{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T14:05:43Z","timestamp":1788617143372,"version":"build-2803163510"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T00:00:00Z","timestamp":1696464000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Society for Women\u2019s Health Science Research","award":["N\/A: received in 2019"],"award-info":[{"award-number":["N\/A: received in 2019"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Enhanced recovery is the gold standard in modern perioperative management, including that for cesarean deliveries. However, qualitative and quantitative data on the physical and psychological recovery of women after vaginal childbirth are limited. Whether neuraxial labor analgesia influences postpartum recovery is unknown.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Primiparous women anticipating a vaginal childbirth between January 2020 and May 2021 were enrolled. Women with major comorbidities or postpartum complications and those who underwent a cesarean delivery were excluded. Daily step count was measured using a wrist-worn activity tracker (Fitbit<jats:sup>TM<\/jats:sup> Inspire HR) for 120 hours after vaginal childbirth. Subjective fatigue levels and health-related quality of life were assessed using the Multidimensional Fatigue Inventory (MFI) and EuroQol 5 Dimension 5 Level (EQ-5D-5L), respectively, at the 3<jats:sup>rd<\/jats:sup> trimester antenatal visit, on postpartum day 1 and 3, and at the one-month postpartum visit. Rest and dynamic pain scores and the location of pain were documented by participants during postpartum hospitalization.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among 300 women who were enrolled antenatally, 95 and 116 had a vaginal delivery without (NCB group) and with (EPL group) epidural analgesia, respectively. The median number of steps per 24 hours increased daily in both groups, and no significant difference was detected between the groups. Postpartum pain was mild overall, with median rest and dynamic pain scores being less than 4 and similar between the groups. MFI and EQ-5D-5L scores were the worst on postpartum day 1 in both groups and gradually improved to antepartum level by the one-month postpartum visit. Higher MFI score on postpartum day 1, but not the use of epidural analgesia, was associated with lower odds of achieving adequate postpartum ambulation (defined as &gt;3500 steps between 48 and 72 hours postpartum).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The use of epidural analgesia was not associated with worse recovery outcomes during postpartum hospitalization.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p>UMIN-CTR, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/center6.umin.ac.jp\/cgi-open-bin\/ctr_e\/ctr_view.cgi?recptno=#UMIN000039343\" xlink:type=\"simple\">#UMIN000039343<\/jats:ext-link>, registered on January 31, 2020.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0292393","type":"journal-article","created":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T18:00:05Z","timestamp":1696528805000},"page":"e0292393","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Physical and psychological recovery after vaginal childbirth with and without epidural analgesia: A prospective cohort study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6919-6465","authenticated-orcid":true,"given":"Ayumi","family":"Maeda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rimu","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rie","family":"Maurer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumie","family":"Kurokawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miki","family":"Kaneko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rie","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromi","family":"Nakajima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoko","family":"Ogura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiko","family":"Yamanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9474-0020","authenticated-orcid":true,"given":"Tokujiro","family":"Uchida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6259-3388","authenticated-orcid":true,"given":"Yasuko","family":"Nagasaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,5]]},"reference":[{"issue":"3","key":"pone.0292393.ref001","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/aas.12651","article-title":"Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice","volume":"60","author":"A Feldheiser","year":"2016","journal-title":"Acta Anaesthesiol Scand"},{"issue":"6","key":"pone.0292393.ref002","doi-asserted-by":"crossref","first-page":"523 e1","DOI":"10.1016\/j.ajog.2018.09.015","article-title":"Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1)","volume":"219","author":"RD Wilson","year":"2018","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"pone.0292393.ref003","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1213\/ANE.0000000000005257","article-title":"Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean","volume":"132","author":"L Bollag","year":"2021","journal-title":"Anesth Analg"},{"issue":"1","key":"pone.0292393.ref004","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.physio.2015.03.3722","article-title":"Early enforced mobilisation following surgery for gastrointestinal cancer: feasibility and outcomes","volume":"102","author":"M van der Leeden","year":"2016","journal-title":"Physiotherapy"},{"issue":"4","key":"pone.0292393.ref005","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1097\/AOG.0000000000001579","article-title":"National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism","volume":"128","author":"ME D\u2019Alton","year":"2016","journal-title":"Obstet Gynecol"},{"issue":"3","key":"pone.0292393.ref006","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1111\/jog.14640","article-title":"Multimodal perioperative pain protocol for gynecologic laparotomy is associated with reduced hospital length of stay","volume":"47","author":"J Mattson","year":"2021","journal-title":"J Obstet Gynaecol Res"},{"issue":"S 01","key":"pone.0292393.ref007","doi-asserted-by":"crossref","first-page":"e215","DOI":"10.1055\/s-0040-1709456","article-title":"Enhanced Recovery after Surgery for Cesarean Delivery Decreases Length of Hospital Stay and Opioid Consumption: A Quality Improvement Initiative","volume":"38","author":"JK Shinnick","year":"2021","journal-title":"Am J Perinatol"},{"issue":"3","key":"pone.0292393.ref008","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1097\/AOG.0000000000003406","article-title":"Enhanced Recovery After Surgery to Change Process Measures and Reduce Opioid Use After Cesarean Delivery: A Quality Improvement Initiative","volume":"134","author":"M Hedderson","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"9","key":"pone.0292393.ref009","article-title":"Physical Activity and the Occurrence of Postnatal Depression-A Systematic Review","volume":"55","author":"D Kolomanska-Bogucka","year":"2019","journal-title":"Medicina (Kaunas)"},{"issue":"4","key":"pone.0292393.ref010","doi-asserted-by":"crossref","first-page":"e178","DOI":"10.1097\/AOG.0000000000003772","article-title":"Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804","volume":"135","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"4","key":"pone.0292393.ref011","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1080\/03091902.2018.1472822","article-title":"Validation of the Fitbit Zip and Fitbit Flex with pregnant women in free-living conditions","volume":"42","author":"A St-Laurent","year":"2018","journal-title":"J Med Eng Technol"},{"issue":"3","key":"pone.0292393.ref012","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1097\/ALN.0000000000001979","article-title":"Using Activity Trackers to Quantify Postpartum Ambulation: A Prospective Observational Study of Ambulation after Regional Anesthesia and Analgesia Interventions","volume":"128","author":"J Ma","year":"2018","journal-title":"Anesthesiology"},{"issue":"8","key":"pone.0292393.ref013","doi-asserted-by":"crossref","first-page":"e10527","DOI":"10.2196\/10527","article-title":"Accuracy of Fitbit Devices: Systematic Review and Narrative Syntheses of Quantitative Data","volume":"6","author":"LM Feehan","year":"2018","journal-title":"JMIR Mhealth Uhealth"},{"issue":"3","key":"pone.0292393.ref014","doi-asserted-by":"crossref","first-page":"e110","DOI":"10.2196\/jmir.9157","article-title":"Using Fitness Trackers and Smartwatches to Measure Physical Activity in Research: Analysis of Consumer Wrist-Worn Wearables","volume":"20","author":"A Henriksen","year":"2018","journal-title":"J Med Internet Res"},{"issue":"18","key":"pone.0292393.ref015","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1001\/jama.290.18.2455","article-title":"Efficacy of postoperative epidural analgesia: a meta-analysis","volume":"290","author":"BM Block","year":"2003","journal-title":"JAMA"},{"issue":"5","key":"pone.0292393.ref016","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3109\/07853890109002087","article-title":"EQ-5D: a measure of health status from the EuroQol Group","volume":"33","author":"R Rabin","year":"2001","journal-title":"Ann Med"},{"issue":"10","key":"pone.0292393.ref017","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"M Herdman","year":"2011","journal-title":"Qual Life Res"},{"issue":"1","key":"pone.0292393.ref018","first-page":"47","article-title":"Developing a Japanese version of the EQ-5D-5L value set. (Japanese)","volume":"64","author":"ST Ikeda S","year":"2015","journal-title":"Journal of the National Institute of Public Health"},{"issue":"3","key":"pone.0292393.ref019","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/0022-3999(94)00125-O","article-title":"The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue","volume":"39","author":"EM Smets","year":"1995","journal-title":"J Psychosom Res"},{"issue":"12","key":"pone.0292393.ref020","first-page":"233","article-title":"Reliability and Validity of the Japanese Version of Multidimensional Fatigue lnventory (MFI) (Japanese)","author":"KH Sugaya N","year":"2005","journal-title":"Job Stress Res"},{"issue":"1","key":"pone.0292393.ref021","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1186\/s12884-018-2038-0","article-title":"Postpartum quality of life in Indian women after vaginal birth and cesarean section: a pilot study using the EQ-5D-5L descriptive system","volume":"18","author":"S Kohler","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"issue":"5","key":"pone.0292393.ref022","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1080\/00016340701275424","article-title":"New insights into fatigue and health-related quality of life after delivery","volume":"86","author":"AJ Jansen","year":"2007","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"3","key":"pone.0292393.ref023","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software \u2019EZR\u2019 for medical statistics","volume":"48","author":"Y. Kanda","year":"2013","journal-title":"Bone Marrow Transplant"},{"key":"pone.0292393.ref024","unstructured":"Ministry of Health Labour and Welfare. National Health and Nutrition Survey (2019) 2019 [Available from: https:\/\/www.mhlw.go.jp\/content\/10900000\/000687163.pdf (Accessed on: July 27, 2022)."},{"issue":"2","key":"pone.0292393.ref025","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/AOG.0b013e3182260a2d","article-title":"Early breastfeeding experiences and postpartum depression","volume":"118","author":"S Watkins","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"3","key":"pone.0292393.ref026","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1097\/AOG.0b013e318280d50a","article-title":"Ambulation of hospitalized gynecologic surgical patients: a randomized controlled trial","volume":"121","author":"M Liebermann","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"1","key":"pone.0292393.ref027","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.bjpt.2016.12.003","article-title":"Implications of pain in functional activities in immediate postpartum period according to the mode of delivery and parity: an observational study","volume":"21","author":"TRC Pereira","year":"2017","journal-title":"Braz J Phys Ther"},{"issue":"4","key":"pone.0292393.ref028","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1097\/ALN.0000000000001789","article-title":"Recovery after Nulliparous Birth: A Detailed Analysis of Pain Analgesia and Recovery of Function","volume":"127","author":"R Komatsu","year":"2017","journal-title":"Anesthesiology"},{"issue":"11","key":"pone.0292393.ref029","first-page":"1773","article-title":"Does epidural analgesia play a role in postpartum urinary incontinence? Medium-term results from a case-control study","volume":"29","author":"MA Burgio","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"2","key":"pone.0292393.ref030","first-page":"161","article-title":"Does intrapartum epidural analgesia affect nulliparous labor and postpartum urinary incontinence?","volume":"30","author":"CC Liang","year":"2007","journal-title":"Chang Gung Med J"},{"issue":"4","key":"pone.0292393.ref031","doi-asserted-by":"crossref","first-page":"e0284106","DOI":"10.1371\/journal.pone.0284106","article-title":"Acute pain and analgesic requirement after vaginal childbirth with and without neuraxial labor analgesia-Retrospective cohort study","volume":"18","author":"A Maeda","year":"2023","journal-title":"PLoS One"},{"issue":"1","key":"pone.0292393.ref032","doi-asserted-by":"crossref","first-page":"e30791","DOI":"10.2196\/30791","article-title":"Accuracy and Acceptability of Wrist-Wearable Activity-Tracking Devices: Systematic Review of the Literature","volume":"24","author":"F Germini","year":"2022","journal-title":"J Med Internet Res"},{"key":"pone.0292393.ref033","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.jss.2021.01.030","article-title":"Utility of Wearable Sensors to Assess Postoperative Recovery in Pediatric Patients After Appendectomy","volume":"263","author":"C De Boer","year":"2021","journal-title":"J Surg Res"},{"issue":"3","key":"pone.0292393.ref034","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1093\/bja\/aeu149","article-title":"Prospective longitudinal cohort questionnaire assessment of labouring women\u2019s preference both pre- and post-delivery for either reduced pain intensity for a longer duration or greater pain intensity for a shorter duration","volume":"113","author":"B Carvalho","year":"2014","journal-title":"Br J Anaesth"},{"key":"pone.0292393.ref035","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.ejogrb.2018.06.038","article-title":"What women want? Results from a prospective multicenter study on women\u2019s preference about pain management during labour","volume":"228","author":"A Favilli","year":"2018","journal-title":"Eur J Obstet Gynecol Reprod Biol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292393","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T18:00:33Z","timestamp":1696528833000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292393"}},"subtitle":[],"editor":[{"given":"Renato S.","family":"Melo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,10,5]]},"references-count":35,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0292393","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,5]]}}}