When pain overshadows pregnancy, specialized care can make all the difference
When Claire welcomed her first child, she expected the sleepless nights, diaper changes and steep learning curve that come with new parenthood. What she didn’t expect was chronic pain.
About six weeks after delivering her daughter by Caesarean section, Claire began experiencing severe pain around her surgical scar. Some days, it was so debilitating that she struggled to lift her baby.
“It was certainly impacting my day-to-day functioning,” says Claire, a PhD student in clinical psychology. “There were days when I couldn’t lift her, and I couldn’t do things that I needed to do as a mom.”
Tests showed nothing unusual: Her incision had healed well; an ultrasound was normal. Yet the pain persisted.
Like many patients experiencing pain during and after pregnancy, Claire found herself navigating a gap in care. Her obstetrician (OB) couldn’t identify a clear cause, and once she was discharged from routine postpartum care, she didn’t know where to turn.
“My family doctor didn’t know what to do with it. My OB didn’t really know what to do with it," she recalls. “I was just floundering, thinking, ‘What am I going to do? Who do I see?’”
That experience would shape her next pregnancy and ultimately connect her with Dr. Rebecca Titman, a physical medicine and rehabilitation specialist with Sinai Health’s Pain in Pregnancy Program at the Wasser Pain Management Centre.
When pain is dismissed as “just part of pregnancy”
While aches and pains are often considered a normal part of pregnancy, significant pain can have a profound impact on health and quality of life.
According to Dr. Titman, up to 70 per cent of pregnant individuals experience back pain, and roughly one-third experience symptoms severe enough to interfere with work, caregiving, exercise and other daily activities. Yet, she says, pain during pregnancy is frequently overlooked or minimized. “There are many cultural and societal beliefs about what pregnancy should look like,” she says.
The consequences can be serious.
Dr. Titman says individuals experiencing significant pain are at greater risk of mental health challenges1. What’s more, pain can become a barrier to physical activity, which is known to benefit both parent and baby. “If people are in pain,” she says, “they’re not able to get the movement and exercise so important for health during pregnancy.”
Building a roadmap for better pain management
Recognizing an unmet need, Sinai Health launched its Pain in Pregnancy Program in 2019.
The program brings together specialists with expertise in chronic pain, musculoskeletal conditions, headaches and medication management during pregnancy. Patients receive individualized assessments and evidence-based strategies to help them manage pain before conception, during pregnancy and into the postpartum period.
For Dr. Titman, one of the most important parts of the work is simply listening. “Often the first step is understanding how pain is affecting someone’s day-to-day life,” she says. “Then we develop a toolkit of strategies that can help them manage symptoms throughout pregnancy.”
That toolkit may include movement and exercise plans, pelvic health physiotherapy, medication guidance, injections or referrals to other specialists, depending on each patient’s needs. The goal is to help patients stay active, informed and empowered throughout their pregnancy journey.
For Claire, that support proved invaluable.
When she became pregnant with her second child just 13 months after her first delivery, she worried the chronic pain she had experienced after her daughter’s birth would return or worsen.
Her obstetrician referred her to Dr. Titman’s team early in the pregnancy. “I felt like I had someone who could follow me through the entire journey,” says Claire.
Dr. Titman worked with Claire to develop a plan, which involved connecting her with anesthesia specialists and ensuring she had access to physiotherapy and other supports if needed. Just as importantly, Claire says, she felt heard.
“She took my concerns seriously,” Claire says. “It felt validating to know she’d seen other people in my shoes and that I wasn’t some strange anomaly. She gave me confidence that we were doing everything we could to set me up for success.”
Today, 10 months after the birth of her son, Claire’s postpartum experience has been dramatically different from her first. “I’m much more functional,” she says. “I haven’t been knocked out of commission for days on end at all.”
Sharing expertise across Canada
As demand for specialized care grows, Dr. Titman and her colleagues are working to ensure expertise reaches beyond Sinai Health’s walls.
That effort is taking shape through Project ECHO, a donor-supported education initiative that equips health-care providers with the practical skills and confidence to help patients manage pain during pregnancy in their own communities.
Using the internationally recognized ECHO model, the program brings together obstetricians, family physicians, nurse practitioners, pharmacists, physiotherapists, midwives and other health professionals for case-based learning and expert-led discussions. “We wanted to help other providers feel confident supporting these patients locally,” Dr. Titman says.
Since its launch, Project ECHO has attracted approximately 150 participants from communities across Canada. Based on a model of health-care provider education used extensively in Ontario, the program combines eight weeks of expert-led teaching with real-world case discussions. Feedback has been overwhelmingly positive, with providers reporting increased knowledge and confidence in caring for patients experiencing pain during pregnancy, furthering the reach of Sinai Health's expertise well beyond Toronto.
Supported by donors, the initiative is helping build capacity throughout the health-care system while reducing barriers to specialized care.
“The care I received was tremendously beneficial to me,” says Claire. “I felt more in control working with Dr. Titman. I always felt we had a game plan in place, and that made me feel confident that we were going to manage whatever happened.”
You can help ensure patients like Claire receive the support they need
Pain during pregnancy can have lasting effects on physical health, mental well-being and quality of life. With donor support, Sinai Health is expanding access to specialized care through its Pain in Pregnancy Program, while sharing expertise with health-care providers across Canada through Project ECHO.
The Wasser Pain Management Centre provides comprehensive, whole-person care for people living with acute and chronic pain. Through inpatient and outpatient services, the Centre combines non-opioid pain management with specialized clinical care and psychosocial supports, including mindfulness, cognitive behavioural therapy, pain reprocessing therapy, virtual care and group programs, to help patients better manage pain and improve their quality of life.
Your generosity helps patients like Claire receive the support they need and helps build a future where fewer families face pain alone. Support innovative programs that are improving care for patients and families.
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