Do perfectionism, body image concerns, and intimacy predict genitopelvic pain in the postpartum? A prospective study of new mothers.

BACKGROUND: Genitopelvic pain following childbirth is common and likely to challenge the psychological, relational, and sexual well-being of new mothers. While genitopelvic pain generally decreases during the postpartum period, personal and interpersonal characteristics may explain why genitopelvic pain persists beyond the period of physical recovery in some mothers. Body image concerns, increased stress, and relationship challenges would be particularly salient during pregnancy and the postpartum period, which could put new mothers at greater risk of sexual difficulties. Also, mothers may display a negative appraisal regarding genitopelvic pain and doubt their ability to cope with it, which may contribute to the pain. AIM: The current study aimed to examine the role of perfectionism, body image concerns, and perceived intimacy in the occurrence and change in genitopelvic pain in new mothers in postpartum. METHODS: A total of 211 new mothers and their partners were recruited for a larger prospective dyadic study on the transition to parenthood. OUTCOMES: Mothers completed a single item assessing genitopelvic pain, in addition to brief validated questionnaires measuring perfectionism, body image concerns, and perceived couple intimacy during pregnancy and at 4, 8, and 12 months postpartum. RESULTS: Five multilevel modeling analyses revealed that adaptive perfectionism, maladaptive perfectionism, and body image concerns were associated with a higher occurrence of genitopelvic pain from 4 to 12 months postpartum. Mothers' and partners' perceived intimacy was not significantly related to new mothers' genitopelvic pain. None of the predictors modified the trajectory of genitopelvic pain over time. CLINICAL IMPLICATIONS: Raising awareness among health care professionals regarding the role of perfectionism and body image concerns in genitopelvic pain may help them identify new mothers at risk of chronic genitopelvic pain, while offering a new avenue of intervention. STRENGTHS AND LIMITATIONS: There has been little research examining the role of perfectionism, body image concerns, and intimacy in postpartum genitopelvic pain. Based on a longitudinal prospective approach, this study identified perfectionism and body image concerns as significant predictors of postpartum genitopelvic pain. However, prepregnancy genitopelvic pain, genitopelvic pain intensity, and sexual distress were not measured. CONCLUSION: Adaptive and maladaptive perfectionism and body image concerns are associated with new mothers' genitopelvic pain up to 12 months postpartum.

Parental Report of Morphine Use at Home after Pediatric Surgery.

OBJECTIVE: To describe the use of morphine at home for acute postoperative pain in children. STUDY DESIGN: This was a prospective, descriptive study. Patients less than 12 years of age who underwent surgery and who received a discharge prescription for morphine between January and May 2014 were included. Parents were given a logbook to note their use of morphine at home. A follow-up call was performed 3 days after discharge. The primary outcome was whether or not parents administered morphine according to the discharge prescription. Prescription filling rates, storage at home, administration devices used, and disposal of remaining morphine were also evaluated. RESULTS: A total of 243 subjects were recruited; 56% (95% CI, 46%-66%) of participants with a regular basis prescription administered the medication as prescribed. This number was 85% (95% CI, 78%-92%) in subjects receiving an as-needed prescription, including those who did not administer any morphine because of an absence of pain. Although 76% (95% CI, 68%-84%) of parents filled the morphine prescription when prescribed as needed, most administered two doses or less. In a subset of 77 subjects for whom we obtained detailed prescription data, only 9.2% of prescribed doses were administered. CONCLUSION: We observed that large amounts of morphine have been prescribed and dispensed into homes without being administered. This study identified a need to re-evaluate the quantity of morphine prescribed and dispensed after pediatric surgery.