Burden of Back Pain among Postpartum Women In Canada: A Mixed Methods Study of The Prevalence, Risk Factors, Comorbidities and Lived-Experiences
Date
2023-05-02
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
ORCID
0000-0001-8398-0785
Type
Thesis
Degree Level
Doctoral
Abstract
Globally, back pain (BP) is considered a serious public health problem and is of particular concern among parous women. It is estimated that at least half of all pregnant women experience some type of BP during pregnancy, and a substantial number of these women may continue to have unresolved BP after childbirth or develop new symptoms postpartum that can persist for several months and even years after childbirth. When left unmitigated, persistent BP postpartum carries several short and long-term ramifications for affected women, their families, and the society, including resulting in chronic pain later in life. In Canada, chronic BP remains an ongoing and costly public health concern. It is possible that persistent BP postpartum contributes to this burden. However, BP occurring in the postpartum population is relatively underexamined and understudied within the Canadian back pain landscape. Importantly, there appears to be no known nationally representative studies on persistent BP postpartum, and no studies exist that explore in depth women’s experiences of living with persistent BP after childbirth, using qualitative methods. This paucity of information for such a large susceptible subpopulation necessitated undertaking this research. Furthermore, gaining information on the breadth and depth of the burden of BP in the Canadian postnatal population is crucial to provide a basis for developing tailored healthcare services and policies that can better meet women’s needs relating to BP management and optimize maternity care both during and after pregnancy. This can in the long run contribute to reducing the chronic back pain burden in Canada.
Using a convergent parallel mixed-methods research design, which entailed parallel analysis of nationally representative secondary quantitative data, as well as primary qualitative semi-structured interviews, this thesis examined the burden of persistent BP among postpartum mothers in Canada, covering aspects of disease burden relating to prevalence, risk factors, associated comorbidities, and lived- experiences, in order to uncover the impact on women’s postnatal health and wellbeing.
The key findings of the studies presented in this thesis work are as follows:
Back pain is considerably prevalent among postpartum mothers in Canada. More than a third of mothers in Canada experienced some degree of problematic back pain up to three months after childbirth; 24% considered their BP to be somewhat problematic, while for 12% of mothers, BP was perceived to be a great deal of a problem. When examined at 5-14 months after childbirth, almost half (46%) of the mothers reporting some degree of problematic BP in the early postnatal months continued to have ongoing or persistent BP symptoms.
A range of biopsychosocial factors were identified to be associated with an increased risk of having worse problematic BP during the first 3 months postpartum (i.e. younger maternal age; immigrant status; underweight or obese pre-pregnancy BMI; vaginal birth; lower self-rated health; higher perceived stress, higher number of stressful life events; inadequate social support after childbirth; history of violent abuse; pre-pregnancy depression; province of residence; lower educational attainment; lower household income; and having perceived inadequate information about BP during pregnancy), and persistence of BP up to 5-14 months postpartum (i.e. maternal age + degree of problematic BP in early postpartum, immigrant status, having other pain conditions, poorer self-rated health, inadequate social support postpartum, and history of violent abuse).
Both BP degree during the first three months postpartum and duration up to 5-14 months postpartum are associated with higher risk of reporting comorbid urinary incontinence (UI) and postpartum depression (PPD), in which women reporting the worse categories of BP (greatly problematic, and persistent duration) showed the highest probability of the outcomes (PPD and persistent UI). In addition to BP, a range of biopsychosocial factors were also associated with reporting PPD and UI at 5-14 months postpartum.
Semi-structured interviews with 11 postpartum women with BP revealed that persistent BP carries substantial negative impacts for affected mothers, making life more difficult during pregnancy and postpartum from physical, psychological, and social perspectives. Coping effectively with BP is a continuous process learned over time, in which being able to receive needed support from loved ones, and the ability to elicit self-management strategies enabled mothers to better cope with pain. However, saddled with the numerous responsibilities, many mothers may have no option but to push through the pain and/ or forgo care in order to keep up with their maternal, home, school or work demands. Unfortunately, there seems to be a lack of adequate support for mothers dealing with persistent BP postpartum from maternity care providers. Overall, the mothers experienced unmet healthcare needs regarding their persistent BP complaints postpartum, and their postpartum care in general (in terms of quality and duration of care), as well as several practical barriers in accessing needed care. Specifically, the mothers highlighted a ‘normalization’ and/or lack of acknowledgement of BP among care providers, inadequate referral to appropriate services, and financial constraints as the main barriers to seeking and/or receiving needed care. As a result, the mothers call for greater support from healthcare providers, in terms of better education about BP and adequate referral to available services to better manage BP both during and after pregnancy. They also advocated for more holistic postpartum care, involving the provision of affordable routine individualized physiotherapy, as well as better societal attitudes and support for women with BP during pregnancy and beyond.
The final take-home message from this thesis is that persistent BP after childbirth, represents a considerable burden among postpartum mothers in Canada, and measures to address this ongoing burden calls for concerted efforts from clinical, policy and societal perspectives, as well as a coordinated holistic maternity care system that incorporates a biopsychosocial approach, deployed within a multidisciplinary care model. Furthermore, it is imperative to improve awareness and acknowledgement of BP among health care providers (HCPs) and potential mothers, promote effective referral to relevant services, and ensure affordability of available services in order to minimize barriers to early diagnosis and management of BP, prevent delayed care seeking, improve uptake of needed services and reduce individual suffering. These measures can in turn mitigate the prevalence of chronic BP and ultimately enhance the health and quality of life of women during pregnancy, postpartum and beyond.
Description
Keywords
Back pain, pregnancy, postpartum, risk factors, biopsychosocial, prevalence, lived experiences, Canada
Citation
Degree
Doctor of Philosophy (Ph.D.)
Department
School of Public Health
Program
Epidemiology