{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:08:01Z","timestamp":1789186081729,"version":"build-2803163510"},"reference-count":47,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2019,11,18]],"date-time":"2019-11-18T00:00:00Z","timestamp":1574035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Despite abundant literature on antenatal and delivery care received by pregnant women, there is a wide knowledge gap on the prevalence of symptoms of discomfort or problems during the postpartum period and their relationship with the mode of delivery. This cross-sectional study, carried out with 3324 participants in Spain in 2017, aimed to investigate the association between the mode of delivery and self-reported postpartum symptoms of discomfort and maternal problems during the puerperium. An ad hoc online questionnaire was used to collect data on socio-demographic and obstetric variables, symptoms of discomfort, and maternal problems during the puerperium. The crude odds ratios (OR) and adjusted OR (aOR) and their 95% confidence intervals (95%CI) were calculated using binary logistic regression. In total, 3324 women participated. Compared to a normal vaginal delivery, having a cesarean section was associated with increased odds of an infected surgical wound (aOR: 11.62, 95%CI: 6.77\u201319.95), feeling sad (aOR: 1.31, 23 95%CI: 1.03\u20131.68), and symptoms of post-traumatic stress (aOR: 4.64, 95%CI: 2.94\u20137.32). Instrumental delivery vs. normal vaginal delivery was a risk factor for constipation (aOR: 1.35 95%CI: 25 1.10\u20131.66), hemorrhoids (aOR: 1.28, 95%CI: 1.04\u20131.57), urinary incontinence (aOR: 1.30, 95%CI: 26 1.05\u20131.61), and fecal incontinence (aOR: 1.94, 95%CI: 1.29\u20132.92) during the puerperium. Women who gave delivery via cesarean section or instrumental delivery had higher incidences of infection and psychological alterations than those who had a normal vaginal delivery. Identifying women at risk of giving birth by cesarean section and informing them about subsequent symptoms of discomfort and maternal problems during the puerperium must be included in pregnancy health program policies and protocols to allow women to make informed decisions regarding their birthing plan.<\/jats:p>","DOI":"10.3390\/ijerph16224564","type":"journal-article","created":{"date-parts":[[2019,11,18]],"date-time":"2019-11-18T11:18:48Z","timestamp":1574075928000},"page":"4564","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Symptoms of Discomfort and Problems Associated with Mode of Delivery During the Puerperium: An Observational Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Juan Miguel","family":"Mart\u00ednez-Galiano","sequence":"first","affiliation":[{"name":"Department of Nursing, University of Jaen, 23071 Jaen, Spain"},{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Delgado-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain"},{"name":"Department of Health Sciences, University of Jaen, 23071 Jaen, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6239-2842","authenticated-orcid":false,"given":"Juli\u00e1n","family":"Rodr\u00edguez-Almagro","sequence":"additional","affiliation":[{"name":"Department of Nursing, Faculty of Nursing of Ciudad Real, University of Castilla-La Mancha, 13071 Ciudad Real, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9100-1134","authenticated-orcid":false,"given":"Antonio","family":"Hern\u00e1ndez-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Nursing, Faculty of Nursing of Ciudad Real, University of Castilla-La Mancha, 13071 Ciudad Real, Spain"},{"name":"Department of Obstetrics &amp; Gynecology, Mancha-Centro Hospital, 13600 Alc\u00e1zar de San Juan Mancha, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/j.jogc.2018.01.022","article-title":"Association Between Hypertensive Disorders During Pregnancy and the Subsequent Risk of End-Stage Renal Disease: A Population-Based Follow-Up Study","volume":"40","author":"Dai","year":"2018","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1161\/HYPERTENSIONAHA.115.06005","article-title":"Earlier Age of Onset of Chronic Hypertension and Type 2 Diabetes Mellitus After a Hypertensive Disorder of Pregnancy or Gestational Diabetes Mellitus","volume":"66","author":"Heida","year":"2015","journal-title":"Hypertension"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1016\/S0140-6736(09)60731-5","article-title":"Type 2 diabetes mellitus after gestational diabetes: A systematic review and meta-analysis","volume":"373","author":"Bellamy","year":"2009","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1007\/s00192-018-3567-9","article-title":"Impact of subsequent pregnancies on pelvic floor functional anatomy","volume":"29","author":"Dietz","year":"2018","journal-title":"Int. Urogynecol. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jad.2007.10.008","article-title":"Non-psychotic psychiatric disorders after childbirth: Prevalence and comorbidity in a community sample","volume":"109","author":"Navarro","year":"2008","journal-title":"J. Affect. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"102","DOI":"10.5603\/GP.a2018.0017","article-title":"The phenomenon of pregnancy\u2014A psychological view","volume":"89","author":"Bjelica","year":"2018","journal-title":"Ginekol. Pol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1097\/EJA.0000000000000535","article-title":"Incidence and severity of chronic pain after caesarean section","volume":"33","author":"Weibel","year":"2016","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/birt.12220","article-title":"Induced Labor in Sweden, 1999\u20132012: A Population-Based Cohort Study","volume":"43","author":"Lindgren","year":"2016","journal-title":"Birth"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lazariu, V., Nguyen, T., McNutt, L.-A., Jeffrey, J., and Kacica, M. (2017). Severe maternal morbidity: A population-based study of an expanded measure and associated factors. Landau R, editor. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0182343"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Huque, S., Roberts, I., Fawole, B., Chaudhri, R., Arulkumaran, S., and Shakur-Still, H. (2018). Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: Analysis of data from the WOMAN trial. BMC Pregnancy Childbirth, 18.","DOI":"10.1186\/s12884-018-1829-7"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/uog.19085","article-title":"Fundal pressure in second stage of labor (Kristeller maneuver) is associated with higher risk of levator ani muscle avulsion","volume":"53","author":"Youssef","year":"2018","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_12","first-page":"CD005302","article-title":"Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more)","volume":"1","author":"Middleton","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Liu, X., Landon, M.B., Cheng, W., and Chen, Y. (2018). A comparison of maternal and neonatal outcomes with forceps delivery versus cesarean delivery. J. Matern. Neonatal. Med., 1\u20137.","DOI":"10.1080\/14767058.2018.1490720"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Fan, D., Li, S., Wang, W., Tian, G., Liu, L., Wu, S., Guo, X., and Liu, Z. (2017). Sexual dysfunction and mode of delivery in Chinese primiparous women: A systematic review and meta-analysis. BMC Pregnancy Childbirth, 17.","DOI":"10.1186\/s12884-017-1583-2"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Rowlands, I.J., and Redshaw, M. (2012). Mode of birth and women\u2019s psychological and physical wellbeing in the postnatal period. BMC Pregnancy Childbirth, 12.","DOI":"10.1186\/1471-2393-12-138"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"M\u00f6ller, L., Josefsson, A., Bladh, M., Lilliecreutz, C., Andolf, E., and Sydsj\u00f6, G. (2017). Mental health after first childbirth in women requesting a caesarean section; a retrospective register-based study. BMC Pregnancy Childbirth, 17.","DOI":"10.1186\/s12884-017-1514-2"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.srhc.2014.09.007","article-title":"Mode of delivery and pain during intercourse in the postpartum period: Findings from a developing country","volume":"6","author":"Ataya","year":"2015","journal-title":"Sex. Reprod. Healthc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e018479","DOI":"10.1136\/bmjopen-2017-018479","article-title":"Postpartum urinary tract infection by mode of delivery: A Danish nationwide cohort study","volume":"8","author":"Gundersen","year":"2018","journal-title":"BMJ Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1111\/j.1471-0528.2011.02950.x","article-title":"Is mode of delivery associated with postpartum depression at 6\u00b0 weeks: A prospective cohort study","volume":"118","author":"Sword","year":"2011","journal-title":"BJOG"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"World Health Organization (1985). Appropriate technology for birth. Lancet, 2, 436\u2013437.","DOI":"10.1016\/S0140-6736(85)92750-3"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"317","DOI":"10.3109\/01443615.2013.873776","article-title":"Maternal request for caesarean section: Audit of a care pathway","volume":"34","author":"Green","year":"2014","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.srhc.2011.03.002","article-title":"A comparative study of the experience of childbirth between women who preferred and had a caesarean section and women who preferred and had a vaginal birth","volume":"2","author":"Nystedt","year":"2011","journal-title":"Sex. Reprod. Healthc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ejogrb.2015.06.014","article-title":"Caesarean section at maternal request\u2014the differing views of patients and healthcare professionals: A questionnaire based study","volume":"192","author":"Sharpe","year":"2015","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1111\/j.1471-0528.2008.01892.x","article-title":"Vaginal delivery compared with elective caesarean section: The views of pregnant women and clinicians","volume":"115","author":"Turner","year":"2008","journal-title":"BJOG"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1016\/j.jogc.2017.12.009","article-title":"No. 361-Caesarean Delivery on Maternal Request","volume":"40","author":"Alsayegh","year":"2018","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.midw.2010.05.005","article-title":"Behind the myth\u2014few women prefer caesarean section in the absence of medical or obstetrical factors","volume":"27","author":"Nystedt","year":"2011","journal-title":"Midwifery"},{"key":"ref_27","first-page":"205","article-title":"[Caesarean delivery in Andalusia, Spain: Relationship with social, clinical and health services factors (2007\u20132009)]","volume":"85","year":"2011","journal-title":"Revista Espa\u00f1ola de Salud P\u00fablica"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/j.purol.2015.06.002","article-title":"Prise en charge de l\u2019incontinence anale du post-partum: Revue de la litt\u00e9rature","volume":"25","author":"Villot","year":"2015","journal-title":"Progr\u00e8s en Urologie"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"11763","DOI":"10.1038\/s41598-019-47881-3","article-title":"Relationship between parity and the problems that appear in the postpartum period","volume":"9","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"86","DOI":"10.24171\/j.phrp.2018.9.2.08","article-title":"Factors Associated with Cesarean Section in Tehran, Iran using Multilevel Logistic Regression Model","volume":"9","author":"Amini","year":"2018","journal-title":"Osong Public Health Res. Perspect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5740534","DOI":"10.1155\/2016\/5740534","article-title":"The Effect of Epidural Analgesia on the Delivery Outcome of Induced Labour: A Retrospective Case Series","volume":"2016","author":"Antonakou","year":"2016","journal-title":"Obstet. Gynecol. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1590\/S0102-311X2006001000012","article-title":"Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil","volume":"22","author":"Chor","year":"2006","journal-title":"Cad. Saude Publica"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.wombi.2007.03.005","article-title":"Birth outcomes associated with interventions in labour amongst low risk women: A population-based study","volume":"20","author":"Tracy","year":"2007","journal-title":"Women Birth"},{"key":"ref_34","first-page":"1848","article-title":"Association between mode of delivery and pelvic floor dysfunction","volume":"134","author":"Hannestad","year":"2014","journal-title":"Tidsskrift Den Norske Legeforening"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1097\/AOG.0000000000000141","article-title":"Association of Mode of Delivery with Urinary Incontinence and Changes in Urinary Incontinence over the First Year Postpartum","volume":"123","author":"Chang","year":"2014","journal-title":"Obstet. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.tjog.2014.08.001","article-title":"Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor","volume":"53","author":"Bozkurt","year":"2014","journal-title":"Taiwan J. Obstet. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"265","DOI":"10.2217\/WHE.13.17","article-title":"Vaginal childbirth and pelvic floor disorders","volume":"9","author":"Memon","year":"2013","journal-title":"Women Health"},{"key":"ref_38","first-page":"144","article-title":"Type of delivery and self-reported postpartum symptoms among Iranian women","volume":"40","author":"Nikpour","year":"2013","journal-title":"Clin. Exp. Obstet. Gynecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.ajog.2014.01.032","article-title":"Pelvic pain and mode of delivery","volume":"210","author":"Blomquist","year":"2014","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1046\/j.1523-536X.2002.00167.x","article-title":"Prevalence and persistence of health problems after childbirth: Associations with parity and method of birth","volume":"29","author":"Thompson","year":"2002","journal-title":"Birth"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"105","DOI":"10.11606\/S1518-8787.2017051000389","article-title":"Maternal complications and cesarean section without indication: Systematic review and meta-analysis","volume":"51","author":"Mascarello","year":"2017","journal-title":"Rev. Saude Publica"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.1523-536X.2012.00551.x","article-title":"Physical Health and Recovery in the First 18 Months Postpartum: Does Cesarean Section Reduce Long-Term Morbidity?","volume":"39","author":"Woolhouse","year":"2012","journal-title":"Birth"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1016\/j.wombi.2016.06.007","article-title":"Prediction of posttraumatic stress disorder symptomatology after childbirth\u2014A Croatian longitudinal study","volume":"30","year":"2017","journal-title":"Women Birth"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"356","DOI":"10.4103\/amhsr.amhsr_397_15","article-title":"Correlation between Kind of Delivery and Posttraumatic Stress Disorder","volume":"6","author":"Mahmoodi","year":"2016","journal-title":"Ann. Med. Health Sci. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1080\/01443610400023064","article-title":"Predictors of women\u2019s physical health problems after childbirth","volume":"26","author":"Ansara","year":"2005","journal-title":"J. Psychosom. Obstet. Gynaecol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/DCR.0b013e3181fd2356","article-title":"Prevalence of Pelvic Floor Disorders in the Female Population and the Impact of Age, Mode of Delivery, and Parity","volume":"54","author":"Kepenekci","year":"2011","journal-title":"Dis. Colon Rectum"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/S0304-5013(09)72629-9","article-title":"Tasa de partos instrumentales en Espa\u00f1a","volume":"52","year":"2009","journal-title":"Progresos de Obstetricia y Ginecolog\u00eda"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/22\/4564\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:35:29Z","timestamp":1760189729000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/22\/4564"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,18]]},"references-count":47,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2019,11]]}},"alternative-id":["ijerph16224564"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16224564","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,18]]}}}