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Introduction. Persistent pain in the operated region is a common complication of many types of surgery. Previous research suggests that at least 5-10% of women experience persistent scar pain following caesarean section (CS), but does not explain why women rarely access health care, how this pain may affect them or what their perceived health care needs are. This study employed a mixed methods approach to establish the impact of caesarean scar problems and any associated healthcare needs, from the perspective of the individual. Permissions for the study were received from the University of Brighton, Research Ethics & Governance Committee, National Information Governance Board and the researcher's NHS Trust. The study was conducted in three sequential phases. Phase 1. Self report. Women rarely visit clinics for persistent post-CS pain, so their perspective was gained initially by investigating informal discussions on publicly accessible internet sites. Findings: Pain in the scar area, but also healing difficulties and scar shape, were a problem for some women. There might be a need for improved information, advice and treatment. Phase 2. Survey. In order to overcome the bias inherent in internet reporting, a postal questionnaire was designed to explore the issues identified in Phase 1 in the local population. The questionnaire was sent out to 630 women, all of whom had undergone CS at the researcher's NHS Trust 6 to 30 months previously. Findings: Scar related issues from phase 1 were confirmed. CS scars clearly affected participants in various ways and some were troubled by them, but it was not clear why few sought professional help. Phase 3. Qualitative interviews. In order to explore the findings in greater depth, 19 respondents from Phase 2 were interviewed. Topics were the impact of the CS scar on the individual, concerns related to the scar and perceived associated healthcare needs. Themes were identified and analysed using a Framework approach. Findings: Most participants had learned to live with any CS scar problems they might have. Their main concerns were related to a potential subsequent pregnancy. However, many felt that information and advice received before and immediately after CS had not met their needs, making recovery from CS and learning to cope with any remaining problems difficult. Conclusion. This study identified problems with effective provision of information to service users. Women feel poorly prepared for potential consequences of CS such as slow recovery, impact on activity, scar shape, and altered body image and confidence. This raises questions over the issue of informed consent and shared decision making. |
