Table 2.
Symptoms and concerns associated with postpartum recovery grouped into domains
| Recovery domain* | Symptoms/items/concerns contributing to recovery domain |
|---|---|
|
| |
| Psychological distress (50 in total): (a) Depression (1) (b) Anxiety (1) (c) Psychological other (48) |
Previously identified: depression |
| Previously identified: anxiety Previously defined: baby blues, general health perception, emotional role, emotional adaptation, negative emotional experience, mood, enjoyment of life, fulfilment, mental health disorder, motivation, guilt/worthlessness, helpless/hopelessness, wellbeing, psychomotor retardation, in control, angry, confused, appetite, reduced activity (psychological), stress, life satisfaction, coping behaviour, embarrassment, feeling alone Obstetrician: motivation, mourning for delivery mode not achieved, overwhelmed, detached, grief, frustration, fear of becoming pregnant again, tearful, disappointment Nurse: PTSD (repeated), loss of self-identity Patient: patience, meeting expectations, feeling of inadequacy, anhedonia, tearful, mental change, impact of COVID-19 pandemic on mood Focus 2: suicidal, thoughts about feticide, pain catastrophising, feeling judged | |
| Psychosocial support (43) | Previously identified: lifestyle, participation in community activities, social role, interaction with others, social relationships, social function, support from family/staff/friends, psychological support, home/environment adaptation/maintenance of personal dignity, Obstetrician: social isolation, no fixed abode, single mother/donor egg (no spouse), advanced maternal age, access to obstetrician, distance to hospital Focus 1: transition to returning to work Nurse: childcare/nanny issues, change in relationship dynamic with spouse/partner, level of community support Patient: duration of paternity leave, temperament of partner, division of chores, help with overnight childcare chores, change in family dynamic, less personal space, hosting family, connection with partner, older sibling response to new baby, impact of shelter in place due to COVID-19 pandemic, cultural variability, language spoken, spirituality e.g. praying Focus 2: low financial resources, loss of privacy, competition among mothers, domestic violence |
| Surgical and medical factors (urology/obstetric/gynaecology/colorectal/anaesthesia/medical) (40) | Previously identified: urology (urinary symptoms, incontinence, micturition); gynaecology (dysmenorrhoea, uterine prolapse); colorectal (faecal symptoms, incontinence, haemorrhoids, anal fissure, nausea and vomiting) Obstetrician: obstetric/gynaecology (multiple gestation, PV bleeding, lochia, vaginal laceration, incision, cutaneous paraesthesia/pruritus/oedema, SSI, reduced perineal sensation, retained products of conception, uterine sub-involution, hypertension and pre-eclampsia management, amenorrhoea, parity, unplanned delivery mode); colorectal (constipation); medical (infection, fever); medical (carpal tunnel syndrome, thromboembolism, anaemia) Nurse: urology (cystocele); colorectal (rectocele) Patient: medical (night sweats, oedema, cardiomyopathy) Focus 2: anaesthesia (postdural puncture headache, paraesthesia) |
| Infant health (21) | Obstetrician: fetal scalp lacerations, unexpected morbidity, cardiac morbidity, neonatal demise Patient: concern about infant health, concern about infant weight, assistance with nutrition, need for light therapy/antibiotics/CPAP/ECMO, requirement for NICU, prolonged NICU, requirement for repeat hospitalisation, requirement for investigations, prematurity, checking repeatedly for breathing, tongue tie, reflux, wind, type of baby (e.g. contented, cries excessively) |
| Pain (18) | Previously identified: incision/wound; body; muscle, back pain/backache, headache, sensory/affective, pelvic Obstetrician: vaginal, breast, hip, abdominal Patient: requirement for opioids, neck pain/tightness Focus 2: neuropathic pain |
| Sleep (18) | Previously identified: sleep quality, latency, sleep quantity, insomnia (middle, terminal), medication requirement, daytime somnolence, sleep disturbance, reduced energy due to lack of sleep, nightmares Obstetrician: number of wake ups per night, influence of sleep on mood, difficulty getting back to sleep after being awoken Patient: sleep quality before pregnancy, vivid dreams about baby, sleep deprivation, unpredictable sleep pattern |
| Appearance/cosmetic (16) | Previously identified: physical appearance, wound (scar appearance, healing, dehiscence) Obstetrician: desire to return to pre-pregnancy weight, wound (stitches, granulation tissue, discharge, inflammation) Nurse: wound healing Focus 1: body dysmorphia Patient: stretch marks, dissatisfaction with appearance Focus 2: hair loss, grooming |
| Infant feeding/Breastfeeding Breast health (14) |
Previously identified: breastfeeding, lactation, breast health (mastitis) Obstetrician: breastfeeding (latch, milk supply, engorgement, comfort with pumping), confidence in feeding (breast/bottle) breast health (cracked nipples, bleeding nipples) Patient: supplementation of breast milk with bottle, perceived success of feeding, time till expression of milk |
| Physical function (12) | Previously identified: limited function due to musculoskeletal pathology, cardiovascular deconditioning, ability to perform ADLs, physical independence Obstetrician: ability to hold baby, ability to drive, ability to perform heavy lifting, ability to mobilise, ability to sit Nurse: abdominal core strength Patient: intake of adequate nutrition Focus 2: ability to exercise |
| Sexual function (12) | Previously identified: behavioural emotive, arousal, physical, partner-related, desire, lubrication, orgasm, dyspareunia, sex satisfaction Obstetrician: contraception, sexual health Focus 2: return of sexuality |
| Motherhood experience (8 in total): (a) Adapting to maternal role (6) (b) Maternal–neonatal bonding (2) |
Previously identified: caring for baby, parenting Obstetrician: adapting to new role, looking after and interacting with other siblings Focus 1: caregiving responsibilities Patient: time management Previously defined: bonding, attachment |
| Fatigue (6) | Previously identified: mental fatigue, physical fatigue Obstetrician: exhaustion, feeling rested Nurse: tiredness Patient: energy levels |
| Cognition (6) | Previously identified: memory, critical thinking, problem solving Patient: forgetfulness Focus 2: decision-making capacity, executive function |
Abbreviations: ADLs, activities of daily living; COVID-19, coronavirus disease 2019; CPAP, continuous positive airway pressure; ECMO, extracorporeal membrane oxygenation; NICU, neonatal intensive care unit; PTSD, post-traumatic stress disorder; PV, per vagina; SSI, surgical site infection.
*
Domains are listed in order of the number of individual symptoms/concerns/items within each domain identified from review and interviews (highest to lowest); Items presented above as ‘previously identified’ have been proposed in a published scoping review by Sultan et al.8; A total of 264 symptoms/concerns/items were identified by stakeholders that were deemed to influence outpatient postpartum recovery.