Empowered Relief for Severe Pain After Cesarean Delivery During the Inpatient Period

Severe acute pain following cesarean delivery may interfere with postpartum recovery and functioning. This pilot feasibility study will evaluate the feasibility of delivering Empowered Relief (ER) during the inpatient postpartum period to patients experiencing severe pain following cesarean delivery.

Eligible participants experiencing severe pain, defined as more than 2 numeric rating scale (NRS) pain scores >6/10 during the inpatient postpartum period, will be enrolled during their inpatient postpartum hospitalization and randomized 1:1 to an intervention or control group. Participants assigned to the intervention group will receive ER in addition to standard postpartum care. ER is a single 120-minute pain relief skills class that includes pain education, cognitive behavioral skills such as relaxation, deep breathing, and cognitive reframing, and development of a personalized plan. Participants will also receive access to a relaxation resource and weekly supportive text messages. Participants assigned to the control group will receive standard postpartum care alone.

The primary objective is to assess the feasibility of delivering the ER intervention during the inpatient postpartum period. Additional feasibility and acceptability outcomes include recruitment, registration and attendance at the ER session, treatment satisfaction, treatment skills use, adherence to study procedures, and participant retention. Pain-related patient-reported outcomes will also be explored over the 12-week follow-up period. Participants will complete follow-up assessments at 3, 6, and 12 weeks postpartum, with brief PEG pain assessments collected weekly through week 12.

Inclusion criteria

• Complete informed consent.
• Age 18 years or above.
• Postpartum woman who delivered by cesarean within the Stanford Healthcare system.
• Viable birth (singleton or multiple gestation).
• All maternal demographics and complications are eligible: parity, medical conditions (e.g., pre-eclampsia, gestational diabetes), and post-surgical complications (e.g., hysterectomy, ICU admission, extended hospital stay), provided the participant is clinically able to complete the study intervention and procedures.
• Currently hospitalized during the postpartum period following cesarean delivery.
• Severe pain, defined as more than 2 pain scores >6/10 on the numeric rating scale (NRS), following cesarean delivery.
• English fluency, with ability to read and write.
• Ability to adhere to and complete study procedures.
• Access to a smart device if attending ER session via Zoom.

Exclusion criteria

• Age under 18 years.
• Medical or clinical instability that, in the judgment of the treating or research team, would preclude safe participation in the study procedures and/or intervention.
• Chronic pain prior to pregnancy.
• Cognitive impairment or psychological factors that would preclude comprehension of study material or full participation.
• Unable or unwilling to provide informed consent.