Postpartum quality of life in Indian women after vaginal birth and cesarean section: a pilot study using the EQ-5D-5L descriptive system

Abstract

BackgroundThere has been little evaluation of the postpartum quality of life (QOL) of women in India and its association with the mode of birth. This study piloted the use of the generic EQ-5D-5L questionnaire to assess postpartum QOL experienced by rural Indian women.MethodsA convenience sample of rural women who gave birth in a health facility in Gujarat or Madhya Pradesh was recruited into this pilot study. QOL was measured during three interviews within 30 days of birth using the EQ-5D-5L questionnaire. Patient-level quality-adjusted life days (QALDs) were estimated. Multivariate regression was used to adjust for selected baseline characteristics.ResultsForty-six women with cesarean section and 178 with vaginal birth from 17 public and private health facilities were studied. Postpartum QOL in both groups improved between interviews 1 and 3. Comparing between vaginal and cesarean births indicated that the vaginal birth group had a higher QOL (0–3 days postpartum: 0.28 vs. 0.57, 3–7 days postpartum: 0.59 vs. 0.81; P < 0.001) and was more likely to report no or slight problems in 4 of 5 health dimensions (mobility, self-care, usual activities, pain or discomfort; P ≤ 0.04) during interviews 1 and 2. Postpartum QOL converged, but still differed between groups by the time of interview 3 (21–30 days postpartum: 0.85 vs. 0.93; P < 0.001). While most women reported no problems by the end of the first postpartum month, the difference in the ability to perform usual activities persisted (P = 0.001). In result, fewer QALDs were attained by women in the cesarean section group between day 1 and day 21 postpartum (13.1 vs. 16.6 QALDs; P < 0.001). Subgroup analysis showed that having had an episiotomy during vaginal birth was also associated with reduced QOL postpartum, but to a lesser extent than cesarean section. Similar results were obtained when adjusting for socioeconomic, pregnancy and birth characteristics, but postpartum QOL already ceased to be statistically different between groups before interview 3.ConclusionsVaginal births, even with episiotomy, were associated with a higher postpartum QOL than cesarean births among the Indian women in our pilot study. Finding these expected results suggests that the EQ-5D-5L questionnaire is a suitable instrument to assess postpartum QOL in Indian women.

Prediction of postpartum depression based on women’s quality of life

“…In contrast, the findings of a cohort study performed on primiparous women of a large Danish population showed that hyperemesis-gravidarum, hypertension, pre-eclampsia, and caesarean section were associated with increased risk of PPD [7]. Similarly, a study on women in rural Indian revealed that vaginal delivery (even with an episiotomy) was associated with higher postpartum quality of life (QoL) than caesarean delivery [45]. Differences between the results of the current study and other studies may be due to the number of samples, area of study, study design and tools of data collection.…”

Materno-fetal and neonatal outcomes associated with caesarean section delivery in private and public hospitals in low- and middle-income countries: a systematic review

“…This review laid out the relevance of the facilities' ownership in materno-fetal and neonate CSDrelated outcomes. Of the 14 studies targeting both public and private facilities [4,45,48,[52][53][54][55]57,[59][60][61][62]64,65], only Murta et al [60] and Kilsztajn et al [59] have frontally compared the CSD outcomes between participants in public and private institutions. In the case of the former, private institutions led statistically to fewer LBW babies (OR = 1.4 vs. 2.33), while in Kilsztajn et al's study, the likelihood of dying from CSD was 3.3 times higher [59].…”

“…and Quality Adjusted Life Days (QALDs). Thus, Kohler et al [52] found that the VD group had a higher QOL (0-3 days postpartum: 0.28 vs. 0.57, 3-7 days postpartum: 0.59 vs. 0.81; p < 0.001) and was more likely to report no or slight problems in 4 of 5 health dimensions (mobility, self-care, usual activities, pain or discomfort; p < 0.04) during interviews (1 st and 7 th days). Similarly, in Nepal, Sharma and Dhakal [49] found that VD led to fewer complications for mothers compared to CSD (39%, vs. 53.5%) and likewise for newborns (28.4% vs. 52.1%).…”

“…In terms of ownership, 14 included both public and private health facilities, 11 run in public facilities only, and one run in a private facility only (Fig 2). Of these reviewed articles, there were seven from Africa [42-48], seven from Asia [49][50][51][52][53][54][55], and 10 from Latin America [4,41,[56][57][58][59][60][61][62][63], as well as two cross-continental papers [64,65]. The study contexts were both the private and public sectors (Fig 1).…”

Health Related Quality of Life Post Labour Induction With Misoprostol Versus Dinoprostone at Muhimbili National Hospital in Dar es Salaam, Tanzania: A Cross Sectional Study

“…At Muhimbili National Hospital (MNH), 52.5% of patients undergoing labour induction receive Complication free vaginal delivery is the primary goal of labour induction 7,8 . A method that is associated with increased vaginal birth would enhance women's Health Related Quality of Life (HRQoL) post-delivery 23 . Postpartum women following vaginal birth are less likely to have problems with mobility, self-care, routine activities, pain or discomfort 23 .…”