003est\u0026minus;\u003c/sup\u003e degree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.77 3.07\u0026ndash;14.92) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.620 (2.42\u0026ndash;13.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2\u003csup\u003end\u0026minus;\u003c/sup\u003edegree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (43.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29 (56.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.98(1.504\u0026ndash;5.89) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.95 (1.413\u0026ndash;6.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3rd /4\u003csup\u003eth\u0026minus;\u003c/sup\u003edegree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (27.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13 (72.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.87(1.94\u0026ndash;17.73) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.66 (1.40-15.497)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePost-natal perineal pain on day three\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c4\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMultiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e139(75.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46 (24.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrimiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91(53.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80 (46.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.656 (1.696\u0026ndash;4.161)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.66 (1.57\u0026ndash;4.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eMode of delivering\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"2\" nameend=\"c4\" namest=\"c1\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntact perineum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e106(93.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpisiotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45(41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e63 (58.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e18.55(8.23\u0026ndash;41.87) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18.176(7.90-41.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVacuum/forceps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19(90.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.395(0.275\u0026ndash;7.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.345(0.258-7.012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.725\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDegree of perineal tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e1\u003csup\u003est\u0026minus;\u003c/sup\u003e degree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25(56.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19(43.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.07(3.96\u0026ndash;25.62) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7.975(3.06\u0026ndash;20.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e2\u003csup\u003end\u0026minus;\u003c/sup\u003e degree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26(51.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25(49.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12.74(5.16\u0026ndash;31.47) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.48(4.90-31.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e3rd /4\u003csup\u003eth\u0026minus;\u003c/sup\u003e degree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9(50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9(50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13.25(4.11\u0026ndash;42.71) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10.13(3.013\u0026ndash;34.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePost-natal perineal pain on day seven\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMultiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e173(93.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12(6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrimiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e150(87.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21(12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.408(0.186\u0026ndash;0.894) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.454(0.20-1.022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eMode of delivering\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"2\" nameend=\"c4\" namest=\"c1\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntact perineum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e112(98.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eReferences.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpisiotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89(82.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19(17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.96(2.72\u0026ndash;2.695) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9.760(2.19\u0026ndash;43.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVacuum/forceps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20(95.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.80(0.242\u0026ndash;32.355)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.68(0.230\u0026ndash;31.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.431\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDegree of perineal tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"2\" nameend=\"c3\" namest=\"c1\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1\u003csup\u003est\u0026minus;\u003c/sup\u003e degree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41(93.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.098(0.66\u0026ndash;25.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.313(0.53\u0026ndash;20.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.202\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2\u003csup\u003end\u0026minus;\u003c/sup\u003e degree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46(90.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5(9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.087(1.14\u0026ndash;32.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.51(1.024\u0026ndash;29.618\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.047\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3rd or 4\u003csup\u003eth\u0026minus;\u003c/sup\u003e degree tear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15(83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.20(1.729\u0026ndash;72.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.754(1.32-57.822)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cstrong\u003eAbbreviation:\u003c/strong\u003e\u0026nbsp; \u0026nbsp;COR- crude odd ratio, AOR-Adjusted Odd ratio, CI-confidence interval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003csup\u003est\u003c/sup\u003e\u003c/strong\u003e-first degree tear,\u003cstrong\u003e2\u003csup\u003end\u003c/sup\u003e-\u003c/strong\u003eseconds degrees tears,\u003cstrong\u003e3\u003csup\u003erd\u003c/sup\u003e\u003c/strong\u003e- third-degree tear,\u003cstrong\u003e4\u003csup\u003eth\u003c/sup\u003e\u003c/strong\u003e- fourth-degree tear.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e **-statistically significant p\u0026lt;.0.001, *-significant p\u0026lt;0.05.\u003c/p\u003e\u003cp\u003eFirst-degree perineal tears after vaginal delivery increased a woman's chances of having moderate to severe perineal pain by 5.6 times (AOR\u0026thinsp;=\u0026thinsp;5.62, 95% CI\u0026thinsp;=\u0026thinsp;2.42\u0026ndash;13.19) on day one and 7.9 times (AOR\u0026thinsp;=\u0026thinsp;7.90, 95% CI\u0026thinsp;=\u0026thinsp;3.018\u0026ndash;20.701) on day three (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Besides, second-degree perineal tears increase the odds of having moderate to severe perineal pain by 2.9 times (AOR\u0026thinsp;=\u0026thinsp;2.99, 95% CI\u0026thinsp;=\u0026thinsp;1.42\u0026ndash;6.32) on day one, 12.8 times (AOR\u0026thinsp;=\u0026thinsp;12.8, 95% CI\u0026thinsp;=\u0026thinsp;4.62\u0026ndash;30.25) on day three, and 5.9 times (AOR\u0026thinsp;=\u0026thinsp;5.99, 95% CI\u0026thinsp;=\u0026thinsp;1.08\u0026ndash;33.19) on day seven. Women with third to fourth-degree perineal tears also had an increased chance of feeling moderate to severe postpartum perineal pain 4.78 times (AOR\u0026thinsp;=\u0026thinsp;4.870, 95% CI\u0026thinsp;=\u0026thinsp;1.4\u0026ndash;16.4) on day one, 10.21 times (AOR\u0026thinsp;=\u0026thinsp;10.21, 95% CI\u0026thinsp;=\u0026thinsp;3.018\u0026ndash;34.5) on day three, and 8.37 times (AOR\u0026thinsp;=\u0026thinsp;8.37, 95% CI\u0026thinsp;=\u0026thinsp;1.218\u0026ndash;57.51) on day seven when compared to intact perineum (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eWomen throughout the world have been experiencing perineal pain as a result of continuous perineal trauma following delivery. This study aimed to assess the incidence, severity, and associated factors of postnatal perineal pain after vaginal delivery. Our results show that postnatal perineal pain occurs commonly in the first two days (day one and day three) and that higher perineal injuries were associated with more moderate-to-severe perineal pain.\u003c/p\u003e \u003cp\u003eThe incidence of moderate to severe post-natal perineal pain in our study was 59.8% (95% CI\u0026thinsp;=\u0026thinsp;54.8\u0026ndash;65.4) on day one, 35.4% (95% CI\u0026thinsp;=\u0026thinsp;30.6\u0026ndash;39.9) on day three, and 8.4% (95%, CI\u0026thinsp;=\u0026thinsp;5.6\u0026ndash;11.8) on day seven. The incidence was 30.7%, 7.0%, and 1.8% in intact perineum on days one, three, and seven, respectively; in episiotomy, it was 83.3%, 58.3%, 17.6%; for instrumental delivery, was 61.9%, 9.5%, 4.8%; first degree tears were 75.0%, 43.2%, 6.8%; second-degree tears were 56.9%, 49.0%, 9.8%; and third-and fourth-degree tears were 72.2%, on days one, three, and seven respectively. However, these results are lower than the prospective study done in Nigeria, with intact perineum (38%, 27.7%), episiotomy (86.8%, 69.1%), and first or second degree tear (71%, 50%) on days one and three, respectively (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). A cohort study conducted in Canada found that the incidence of postnatal perineal pain was 75% and 38% in intact perineum, 97% and 71% in episiotomies, 95% and 60% first or second degree tears, and 100% and 91% third or fourth degree tears on days one and seven, respectively (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The difference may be due to differences in sample size, the study area, study design, and population differences.\u003c/p\u003e \u003cp\u003eWe found that having a university degree increased the probability of having moderate to severe perineal pain on day one by 3.6 times compared to not being able to read and write. But there was no statistical significance on the 3rd or 7th days. The possible reason may be basic demographic covariates; a residence is all associated significantly with higher reporting of pain. This result supported a study done in the USA, on the education and pain among adults (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), and in France, by NRS assessment tool on days 1,4 and 8, predictive factors of post-surgical pain results show that high school diploma level report more pain than other groups(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) .but, one study discrepancy from our results of the study conducted the impact of educational status on postoperative pain perception (Red Cross Athens General Hospital, Greece, pain assessment tool NRS), to compared lower education up to junior school and high school up university, lower education ( junior school) more pain than higher education in the post-operative the 2nd ,3rd ,4th and 6th day due to different reason low understanding of preoperative information, level of anxiety to (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). So, health care providers should provide non-pharmacological treatments to relieve pain in women, like awareness creation and reassuring the parturient, and they might be informed of these modifying factors as they are directly involved in their pain management.\u003c/p\u003e \u003cp\u003eIn this study, primiparous women who had vaginal deliveries 3.2 times on day one and 2.6 times on day three had a significant association with moderate to severe postnatal perineal pain as compared to those with a multiparous woman. Possible reasons: some postnatal perineal pain following vaginal delivery in primiparous women is associated with high pain scores (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), perineum exposure to tears, surgical episiotomy, and instrumental delivery. This finding was supported by the studies done in Brazil (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) and Turkey (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Besides this, other studies conclude that post-natal perineal pain is significantly associated with primiparous women at the time of hospital\u0026ndash;home discharge (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Therefore, it may be possible to support and be aware of the problematic ways that pain and stress are related to parity, such as the management of anxiety including meditation, relaxation therapy, and individualization of privacy. Understanding the causes will shed light on the several modifiable factors by which social factors cause distress.\u003c/p\u003e \u003cp\u003eIn women who had undergone delivery with surgical episiotomy, the odds of having moderate to severe perineal pain were 11.9 times on day one, 18.17 times on day three, and 10.5 times on day seven, when compared to those women with an intact perineum. This may be because episiotomy increased the risk for perineal pain and delayed wound healing until the third-week postpartum period (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), welling, the collection of blood in the perineal tissue, the increased risk of infection, and perineal scars. These results supported research done in the USA, Brazil, Turkey, and Sweden (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). In light of the above-mentioned facts, increase awareness of restricted episiotomies, conduct in-service training programmes, and encourage medical professionals to risk-stratify labouring women, manage according to their experience of perineal pain, and give the best possible care, like labor epidural analgesia.\u003c/p\u003e \u003cp\u003eIn our study, we found that women who experienced perineal tears during childbirth were more likely to have moderate to severe painful postnatal periods. The likelihood of having pain on patients with first degree perineal tears was 5.6 times on day one, 7-fold on day three, but not statistically significant on day seven. On the other hand, the likelihood of having pain on second\u003csup\u003e\u0026minus;\u003c/sup\u003edegree tear was 2.95 times on day one, 12.48-fold on day three, and 3.3 times on day seven. And also, the likely of having pain with the third or fourth-degree perineal tear was 4.66 times on day one, 10.1 times on day three, and 8.7 times on day seven, as compared with that of SVD with an intact perineum. The scientific reason for postnatal perineal pain after encountering a perineal tear is usually perineal oedema, which heals in 4\u0026ndash;6 weeks, with poor wound care and scar formation. This result is higher than the studies conducted in Brazil (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) and Canada (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Hence, healthcare providers should take preventative steps to provide women with a choice of appropriate pain treatment options due to the frequency of perineal pain and the scientific evidence for procedures that can prevent perineal trauma, such as the restricted use of episiotomies.\u003c/p\u003e \u003cp\u003eFor participants who underwent delivery assisted with a vacuum or forceps, the odds of having moderate to severe perineal pain was 4.54-fold on day one, but on days three and seven, were not statistically significant when compared to those with an intact perineum. Possible reasons may be lower genital tract lacerations (such as a deep laceration of the vaginal sulcus), vulvar or vaginal hematomas, haemorrhage, local infection, and hematoma, cervical laceration, and vaginal laceration (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). However, compared to a study conducted in Thailand on day one, our findings are higher than on day one (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The reason may be due to the sample size and the difference on the setup. Another study from New York conclude that instrumental delivery was significantly associated with personal discomfort or perineal pain (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilar to research conducted in Thailand and Brazil (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), our results showed that the first, third, and seventh-day post-natal perineal pain was not statistically significantly associated with bivariable and multiple logistic regression analysis, variables like the mother's age, the newborn's weight, or the suturing material. A Cochrane database systematic review reported that catgut sutures resulted in more pain experiences as compared to synthetic sutures (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eStrength and Limitations of the study\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eOur study had several strengths\u003c/strong\u003e \u003cp\u003ewe used primary data, and conducted a follow-up study and the first study in our country.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations of the study\u003c/strong\u003e \u003cp\u003eBecause primary pain is a subjective response that is self-reported using a questionnaire, it was not assessed using an objective tool. Women have difficulty remembering the details of their pain, and medications may have been mentioned during the period of data collection. For those who couldn't read or write, measuring pain with a numerical rating scale was difficult.\u003c/p\u003e \u003c/p\u003e"},{"header":"Conclusion and Recommendation","content":"\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: According to this study, a considerable percentage of women feel moderate to severe postpartum perineal pain. Being primiparous, having an episiotomy, and having a perineal tear were all revealed to be significant risk factors for the incidence of moderate to severe postnatal perineal pain. The result should inevitably inspire reflection on medical professionals\u0026apos; efforts to avoid and decrease perineal trauma. In addition, the same study under consideration may have important ramifications for post-natal pain management, the quality of care, and current practices of discharge following vaginal delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTo researchers:\u003c/strong\u003e Scholars urge high-level, ongoing research to be conducted in this area because postnatal perineal pain is a prominent problem, particularly for women when exposed to perineal trauma and the prolonged impact of postnatal pain on mothers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTo clinicians :\u0026nbsp;\u003c/strong\u003eBased on this result, we recommend health care providers consider and act accordingly to treat the pain, especially obstetricians, midwives, and anaesthetists should be able to provide prompt and helpful support for the relief of pain into consideration, and pain management practice following vaginal delivery, and prepared guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProgrammer\u003c/strong\u003e: The programmer and policymaker need to emphasise on postnatal follow-up care.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding declaration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was funded by the University of Gondar.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHassen Ahmed Yimam worte the main manuscript text. Henos Enyew Ashagrie Edited the final version of the manuscript. Tadesse Belayneh Melkie and Abatneh Feleke Agegnehu reviwed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e \u003cp\u003e The data can be obtained from the corresponding author up on request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRaja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-82.\u003c/li\u003e\n\u003cli\u003eMorais \u0026Iacute;, Lemos A, Katz L, Melo LFRd, Maciel MM, Amorim MMRd. Perineal pain management with cryotherapy after vaginal delivery: a randomized clinical trial. Revista brasileira de ginecologia e obstetricia. 2016;38:325-32.\u003c/li\u003e\n\u003cli\u003eFahey JO. Best Practices in Management of Postpartum Pain. 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Thai Journal of Obstetrics and Gynaecology. 2009:139-44.\u003c/li\u003e\n\u003cli\u003eBreivik H, Borchgrevink P-C, Allen S-M, Rosseland L-A, Romundstad L, Breivik Hals E, et al. Assessment of pain. BJA: British Journal of Anaesthesia. 2008;101(1):17-24.\u003c/li\u003e\n\u003cli\u003eBech RD, Lauritsen J, Ovesen O, Overgaard S. The Verbal Rating Scale Is Reliable for Assessment of Postoperative Pain in Hip Fracture Patients. Pain Research and Treatment. 2015;2015:676212.\u003c/li\u003e\n\u003cli\u003eImarengiaye C, Andet A. Postpartum perineal pain among Nigerian women. West African journal of medicine. 2008;27(3):148-51.\u003c/li\u003e\n\u003cli\u003eMacarthur AJ, Macarthur C. Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study. Am J Obstet Gynecol. 2004;191(4):1199-204.\u003c/li\u003e\n\u003cli\u003eZajacova A, Rogers RG, Grodsky E, Grol-Prokopczyk H. 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Cochrane Database of Systematic Reviews. 2010(6).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"postnatal, perineal pain, vaginal delivery, degree of tear, episiotomy","lastPublishedDoi":"10.21203/rs.3.rs-4598238/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4598238/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eMillions of women suffer from perineal trauma during childbirth which is the most common cause of postnatal compliant that lasts for hours, days, weeks, or even months. It is the most common source of postnatal morbidity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis: \u003c/strong\u003eThere is not clinically significant\u003cstrong\u003e \u003c/strong\u003epostnatal perineal pain after vaginal deliveries\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eThe objective of this study was to determine postnatal perineal pain and associated factors among women who had vaginal deliveries.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A multicentre prospective follow-up study was conducted, including a total of 374 women who delivered vaginally at comprehensive specialised hospitals in the Amhara Regional State, Ethiopia, from April 1 to June 30, 2023. Simple random sampling techniques were used to select the samples. Descriptive statistics and logistic regression were performed to determine the incidence of moderate to severe perineal pain, and the association was presented as an odds ratio with a 95% confidence interval. All p-values less than 0.05 were considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The final data analysis includes 356 women out of 374 with a 95% response rate. The incidence of moderate to severe pain was 213 (59.8%) [95%, CI =54.8-65.4], 126 (35.4%) [95%, CI =30.6-39.9], and 30 (8.4%) [95%, CI =5.6-11.8] at days one, three and seven respectively. On postnatal day one, higher level of education [AOR =3.62, 95%, CI (0.99-13.08)], primiparity [AOR =3.22, 95%, CI=1.91-5.42)], episiotomy [AOR =11.90, 95%, CI=5.98-23.75)], and instrumental delivery [AOR =4.54, 95%, CI=1.593-12.91)] were significantly associated with postnatal perineal pain. On the 3rd postnatal day, primiparous [AOR =2.66, 95 %, CI=1.57-4.50)], first degree tear [AOR =7.98,95%,CI=3.06-20.77)], 2nd degree tear [AOR =12.48,95%, CI=4.9031.79)], and 3rd to 4th degree tear [AOR =10.13,95%,CI=3.013-34.04)] were again significantly associated with postnatal perineal pain. On the seventh postnatal day, Episiotomy [AOR =9.76, 95%, CI=2.19-43.54)], 2nd degree tear [AOR =5.51, 95%, CI=1.024-29.618)], and 3rd -4th degree tear [AOR =8.75,95%, CI=1.325-7.822)] were also had a significant association with postnatal perineal pain..\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe incidence of moderate to severe postnatal perineal pain remains high. Based on this result, we recommend health care providers consider and act accordingly to prevent and treat postnatal perineal pain.\u003c/p\u003e","manuscriptTitle":"Postnatal perineal pain after vaginal delivery in comprehensive and specialised hospitals in Amhara regional state, Ethiopia, April to June, 2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-10 15:40:57","doi":"10.21203/rs.3.rs-4598238/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0cab8d5e-cef0-44e8-9e72-08a7d91850e3","owner":[],"postedDate":"July 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-14T06:09:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-10 15:40:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4598238","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4598238","identity":"rs-4598238","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}