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Abdominal Binder Use Increases AmbulaAon and Decreases Pain in Women ADer Cesarean SecAon Patricia Chambers RNC, Jessie Edward RNC, BSN, Lora Kelly BSN, RN, Mary Padovani RN, Mary DiShaw BSN, RNC-­‐MNN, CNML and the Nurses of the Mother-­‐Baby Unit Northern Westchester Hospital, Mt. Kisco, New York BACKGROUND
Women undergoing cesarean delivery (C-section) report more pain with activity than
those who had a vaginal delivery (p < 0.0002) (Hardy-Fairbanks, Lauria, Mackenzie, &
McCarthy, 2013). On postpartum day 2, women after C-section reported significantly more pain
when compared with those with a vaginal delivery (p < 0.04), which requires additional
analgesia medications that can interfere with involvement in baby care activities (HardyFairbanks et al., 2013). Additionally, the increased pain is not associated with demographic or
clinical characteristics (i.e., age, prior birth experiences, prior pregnancies; it is only
significantly associated with cesarean delivery (p= .001) (Dunn & O’Herlihy, 2005; Granot,
Lowenstein, & Yarnitsky, 2003; Pan, Coghill, & Houle, 2006). While narcotic and non-narcotic
analgesia (i.e., Dura morph and Ketorolac) are routinely used and found to reduce pain
significantly after C-section, pain associated with activity can be an important problem for a new
mother who may need to care for her infant and other children immediately postpartum.
Additionally, sleepiness or exacerbation of fatigue caused by increased analgesia use can also be
a source of frustration and lead to women choosing to refrain from optimal pain control to
minimize medication side effects (Tully & Ball, 2014). Offering non-pharmacologic
interventions (i.e., abdominal binders) to decrease pain after C-section would complement the
analgesia effects of medications.
Abdominal binders are identified in the non-professional literature as an effective
intervention to improve ambulation and decrease pain. Pregnancy websites (i.e.,
www.webmd.com/baby/features/belly-wraps-post-pregnancy-hit-or-hype) encourage women to
bring abdominal binders to the hospital when they are admitted for planned cesarean delivery.
Abdominal binders were available for use by patients at Northern Westchester Hospital but were
not part of routine care.
While abdominal binders are identified as an effective intervention to decrease pain
and increase ambulation for women after C-section, little evidence was found to support the use
of the binders. A systematic review of the literature failed to produce primary research studies
about the use of abdominal binders for post-caesarian section patients. PubMed, CINHAL,
EMBASE, and the Cochrane databases were searched for all published articles from electronic
database from 1990 through March 2014. Common to each database were the search limits of
English language publications, human studies. Inclusion criteria for articles included primary
research in women who have had cesarean sections for childbirth. When the search did not
reveal articles, further searches were completed with the key words “abdominal binder” and
“abdominal surgery”. The Proquest Dissertation Abstract database was also searched for doctoral
dissertations to address publication bias within the results of the other database searches.
Three articles were identified that examined the use of abdominal binders to decrease
pain and improve ambulation after abdominal surgery. Abdominal binders were consistently
associated with decreased reports of pain, and increased ambulation (Cheifetz, Lucy, Overend, &
Crowe, 2010; Larson, Ratzer, Davis-Merritt, & Clark, 2009; Olsen, Josefson, & Wiklund, 2009).
Additionally, an improvement in pulmonary function with subsequent decreased atelectasis was
identified as a serendipitous benefit of abdominal binder use related to the “splinting ability “ to
support deep breathing (Larson et al., 2009)
RESULTS
N=94
Average age 33.1 years
(range 20-46 years, SD=5.0 years)
Age or parity not associated wearing a binder
(p=.34)
Number of women wearing a
binder at each assessment
Across all assessment times, wearing an abdominal binder was significantly
associated with
•  Less pain (χ2=27.42(8), p=.001)
•  More ambulation (χ2=19.55(1), p<.000)
•  Decreased request for pain medications (t=3.96(299), p=.000)
During the EBP project HCAP scores for key pain and nursing care increased
•  “Pain well controlled”: increased from 78.9 to 94.4
•  “Pain staff do all they can to help”: increased from 84.2 to 88.9
•  “Rate hospital 9 or 10” : increased from 71.4 to 89.5
•  “Nurses communicate” increased from 83.9 to 95.0
Nurses on the post-partum unit noted that when abdominal binders were offered and
used by women after C-section, they ambulate more frequently and for longer duration compared
to the women after C-section that do not use abdominal binders. It is also noted that the women
after C-section that do not use abdominal binders report more constipation and gas pain, that is
attributed to less frequent ambulation. Additionally, decreased ambulation places patients at risk
for post-operative ileus, deep vein thrombus and pulmonary embolism.
Some of the women after C-section express concern about taking narcotics while
nursing, and suffer pain to prevent medications entering into their breast milk. Also,
breastfeeding is often more successful sitting in a chair. Women also express stress about their
ability to care for their newborn with post-operative pain given the planned discharge after
cesarean section of post-operative day three. The women often state that they “can’t imagine how
I will take care of my newborn, while in so much pain”.. It is anticipated that when women after
cesarean sections use an abdominal binder, pain will decrease; ambulation will increase enabling
women to more effectively engage with baby care activities, and breastfeeding.
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DISCUSSION
Based on the data from this project, the use of an abdominal binder appears to be a
beneficial option to support patient ambulation and pain management. Women wearing abdominal
binders experienced significantly improved pain and increased ambulation, especially within the
first 12 hours after C-section. The women consistently reported that the binders made them feel
more confident and comfortable. There were no changes noted in any incisional assessments from
baseline with a binder. When women were offered the binders more than 95% consented to using a
binder. Additionally the women who had a repeat C-section told the team that they wished they had
a binder at the prior C-section. These positive results suggest improved post C-section mobility and
improved post-operative recovery with decreased risk of DVT or ileus due to increased ambulation.
Based on the project results, offering abdominal binders was included as a standing order
in the standard of care for women after C-Section and has become the standard of practice for
women after C-section as a non-pharmacologic, complimentary intervention to decrease pain.
REFERENCES
Cheifetz, O., Lucy, S. D., Overend, T. J., & Crowe, J. (2010). The effect of abdominal support on
functional outcomes in patients following major abdominal surgery: a randomized controlled
trial. Physiotherapy Canada, 62(3), 242-253. doi: 10.3138/physio.62.3.242
Dunn, E. A., & O’Herlihy, C. (2005). Comparison of maternal satisfaction following vaginal
delivery after caesarean section and caesarean section after previous vaginal delivery.
European Journal Obstetrical Gynecological Reproductive Biology, 12(1), 56-60.
Granot, M., Lowenstein, L., & Yarnitsky, D. (2003). Post cesarean section pain prediction by
preoperative experimental pain assessment. Anesthesiology, 98(6), 1422-1426.
Hardy-Fairbanks, A. J., Lauria, M. R., Mackenzie, T., & McCarthy, M. (2013). Intensity and
Unpleasantness of Pain Following Vaginal and Cesarean Delivery: A Prospective Evaluation.
Birth: Issues in Perinatal Care, 40(2), 125-133. doi: 10.1111/birt.12039
Larson, C. M., Ratzer, E. R., Davis-Merritt, D., & Clark, J. R. (2009). The effect of abdominal
binders on postoperative pulmonary function. Am Surg, 75(2), 169-171.
Olsen, M. F., Josefson, K., & Wiklund, M. (2009). Evaluation of abdominal binder after major
upper gastrointestinal surgery. Advances in Physiotherapy, 11(2), 104-110.
Pan, P. H., Coghill, R., & Houle, T. T. (2006). Multifactorial preoperative predictors for post
cesarean section pain and analgesic requirement. Anesthesiology, 104(3), 417-425.
Tully, K. P., & Ball, H. L. (2014). Maternal accounts of their breast-feeding intent and early
challenges after caesarean childbirth. Midwifery, 30(6), 712-719. doi:
10.1016/
j.midw.2013.10.014
OBJECTIVES
RESEARCH POSTER PRESENTATION DESIGN © 2015
The Mather-Baby Unit Nursing staff partnered with the OB physicians. Since current
practice at NWH required a written MD order for the nurse to offer an abdominal binder to
women post C-section, a standing order was written to allow the nurses to offer the binder starting
the project.
The project was approved by the NWH IRB as exempt from informed consent (IRB
#14-008) because the project met the Health and Human Services requirements for waiver of
informed consent (i.e., the only record linking the subject and the data collection would be the
consent document, the project presents no more than minimal risk of harm to subjects and
involves no procedures for which written consent is normally required outside the research
context).
Procedure
All women after C-section were offered an abdominal binder before the first post-operative
ambulation (i.e., approximately twelve hours post-operative).
–  The abdominal binder would be placed on the patient while lying down, and proper
body mechanics for ambulation will be taught to the patient.
–  Data were collected
•  On both women who chose to wear an abdominal binder and those that did not
choose to wear an abdominal binder
•  Baseline at abdominal binder placement or when offered and refusal
•  Approximately 24 hours post-op (i.e., 12 hours after binder offered)
•  Then every 12 hours until discharge.
•  Data collection forms were de-identified
Our patients' told us…
No significant differences between women wearing or not wearing an
abdominal binder in the
•  Length of time out of bed (p=.40),
•  Level of activity when out of bed (p=.13).
Therefore the goals of this Evidence-Based Practice project in women after C-section were to:
•  Decrease pain ratings to less than 3 on the 0-10 visual analog pain.
•  Increase ambulation
•  Enhance feelings of self-efficacy to care for the newborn at home
PROJECT IMPLEMENTATION
ACKNOWLEDGEMENTS Wearing an abdominal binder was significantly associated with less pain
(t=-4.8(452), p=.0001)
The Evidence-Based Practice and Research Council
The Nursing Staff and Leadership of the Mother Baby Unit
Navid Mootabar MD, Chief Department of Obstetrics and Gynecology
Lauraine Spano- Szekely DNP, MBA, RN, Chief Nursing Officer, Vice President of Patient Care Services
Maria Hale MBA, Vice President, Patient Advocacy & Service Excellence
Fay Wright PhD, RN, APRN-BC, Evidence-Based Practice and research Coordinator