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Shawahna R, Khaskia D, Ali D, Hodroj H, Jaber M, Maqboul I, Hijaz H. Knowledge, attitudes, and practices of pregnant women regarding epidural analgesia: a multicentre study from a developing country. J OBSTET GYNAECOL 2024; 44:2354575. [PMID: 38770655 DOI: 10.1080/01443615.2024.2354575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Epidural analgesia has emerged as one of the best methods that can be used to reduce labour pain. This study was conducted to assess awareness, attitudes, and practices of pregnant women who visited maternity and antenatal healthcare clinics about epidural analgesia during normal vaginal birth. METHODS This multicentre study was conducted in a cross-sectional design among pregnant women using a pre-tested questionnaire. The study population in this study was pregnant women who visited maternity and antenatal healthcare clinics in Palestine. RESULTS In this study, a total of 389 pregnant women completed the questionnaire. Of the pregnant women, 381 (97.9%) were aware of the existence of epidural analgesia, 172 (44.2%) had already used epidural analgesia, and 57 (33.1%) experienced complications as a result of epidural analgesia. Of the pregnant women, 308 (79.2%) stated that epidural analgesia should be available during vaginal birth. Of the pregnant women, 243 (62.5%) stated that they would use epidural analgesia if offered for free or covered by insurance. Multivariate logistic regression showed that women who were younger than 32 years, who have used epidural analgesia, and those who stated that epidural analgesia should be available during vaginal birth were 2.78-fold (95% CI: 1.54-5.04), 4.96-fold (95% CI: 2.71-9.10), and 13.57-fold (95% CI: 6.54-28.16) more likely to express willingness to use epidural analgesia, respectively. CONCLUSIONS Pregnant women had high awareness of the existence, moderate knowledge, and positive attitudes towards epidural analgesia for normal vaginal birth. Future studies should focus on educating pregnant women about all approaches that can be used to reduce labour pain including their risks and benefits.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Clinical Research Center, An-Najah National University Hospital, Nablus, Palestine
| | - Dana Khaskia
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Donya Ali
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Hajar Hodroj
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mohammad Jaber
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Iyad Maqboul
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Hatim Hijaz
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
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Clark CJ, Marahatta SB, Hundley VA. The prevalence of pain catastrophising in nulliparous women in Nepal; the importance for childbirth. PLoS One 2024; 19:e0308129. [PMID: 39106264 DOI: 10.1371/journal.pone.0308129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 07/17/2024] [Indexed: 08/09/2024] Open
Abstract
In Lower-Middle-Income-Countries women are encouraged to present at a birthing facility for skilled care, but attending early can be associated with additional harm. Women admitted in latent labour are more likely to receive a cascade of unnecessary interventions compared with those attending a birthing facility during active labour. One reason that women present early is pain, with higher rates of admission among those who pain catastrophise. The aim of this study was to explore the prevalence of pain catastrophising in nulliparous women in Nepal and to identify predictors for pain catastrophising. A cross sectional study was conducted using a semi-structured survey. The survey was completed by 170 women (18-32 years) in one higher education institution in Kathmandu. The survey included the pain catastrophising scale (PCS), current and previous pain and information about period pain, sociodemographic variables of age, ethnicity, and religion. The prevalence of pain catastrophising reported at a cut off score of PCS≥20 was 55.9% and at a cut off score of PCS≥30 was 17.1%. All women with a PCS ≥30 reported having painful periods. Those with a PCS≥20 were four times [95%CI 1.93-8.42] more likely to report painful periods affecting their daily activities (p<0.001) and those with PCS≥30 three times [95%CI1.10-10.53] more likely (p<0.05). In both cases ethnicity and age were not associated. Women with higher PCS were less likely to take pain medication. A high prevalence of pain catastrophising was reported. It is important to understand how women's previous negative experiences of pain and pain catastrophising are perceived and if they are contributing to the rise in obstetric intervention, particularly caesarean births, in Nepal. We recommend repeating this study with a larger sample representing a more diverse population.
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Affiliation(s)
- Carol J Clark
- Faculty of Health and Social Sciences, Centre of Midwifery and Womens Health, Bournemouth University, Bournemouth, United Kingdom
| | - Sujan Babu Marahatta
- Manmohan Memorial Institute of Health Sciences Kathmandu, Kathmandu, Nepal
- Bournemouth University, Bournemouth, United Kingdom
- Nepal Open University, Lalitpur, Nepal
- Department of Public Health Sciences, University of California, Davis, California, United States of America
| | - Vanora A Hundley
- Faculty of Health and Social Sciences, Centre of Midwifery and Womens Health, Bournemouth University, Bournemouth, United Kingdom
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Ozdemir S, Gonzalez JM, Bansal P, Huynh VA, Sng BL, Finkelstein E. Getting it right with discrete choice experiments: Are we hot or cold? Soc Sci Med 2024; 348:116850. [PMID: 38608481 DOI: 10.1016/j.socscimed.2024.116850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/26/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
Discrete Choice Experiments (DCEs) are widely employed survey-based methods to assess preferences for healthcare services and products. While they offer an experimental way to represent health-related decisions, the stylized representation of scenarios in DCEs may overlook contextual factors that could influence decision-making. The aim of this paper was to evaluate the predictive validity of preferences elicited through a DCE in decisions likely influenced by a hot-cold empathy gap, and compare it to another commonly used method, a direct-elicitation question. We focused on preferences for pain-relief modalities, especially for an epidural during childbirth - a context where direct-elicitation questions have shown a preference for or intention to have a natural birth (representing the "cold" state), yet individuals often opt for an epidural during labor (representing the "hot" state). Leveraging a unique dataset collected from 248 individuals, we incorporated both the stated preferences collected through a survey administered upon hospital admission for childbirth and the actual pain-relief modality usage data documented in medical records. The DCE allowed for the evaluation of scenarios outside of those expected by respondents to simulate decision-making during childbirth. When we compared the predicted epidural use with the actual epidural use during labor, we observed a choice concordance of 71-60%, depending on the model specification. The concordance rate between the predicted and actual choices increased to 77-76% when accounting for the initial use of other ineffective modalities. In contrast, the direct-elicitation choices, relying solely on respondents' baseline expectations, yielded a lower concordance rate of 58% with actual epidural use. These findings highlight the flexibility of the DCE method in simulating complex decision contexts, including those involving hot-cold empathy gaps. The DCE proves valuable in assessing nuanced preferences, providing a more accurate representation of the decision-making processes in healthcare scenarios.
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Affiliation(s)
- Semra Ozdemir
- Department of Population Health Sciences, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Prateek Bansal
- Department of Civil and Environmental Engineering, National University of Singapore, Singapore
| | - Vinh Anh Huynh
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Eric Finkelstein
- Department of Population Health Sciences, Duke University, Durham, NC, USA; Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Varela P, Zervas I, Vivilaki V, Lykeridou A, Deltsidou A. Validity and reliability of the Greek version of Wijma delivery expectancy/experience questionnaire (Version A) among low-risk pregnant women. BMC Psychol 2024; 12:165. [PMID: 38504313 PMCID: PMC10953171 DOI: 10.1186/s40359-024-01662-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/15/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Fear of childbirth is a frequent health issue for pregnant women. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is a widely used instrument to measure the fear of childbirth during the antenatal period. The aim of the study was to assess the psychometric properties of the W-DEQ (version A) in a sample of Greek pregnant women. METHODS Low-risk pregnant women in the second or third trimester of pregnancy (N = 201) were invited to participate in the study and to complete a booklet of questionnaires including the Greek versions of W-DEQ-A, State-Trait Anxiety Inventory (STAI), Coping Orientations to Problems Experienced (Brief COPE), Perceived Stress Scale (PSS-10) and Edinburgh Postnatal Depression Scale (EPDS). Exploratory (EFA) and confirmatory factor analysis (CFA) was performed. RESULTS The mean age of participants was 34.2 years (SD = 4.3 years). EFA yielded six factors ("Lack of self-efficacy", "Lack of positive anticipation", "Lack of feeling lonely", "Concerns about delivery and losing control", "Calmness", and "Concern for the child") of 33 items of W-DEQ-A. CFA confirmed the multidimensionality of the instrument. All Cronbach's alpha were over 0.7, indicating acceptable reliability of the factors. All factors were significantly correlated with each other, and convergent validity was demonstrated by a significant association with stress, anxiety, and depression among low-risk pregnant women. CONCLUSION The Greek version of W-DEQ-A proved to be a valid and reliable instrument of fear of childbirth among Greek low-risk pregnant women.
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Affiliation(s)
- Pinelopi Varela
- Department of Midwifery, University of West Attica, Athens, Greece.
| | - Ioannis Zervas
- National and Kapodistrian University of Athens Medical School, Eginition University Hospital, Athens, MD, Greece
| | | | | | - Anna Deltsidou
- Department of Midwifery, University of West Attica, Athens, Greece
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Bartholomew V, Hundley V, Clark CJ, Parris BA. The RETHINK Study: Could pain catastrophising explain why some women are more likely to attend hospital during the latent phase of labour. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100941. [PMID: 38104503 DOI: 10.1016/j.srhc.2023.100941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To examine the prevalence of pain catastrophising and identify whether it impacts on the timing of hospital admission when in labour. METHODS A longitudinal cohort study. Nulliparous women, experiencing an uncomplicated pregnancy in England, were recruited between 25 and 33 weeks gestation. Participants completed two online questionnaires, (1) on recruitment, including the Pain Catastrophizing Scale (PCS) and the Wijma Delivery Expectancy Questionnaire (WDEQ-A) (2) at three weeks postnatal. RESULTS A total of 389 eligible participants entered the study. The percentage of women who were pain catastrophisers (PCS ≥ 20) was 28.1 %, while 7.6 % had a high pain catastrophising score (PCS ≥ 30). There was no association between pain catastrophising and the timing of hospital admission. The percentage of women reporting fear of childbirth (WDEQ-A score of ≥ 85) was 10.6 %. Fear of childbirth was highly associated with PCS scores (p <.001) at both the lower (≥20) and higher (≥30) thresholds. CONCLUSION Although not statistically significant, there was a tendency for women who pain catastrophise to present to hospital in the latent phase. The highly significant association between PCS and WDEQ-A scores has implications for the identification of these women and suggests that the PCS can be used as a screening tool to identify those women who have heightened fear around pain and who may also go on to develop clinically relevant fear of childbirth. Further studies are needed to confirm the acceptability of the PCS as a screening tool with women.
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Affiliation(s)
- V Bartholomew
- Centre for Midwifery & Women's Health, Bournemouth University, Faculty of Health and Social Sciences, Bournemouth Gateway Building, St Paul's Lane, Bournemouth BH8 8GP, United Kingdom.
| | - V Hundley
- Centre for Midwifery & Women's Health, Bournemouth University, Faculty of Health and Social Sciences, Bournemouth Gateway Building, St Paul's Lane, Bournemouth BH8 8GP, United Kingdom
| | - C J Clark
- Centre for Midwifery & Women's Health, Bournemouth University, Faculty of Health and Social Sciences, Bournemouth Gateway Building, St Paul's Lane, Bournemouth BH8 8GP, United Kingdom
| | - B A Parris
- Department of Psychology, Bournemouth University, Poole House P331, Talbot Campus, Fern Barrow, Poole BH12 5BB, United Kingdom
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Peralta FM, Condon LP, Torrez D, Neumann KE, Pollet AL, McCarthy RJ. Association of pain catastrophizing with labor pain and analgesia consumption in obstetrical patients. Int J Obstet Anesth 2024; 57:103954. [PMID: 38087766 DOI: 10.1016/j.ijoa.2023.103954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/26/2023] [Accepted: 11/05/2023] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Pain catastrophizing is an exaggerated negative orientation to painful stimuli which in obstetric patients is associated with fear of overwhelming labor pain and negative pain-related outcomes. This study aimed to quantitatively examine the association of pain catastrophizing with maternal labor pain outcomes. METHODS We conducted a prospective observational study of women admitted for a vaginal trial of labor. Subjects completed the 13-item Pain Catastrophizing scale (PCS) questionnaire (scored 0 to 52, higher scores representing greater catastrophizing). Pain was assessed at baseline and at request for neuraxial labor analgesia. Labor and postpartum pain intensity was assessed as the average area under the pain intensity by time curve. Pain at request for analgesia, labor pain, postpartum pain, analgesic consumption, and quality of recovery was compared between high (PCS ≥ 17) and low catastrophizing groups. RESULTS Data from 138/157 (88%) subjects were included in the analysis. Median (IQR) pain scores at request for analgesia were 9 (8,10) and 8 (6,9), a difference of 1 (95% CI 0 to 2.5, P = 0.008) in high-catastrophizing and in low-catastrophizing groups, respectively. Adjusted pain during labor, postpartum pain and opioid analgesic use were not significantly different. High-catastrophizers reported less comfort, ability to mobilize and less control during hospitalization. Post-discharge there were no differences in pain or analgesic use. CONCLUSION We did not observe greater labor or post-delivery pain or increased analgesic use in high-catastrophizing parturients. High catastrophizers reported greater pain when requesting analgesia, which is consistent with the role of catastrophizing in intensifying the experience of pain.
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Affiliation(s)
- F M Peralta
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - L P Condon
- Department of Anesthesiology, Rush University, Chicago, IL, USA
| | - D Torrez
- Department of Anesthesiology, Rush University, Chicago, IL, USA
| | - K E Neumann
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A L Pollet
- Department of Anesthesiology, Rush University, Chicago, IL, USA
| | - R J McCarthy
- Department of Anesthesiology, Rush University, Chicago, IL, USA
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Howard S, Houghton CMG, White R, Fallon V, Slade P. The feasibility and acceptability of a single-session Acceptance and Commitment Therapy (ACT) intervention to support women self-reporting fear of childbirth in a first pregnancy. Psychol Health 2023; 38:1460-1481. [PMID: 35060404 DOI: 10.1080/08870446.2021.2024190] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the feasibility and acceptability of a single-session Acceptance and Commitment Therapy intervention to help women manage fear of childbirth during a first pregnancy. DESIGN A mixed-methods approach including qualitative feedback and pre/post-intervention self-report measures. Pregnant women (14-37 weeks gestation) were recruited via the UK National Health Service and attended a single-session (<3 hours) Acceptance and Commitment Therapy intervention alongside routine antenatal care. Data were analysed using content and statistical analyses. MAIN OUTCOME MEASURES Fear of childbirth, anxiety and wellbeing were the main outcome measures. Secondary to these, intolerance of uncertainty and valued life domains (e.g. relationships, recreation) as hypothesised mechanisms of change, were also assessed. RESULTS 33 expressions of interest were received, 21 women signed up, 15 participated, and 11 completed follow-up measures (participation rate: 33%). Findings demonstrated clinical and statistical reductions in fear of childbirth and anxiety alongside positive feedback on the intervention. Intolerance of uncertainty and wellbeing were low at baseline and remained unchanged. CONCLUSION A single-session Acceptance and Commitment Therapy intervention to manage fear of childbirth is potentially feasible and acceptable. A pilot randomised controlled trial is warranted. Further research should explore efficacy and how Acceptance and Commitment Therapy may reduce perinatal distress.
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Affiliation(s)
- Sarah Howard
- Clinical Psychology, University of Liverpool, Liverpool, UK
| | | | - Ross White
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Vicky Fallon
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Pauline Slade
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Van Leugenhaege L, Degraeve J, Jacquemyn Y, Mestdagh E, Kuipers YJ. Factors associated with the intention of pregnant women to give birth with epidural analgesia: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:598. [PMID: 37608256 PMCID: PMC10463581 DOI: 10.1186/s12884-023-05887-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND In Belgium most women receive epidural analgesia during labour. Although, it offers satisfactory pain relief during labour, the risk on a series of adverse advents has been reported. The objective of this study was to determine factors associated with the intention of pregnant women, anticipating a vaginal birth, of requesting epidural analgesia during labour. METHODS A cross-sectional study, using an online self-report questionnaire was performed, including socio-demographic and personal details. Associated factors were examined with the HEXACO-60 questionnaire, the Mental Health Inventory-5, the Tilburg Pregnancy Distress Scale and the Labour Pain Relief Attitude Questionnaire for pregnant women. The level of intention to request epidural analgesia was based on two questions: Do you intend to ask for epidural analgesia (1) at the start of your labour; (2) at some point during labour? Data were collected predominantly during the second and third trimester of pregnancy. Descriptive analysis and a multiple linear regression analysis were performed. RESULTS 949 nulliparous (45.9%) and multiparous (54.1%) pregnant women, living in Flanders (Dutch-speaking part of Belgium) anticipating a vaginal birth completed the questionnaires. Birth-related anxiety (ß 0.096, p < 0.001), the attitude that because of the impact of pregnancy on the body, asking for pain relief is normal (ß 0.397, p < 0.001) and feeling more self-confident during labour when having pain relief (ß 0.034, p < 0.001) show a significant positive relationship with the intention for intrapartum epidural analgesia. The length of the gestational period (ß - 0.056, p 0.015), having a midwife as the primary care giver during pregnancy (ß - 0.048, p 0.044), and considering the partner in decision-making about pain relief (ß - 0.112, p < 0.001) show a significant negative relationship with the intention level of epidural analgesia. The explained variability by the multiple regression model is 54%. CONCLUSIONS A discussion during pregnancy about the underlying reason for epidural analgesia allows maternity care providers and partners to support women with pain management that is in line with women's preferences. Because women's intentions vary during the gestational period, pain relief should be an issue of conversation throughout pregnancy.
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Affiliation(s)
- Luka Van Leugenhaege
- Department of Health and Life Science, School of Midwifery, AP University of Applied Sciences and Arts Antwerp, Noorderplaats 2, 2000, Antwerp, Belgium.
- Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Julie Degraeve
- Department of Obstetrics and Gynecology, University Hospital Antwerp UZA, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics and Gynecology, University Hospital Antwerp UZA, Drie Eikenstraat 655, 2650, Edegem, Belgium
- University of Antwerp, ASTARC and Global Health Institute GHI, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Eveline Mestdagh
- Department of Health and Life Science, School of Midwifery, AP University of Applied Sciences and Arts Antwerp, Noorderplaats 2, 2000, Antwerp, Belgium
- Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Yvonne J Kuipers
- Department of Health and Life Science, School of Midwifery, AP University of Applied Sciences and Arts Antwerp, Noorderplaats 2, 2000, Antwerp, Belgium
- Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
- School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh, EH11 4BN, Scotland
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Kuipers PYJ, van Beeck E. Predictors associated with low-risk women's pre-labour intention for intrapartum pain relief: a cross-sectional study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100070. [PMID: 38745603 PMCID: PMC11080486 DOI: 10.1016/j.ijnsa.2022.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Pregnant women have preferences about how they intend to manage labour pain. Unmet intentions can result in negative emotions and/or birth experiences. Objective To examine the antenatal level of intention for intrapartum pain relief and the factors that might predict this intention. Design A cross-sectional online survey-based study. Setting and participants 414 healthy pregnant women in the Netherlands, predominantly receiving antenatal care from the community-based midwife who were recruited via maternity healthcare professionals and social media platforms. Methods The attitude towards intrapartum pain relief was measured with the Labour Pain Relief Attitude Questionnaire for pregnant women. Personality traits with the HEXACO-60 questionnaire, general psychological health with the Mental Health Inventory-5 and labour and birth anxiety with the Tilburg Pregnancy Distress Scale. Multiple linear regression was performed with the intention for pain relief as the dependant variable. Results The obstetrician as birth companion (p<.001), the perception that because of the impact of pregnancy on the woman's body, using pain relief during labour is self-evident (p<.001), feeling convinced that pain relief contributes to self-confidence during labour (p=.023), and fear of the forthcoming birth (p=.003) predicted women were more likely to use pain relief. The midwife as birth companion (p=.047) and considering the partner in requesting pain relief (p=.045) predicted women were less likely to use pain relief. Conclusion Understanding the reasons predicting women's intention of pain management during labour, provides insight in low-risk women's supportive needs prior to labour and are worth paying attention to during the antenatal period.
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Affiliation(s)
- Prof. Yvonne J Kuipers
- Rotterdam University of Applied Sciences, Institute of Healthcare, Rochussenstraat 198, 3015 EK Rotterdam, Netherlands
- Edinburgh Napier University, School of Health and Social Care, 9 Sighthill Court, Edinburgh EH11 4BN, Scotland, UK
| | - Elise van Beeck
- Rotterdam University of Applied Sciences, Institute of Healthcare, Rochussenstraat 198, 3015 EK Rotterdam, Netherlands
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Hou Y, Zhou X, Yao M, Liu S. Fear of childbirth and its predictors in re-pregnant women after cesarean section: a cross-sectional multicenter study in China. BMC Pregnancy Childbirth 2022; 22:393. [PMID: 35525927 PMCID: PMC9080153 DOI: 10.1186/s12884-022-04721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/28/2022] [Indexed: 11/20/2022] Open
Abstract
Background Since the implementation of China’s two-child policy in 2016, the number of re-pregnant women after cesarean section has increased significantly. These women are more prone to fear of childbirth compared with primiparas due to their history of scarred uterus leading to a more complicated delivery process, which poses a great threat to their physical and mental health. However, there is currently limited research on the problem in China. The aim of this study was to assess fear of childbirth and its predictors in re-pregnant women after cesarean section in China. Methods A cross-sectional multicenter study was conducted in three hospitals from June 7 to December 7, 2020, in Changsha, China. Study hospitals were selected using a random sampling technique. Participants were selected using a convenience sampling technique. Three hundred fifty-eight women during the third trimester of pregnancy who were older than 18 years, having a history of CS(s), and not having major physical or mental health problems were included. Fear of childbirth and its predictors were evaluated using the Childbirth Attitude Questionnaire, the short form of the 32-item Chinese Childbirth Self-Efficacy Inventory, the Social Support Rating Scale, and the demographic-obstetric data sheet. After checking for completeness, data were exported to statistical software for analysis. Both univariate analysis and multiple linear regression analysis were computed to assess fear of childbirth and its predictors. Statistical significance was declared at a P-value of < 0.05. Results The average score of fear of childbirth was 43.76 (standard deviation = 5.27, range 17–58). Number of cesarean sections, experience with previous cesarean section, childbirth self-efficacy and social support were significantly associated with fear of childbirth (P < 0.05). Conclusions In this study, re-pregnant women after cesarean section in China had moderate fear of childbirth, and the number of cesarean sections, experience with previous cesarean section, childbirth self-efficacy and social support were predictors of fear of childbirth. It is important for healthcare professionals to find re-pregnant women after cesarean section at high risk of fear of childbirth and provide appropriate services during pregnancy.
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Affiliation(s)
- Yiping Hou
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital and Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xihong Zhou
- Clinical Nursing Teaching and Research Section and Department of Obstetrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Min Yao
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital and Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Sai Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital and Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Nakić Radoš S, Žigić Antić L, Jokić-Begić N. The Role of Personality Traits and Delivery Experience in Fear of Childbirth: A Prospective Study. J Clin Psychol Med Settings 2022; 29:750-759. [PMID: 35032280 DOI: 10.1007/s10880-022-09848-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/04/2023]
Abstract
This study aimed to examine fear of childbirth (FOC) before and after delivery in relation to personality (anxiety and anxiety sensitivity) and birth experience (type of delivery, pain, and staff support). One-hundred and five women completed questionnaires during pregnancy and one month after childbirth. Participants completed the Wijma Delivery Expectancy/Experience Questionnaire; the State and Trait Anxiety Inventory and Anxiety Sensitivity Index, and the McGill Pain Questionnaire and a Support from staff questionnaire. FOC levels decreased after childbirth, but only in the high-level fear group. Path analysis showed that physical concerns, one aspect of anxiety sensitivity, shape FOC during pregnancy. Together with interventions at delivery (instrumental vaginal delivery and emergency caesarean section), pain and low staff support, this in turn modifies FOC after delivery. In conclusion, FOC decreases after childbirth. However, combined with adverse birth experience and certain personality traits, FOC during pregnancy affects FOC after delivery.
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Affiliation(s)
- Sandra Nakić Radoš
- Department of Psychology, Catholic University of Croatia, Ilica 242, Zagreb, Croatia.
| | - Lana Žigić Antić
- Department of Pediatrics, University Hospital Centre Sisters of Mercy, Vinogradska 29, Zagreb, Croatia
| | - Nataša Jokić-Begić
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Ivana Lučića 3, Zagreb, Croatia
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Clark CJ, Kalanaviciute G, Bartholomew V, Cheyne H, Hundley VA. Exploring pain characteristics in nulliparous women; A precursor to developing support for women in the latent phase of labour. Midwifery 2021; 104:103174. [PMID: 34753016 DOI: 10.1016/j.midw.2021.103174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/08/2020] [Accepted: 10/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Admission to hospital in the latent phase of labour is associated with a cascade of unnecessary intervention. Women who seek early hospital admission may have heightened fear and anxiety in relation to pain routed in their pre-pregnancy experiences. OBJECTIVE To determine the prevalence of pain catastrophising in a healthy non-pregnant population and explore previous pain experiences and fear of childbirth as characteristics that might predict pain catastrophising. DESIGN Prospective observational study across two higher education institutions in Scotland and England using a semi-structured survey administered through Bristol Online Surveys. Four validated questionnaires were used to identify the prevalence of pain catastrophising and fear of childbirth in nulliparous women of reproductive age. RESULTS The survey was completed by 122 women undertaking an undergraduate degree and aged between 18 and 23 years. A high prevalence of pain catastrophising was found: a cut-off score of 20 and above = 47.5% (58/122 participants), a cut-off score of 30 and above = 21.3% (26/122). Fear of pain (β = 0.14, t = 4.21, p <0 .001) and pain-related anxiety (β = 0.40, t = 11.39, p <0 .001) were significant predictors of pain catastrophisation. However, there was no correlation between fear of childbirth and pain catastrophisation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE It is reasonable to hypothesise that the pain catastrophising scale may be a good tool to predict those women likely to require additional support in the latent phase of labour; however further work is needed to explore this with a group of pregnant women.
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Affiliation(s)
- Carol J Clark
- Head of Department and Professor In Physiotherapy, Department of Rehabilitation and Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University.
| | - Guste Kalanaviciute
- Psychology Graduate, Faculty of Science and Technology, Bournemouth University
| | - Vanessa Bartholomew
- Clinical Academic Doctoral Student, Department of Midwifery & Health Sciences, Faculty of Health & Social Sciences, Bournemouth University
| | - Helen Cheyne
- RCM (Scotland) Professor of Midwifery Research, NMAHP Research Unit, University of Stirling
| | - Vanora A Hundley
- Professor of Midwifery, Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University
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13
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Sim XLJ, Tan CW, Yeam CT, Tan HS, Sultana R, Sng BL. Association of Pain Catastrophizing and Depressive States with Multidimensional Early Labor Pain Assessment in Nulliparous Women Having Epidural Analgesia - A Secondary Analysis. J Pain Res 2021; 14:3099-3107. [PMID: 34675639 PMCID: PMC8504655 DOI: 10.2147/jpr.s331703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/23/2021] [Indexed: 01/04/2023] Open
Abstract
Background Labor pain is a variable and complex experience with both sensory and affective components. Pain catastrophizing tendencies are predictive of increased distress during labor. Likewise, pain severity has important associations with increased depressive symptoms in mothers, with consequences on perinatal and infant outcomes. Hence, we investigated the association between increased early labor pain with both pre-delivery pain catastrophizing and depressive states. Methods We recruited nulliparous women who had requested labor epidural analgesia. Pre-delivery questionnaires including short-form McGill pain questionnaire–2 (SF-MPQ-2), pain catastrophizing scale (PCS), and Edinburgh postnatal depression score (EPDS) were administered. Results A total of 712 women completed the pre-delivery questionnaires. There was a significant association between SF-MPQ-2 neuropathic subscale and EPDS ≥ 10 (unadjusted OR 1.74, 95% CI 1.11–2.73, p = 0.0161), as well as PCS ≥ 25 (unadjusted OR 1.55, 95% CI 1.06–2.26, p = 0.0244). SF-MPQ-2 sensory intermittent subscale and EPDS ≥ 10 (unadjusted OR 2.02, 95% CI 1.34–3.03, p = 0.0007), and PCS ≥ 25 (unadjusted OR 1.59, 95% CI 1.14–2.23, p = 0.0069) also showed significant association. Conclusion Increased sensory intermittent and neuropathic subsets of early labor pain are significantly correlated with increased pre-delivery pain catastrophizing and depressive states in nulliparous women. This positive association may be useful for pre-delivery risk stratification for early interventions towards a more holistic care management.
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Affiliation(s)
| | - Chin Wen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore, Singapore.,Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | | | - Hon Sen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore, Singapore.,Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Ban Leong Sng
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore, Singapore.,Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Gelaw T, Ketema TG, Beyene K, Gurara MK, Ukke GG. Fear of childbirth among pregnant women attending antenatal care in Arba Minch town, southern Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth 2020; 20:672. [PMID: 33160330 PMCID: PMC7648954 DOI: 10.1186/s12884-020-03367-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fear of childbirth is one of the life challenges the women encounter during pregnancy. It is an important source of distress for the women and their families and also increases the odds of obstetric complications during childbirth. The aim of this study was to assess the magnitude of fear of childbirth and associated factors among pregnant women attending antenatal care at public health facilities in Arba Minch town, southern Ethiopia. METHODS Institution-based cross-sectional study was carried out among pregnant women who attended antenatal care at public health facilities in Arba Minch from November 1st - 30th 2019. A systematic random sampling technique was employed to include the participants. Data were collected through a face-to-face interview by using a structured and pretested questionnaire. Wijma Delivery Expectancy Questionnaire was used to score fear of childbirth. Epi Data version 3.1 and Statistical Package for the Social Sciences version 25.0 software were used for data management. Descriptive and analytic analyses were done and statistical significance was declared at a p-value < 0.05 and 95% confidence level in multivariable analysis. RESULTS A total of 387 pregnant women have participated in this study. Forty (10.3%) of the pregnant women had a low degree fear, 154(39.8%) had a moderate degree fear, 98(25.3%) had a high degree fear, and 95(24.5%) had severe degree fear of childbirth. Unplanned pregnancy (AOR = 2.30, 95% CI: 1.12, 4.74), current pregnancy-related complications (AOR = 6.24, 95% CI: 2.72, 14.29), and poor social support (AOR = 1.93, 95%CI: 1.01, 3.68) were factors significantly associated with severe degree fear of childbirth. CONCLUSIONS Almost three-fourth of the pregnant women in this study area had moderate to severe degree fear of childbirth. Tailoring counseling during antenatal care visits is needed to address those women who are at a high risk of considerable childbirth fear and its health consequences.
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Affiliation(s)
- Tiruset Gelaw
- Department of Midwifery College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Teklemariam Gultie Ketema
- Department of Midwifery College of Medicine and Health Sciences, Arba Minch University, P.O. Box 21, Arba Minch, Ethiopia
| | - Kassaw Beyene
- Department of Midwifery College of Medicine and Health Sciences, Arba Minch University, P.O. Box 21, Arba Minch, Ethiopia
| | - Mekdes Kondale Gurara
- School of Public Health College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gebresilasea Gendisha Ukke
- Department of Midwifery College of Medicine and Health Sciences, Arba Minch University, P.O. Box 21, Arba Minch, Ethiopia.
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Borrelli S, Evans K, Pallotti P, Evans C, Eldridge J, Spiby H. Mixed-methods systematic review: Childbearing women's views, experiences, and decision-making related to epidural analgesia in labour. J Adv Nurs 2020; 76:3273-3292. [PMID: 32989801 DOI: 10.1111/jan.14555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/13/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Abstract
AIMS To investigate childbearing women's views, experiences and decision-making related to epidural analgesia in labour. DESIGN Mixed-methods systematic review. DATA SOURCES A comprehensive literature search was implemented across Medline, CINAHL and EMBASE from 2000 to September 2018. The literature search was undertaken in January 2018 and updated in September 2018. Thirty papers were selected. RESULTS Four overarching synthesized findings were identified: (a) choice; (b) pain management experience; (c) lack of information; and (d) information provision and consent. REVIEW METHODS Quality appraisal was conducted using JBI levels of evidence and other established tools. NVivo was used to independently dual code and thematically synthesize qualitative data. A narrative synthesis of the quantitative findings from the included studies was undertaken. The GRADE-CERQual approach was used to assess confidence in the review findings based on the qualitative data. A set of integrated mixed-methods synthesized findings was produced. CONCLUSION Recommendations for practice based on the systematic review findings are that midwives should dedicate time to discuss epidural with women and birth partners, ideally during the second or third trimester of pregnancy, asking women what coping strategies or pain relief they have been considering, if any. The factors which may influence the woman's choice of epidural, including pain threshold, ability to cope with pain, timing of epidural and length of labour should be continuously evaluated during labour. The midwife should remain with women after an epidural has been sited, demonstrating understanding of the woman's choice and providing an opportunity for discussion of plans for the remaining labour and birth. IMPACT The findings of this systematic review can inform both healthcare professionals and service users on various aspects of the decision-making process about the use of epidural analgesia in labour. Data can be transferable to similar settings in high-income countries.
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Affiliation(s)
- Sara Borrelli
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Kerry Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Phoebe Pallotti
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
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16
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Investigating the association between labour epidural analgesia and postpartum depression. Eur J Anaesthesiol 2020; 37:796-802. [DOI: 10.1097/eja.0000000000001236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Quach D, Woolley T, Pandit T, Rane A, Ray RA. Women's epidural decision-making in labour: A Townsville perspective. Aust N Z J Obstet Gynaecol 2020; 60:919-927. [PMID: 32510590 DOI: 10.1111/ajo.13199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite being an efficacious means of pain relief, there is a broad range of usage rates of epidural analgesia among countries worldwide. Australia sits between common usage in North America and more conservative usage in the UK. The reason for this is unclear, raising the question of whether there is a difference between Australia and other Western countries in pregnant women's attitudes toward epidural use, or the hospital context. AIM To explore predictors for epidural analgesia request among pregnant women in Townsville, Australia. MATERIALS AND METHODS A three-phase mixed methods exploratory study design, with Phase One involving 12 one-on-one interviews with pregnant and post-partum women regarding attitudes toward labour analgesia decision-making and epidural preferences. Interview data were analysed thematically to develop a survey distributed to 265 third-trimester women in Phase Two. Phase Three involved a chart review of survey participants to record delivery mode, epidural request and indication. Bivariate and logistic regression analysis of Phases Two and Three data were used to develop predictive models for epidural decision-making. RESULTS Interviews revealed several themes influencing analgesia preferences in Townsville women: concerns regarding personal safety, trust in health professionals, and previous experiences with labour. The logistic regression identified epidural request in labour to be predicted by: primiparity, epidural experience, induction or augmentation of labour, and perceived sense of control associated with epidural use. CONCLUSIONS This study suggests that the most significant influencers on Townsville women's epidural decision-making were parity, induction or augmentation of labour, previous experience of epidurals and attitude toward epidurals.
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Affiliation(s)
- Diane Quach
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Monash Women's, Monash Health, Melbourne, Victoria, Australia
| | - Torres Woolley
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Tarsh Pandit
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Logan Hospital, Brisbane, Queensland, Australia
| | - Ajay Rane
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Obstetrics and Gynaecology, Townsville Hospital and Health Service, Townsville, Queensland, Australia.,Department of Obstetrics and Gynaecology, Mater Hospital, Townsville, Queensland, Australia
| | - Robin A Ray
- College of Medicine and Dentistry, Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
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19
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Zeng Y, Tan CW, Sultana R, Chua TE, Chen HY, Sia ATH, Sng BL. Association of Pain Catastrophizing with Postnatal Depressive States in Nulliparous Parturients: A Prospective Study. Neuropsychiatr Dis Treat 2020; 16:1853-1862. [PMID: 32982241 PMCID: PMC7492715 DOI: 10.2147/ndt.s256465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Postnatal depression (PND) is associated with maternal morbidity and socioeconomic burden. Recent studies have shown an association between pain catastrophizing, increased labor pain, and subsequent adverse postnatal adjustment; however, little is known on its role in PND development. We aimed to investigate the association between pain catastrophizing and probable PND. METHODS Parturients planning to undergo epidural labor analgesia were recruited. Predelivery questionnaires, including the Pain Catastrophizing Scale (PCS) and Edinburgh Postnatal Depression Scale (EPDS), were administered during early labor. A phone survey at 5- 9 weeks postdelivery was conducted to determine postdelivery EPDS and Spielberger's State-Trait-Anxiety Inventory scores. The primary outcome was a binary variable of postdelivery EPDS with cutoff of ≥10, whereas the secondary outcome was a continuous variable on increases in EPDS score. RESULTS Probable PND (EPDS ≥10) occurred in 10.5% (95% CI 8.0%-13.5%, 55 of 525) of women who underwent epidural labor analgesia. We found that high pain catastrophizing (PCS ≥25) was associated with increased postdelivery EPDS scores (adjusted β estimate 0.36, 95% CI 0.15-0.57; p=0.0008), but did not meet significance for increased risk of probable PND (p=0.1770). Additionally, presence of breakthrough pain during epidural analgesia (adjusted β estimate 0.24, 95% CI 0.02-0.46; p=0.0306) and lower BMI at term (adjusted β estimate -0.04, 95% CI -0.07 to -0.01; p=0.0055) were associated with increased postdelivery EPDS scores. CONCLUSION No significant association was found between high pain catastrophizing and probable PND; however, high predelivery pain catastrophizing, presence of breakthrough pain during epidural analgesia, and lower BMI at term were associated with increased postdelivery EPDS scores. Further research will be needed to validate this association in the context of the risk of PND development.
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Affiliation(s)
- Yanzhi Zeng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Chin Wen Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Tze-Ern Chua
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.,Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Helen Yu Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.,Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Alex Tiong Heng Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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20
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Rondung E, Ekdahl J, Hildingsson I, Rubertsson C, Sundin Ö. Heterogeneity in childbirth related fear or anxiety. Scand J Psychol 2018; 59:634-643. [DOI: 10.1111/sjop.12481] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Ingegerd Hildingsson
- Department of Women′s and Children′s Health, Obstetrics and Gynecology; Uppsala University; Sweden
- Department of Nursing; Mid Sweden University; Sweden
| | - Christine Rubertsson
- Department of Women′s and Children′s Health, Obstetrics and Gynecology; Uppsala University; Sweden
- Department of Health Sciences; Faculty of Medicine; Lund University; Sweden
| | - Örjan Sundin
- Department of Psychology; Mid Sweden University; Sweden
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21
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Sitras V, Šaltytė Benth J, Eberhard-Gran M. Obstetric and psychological characteristics of women choosing epidural analgesia during labour: A cohort study. PLoS One 2017; 12:e0186564. [PMID: 29045499 PMCID: PMC5646833 DOI: 10.1371/journal.pone.0186564] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/12/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the obstetric and psychological characteristics of women who opt to use epidural analgesia (EDA) during labour and the impact of participating in labour preparation courses on women's decisions to use EDA. DESIGN Longitudinal cohort study. SETTING Akershus University Hospital, Norway. POPULATION 2596 women with singleton pregnancies and intended vaginal delivery. METHODS Data were collected using two self-completed questionnaires at pregnancy weeks 17 and 32. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ). Symptoms of anxiety were measured by the Hopkins Symptom Check List (SCL-25) and depression by the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and socio-demographic information was retrieved from birth records at the maternity ward. MAIN OUTCOME MEASURE Preference for EDA was indicated by the questionnaire item "I would prefer an epidural regardless" on a 4-point scale (1 = highly agree, 4 = highly disagree) at pregnancy week 32. RESULTS Twenty-one percent of the women (540/2596) answered that they would choose EDA as the only alternative method of analgesia during labour. Counselling for fear of childbirth [OR 3.23 (95%CI 2.12; 4.92)] and W-DEQ sum score ≥ 85 [OR 2.95 (95%CI 2.06; 4.23)] were significantly (p<0.001) associated with choice of EDA. Participation in labour preparation courses was significantly (p = 0.008) associated with a reduction of intended use of EDA during labour [OR 0.67 (95%CI 0.49; 0.90)]. CONCLUSION Fear of childbirth is significantly associated with women's choice of EDA during labour. On the other hand, women that participate in labour preparation courses would rather consider other methods of analgesia during labour.
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Affiliation(s)
- Vasilis Sitras
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Oslo, Norway
- Department of Fetal Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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Klomp T, Witteveen AB, de Jonge A, Hutton EK, Lagro-Janssen ALM. A qualitative interview study into experiences of management of labor pain among women in midwife-led care in the Netherlands. J Psychosom Obstet Gynaecol 2017; 38:94-102. [PMID: 27778527 DOI: 10.1080/0167482x.2016.1244522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Many pregnant women are concerned about the pain they will experience in labor and how to deal with this. This study's objective was to explore women's postpartum perception and view of how they dealt with labor pain. METHODS Semistructured postpartum interviews were analyzed using the constant comparison method. Using purposive sampling, we selected 17 women from five midwifery practices across the Netherlands, from August 2009 to September 2010. RESULTS Women reported that control over decision making during labor (about dealing with pain) helped them to deal with labor pain, as did continuous midwife support at home and in hospital, and effective childbirth preparation. Some of these women implicitly or explicitly indicated that midwives should know which method of pain management they need during labor and arrange this in good time. DISCUSSION It may be difficult for midwives to discriminate between women who need continuous support through labor without pain medication and those who genuinely desire pain medication at a certain point in labor, and who will be dissatisfied postpartum if this need is unrecognized and unfulfilled.
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Affiliation(s)
- Trudy Klomp
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Anke B Witteveen
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Ank de Jonge
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Eileen K Hutton
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands.,c Midwifery Education Program , McMaster University Hamilton , Ontario , Canada
| | - Antoine L M Lagro-Janssen
- b Department of Primary Care and Community Care, Women's Studies Medicine , Radboud University Medical Center Nijmegen , the Netherlands
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Rondung E, Thomtén J, Sundin Ö. Psychological perspectives on fear of childbirth. J Anxiety Disord 2016; 44:80-91. [PMID: 27788373 DOI: 10.1016/j.janxdis.2016.10.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/22/2016] [Accepted: 10/13/2016] [Indexed: 11/27/2022]
Abstract
The objective of this narrative review was to examine the literature on fear of childbirth from a psychological perspective, addressing the specificity of childbirth fear, the pathways of fear acquisition, and the physiological, cognitive and behavioral aspects of fear. Systematic procedures for literature search, inclusion and exclusion left 86 original research papers for analysis. Findings summarize the body of knowledge for each area of interest, as well as the number of studies addressing each theme. Overall, few studies adopt a clear-cut psychological perspective, leaving the psychological mechanisms of childbirth fear largely unexplored. Although methodological limitations make conclusions difficult, results give a hint of etiological diversity and possible psychological mechanisms commonly described as transdiagnostic features in anxiety. Systematic investigations of psychological mechanisms, longitudinal studies exploring possible vicious circles of fear, and studies comparing psychological characteristics within the group of women fearing childbirth are identified as research areas of high priority.
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Affiliation(s)
- Elisabet Rondung
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
| | - Johanna Thomtén
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
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Pallant JF, Haines HM, Green P, Toohill J, Gamble J, Creedy DK, Fenwick J. Assessment of the dimensionality of the Wijma delivery expectancy/experience questionnaire using factor analysis and Rasch analysis. BMC Pregnancy Childbirth 2016; 16:361. [PMID: 27871320 PMCID: PMC5117613 DOI: 10.1186/s12884-016-1157-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/14/2016] [Indexed: 12/04/2022] Open
Abstract
Background Fear of childbirth has negative consequences for a woman's physical and emotional wellbeing. The most commonly used measurement tool for childbirth fear is the Wijma Delivery Expectancy Questionnaire (WDEQ-A). Although originally conceptualized as unidimensional, subsequent investigations have suggested it is multidimensional. This study aimed to undertake a detailed psychometric assessment of the WDEQ-A; exploring the dimensionality and identifying possible subscales that may have clinical and research utility. Methods WDEQ-A was administered to a sample of 1410 Australian women in mid-pregnancy. The dimensionality of WDEQ-A was explored using exploratory (EFA) and confirmatory factor analysis (CFA), and Rasch analysis. Results EFA identified a four factor solution. CFA failed to support the unidimensional structure of the original WDEQ-A, but confirmed the four factor solution identified by EFA. Rasch analysis was used to refine the four subscales (Negative emotions: five items; Lack of positive emotions: five items; Social isolation: four items; Moment of birth: three items). Each WDEQ-A Revised subscale showed good fit to the Rasch model and adequate internal consistency reliability. The correlation between Negative emotions and Lack of positive emotions was strong, however Moment of birth and Social isolation showed much lower intercorrelations, suggesting they should not be added to create a total score. Conclusion This study supports the findings of other investigations that suggest the WDEQ-A is multidimensional and should not be used in its original form. The WDEQ-A Revised may provide researchers with a more refined, psychometrically sound tool to explore the differential impact of aspects of childbirth fear. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1157-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J F Pallant
- Department of Rural Health, The University of Melbourne, Graham St, Shepparton, Australia
| | - H M Haines
- Department of Rural Health, The University of Melbourne, Graham St, Shepparton, Australia.
| | - P Green
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - J Toohill
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - J Gamble
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - D K Creedy
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - J Fenwick
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia.,Gold Coast University Hospital Southport, Queensland, 4215, Australia
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Veringa IK, de Bruin EI, Bardacke N, Duncan LG, van Steensel FJA, Dirksen CD, Bögels SM. 'I've Changed My Mind', Mindfulness-Based Childbirth and Parenting (MBCP) for pregnant women with a high level of fear of childbirth and their partners: study protocol of the quasi-experimental controlled trial. BMC Psychiatry 2016; 16:377. [PMID: 27821151 PMCID: PMC5100329 DOI: 10.1186/s12888-016-1070-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 25 % of pregnant women suffer from a high level of Fear of Childbirth (FoC), as assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ-A, score ≥66). FoC negatively affects pregnant women's mental health and adaptation to the perinatal period. Mindfulness-Based Childbirth and Parenting (MBCP) seems to be potentially effective in decreasing pregnancy-related anxiety and stress. We propose a theoretical model of Avoidance and Participation in Pregnancy, Birth and the Postpartum Period in order to explore FoC and to evaluate the underlying mechanisms of change of MBCP. METHODS/DESIGN The 'I've Changed My Mind' study is a quasi-experimental controlled trial among 128 pregnant women (week 16-26) with a high level of FoC, and their partners. Women will be allocated to MBCP (intervention group) or to Fear of Childbirth Consultation (FoCC; comparison group). Primary outcomes are FoC, labour pain, and willingness to accept obstetrical interventions. Secondary outcomes are anxiety, depression, general stress, parental stress, quality of life, sleep quality, fatigue, satisfaction with childbirth, birth outcome, breastfeeding self-efficacy and cost-effectiveness. The total study duration for women is six months with four assessment waves: pre- and post-intervention, following the birth and closing the maternity leave period. DISCUSSION Given the high prevalence and severe negative impact of FoC this study can be of major importance if statistically and clinically meaningful benefits are found. Among the strengths of this study are the clinical-based experimental design, the extensive cognitive-emotional and behavioural measurements in pregnant women and their partners during the entire perinatal period, and the representativeness of study sample as well as generalizability of the study's results. The complex and innovative measurements of FoC in this study are an important strength in clinical research on FoC not only in pregnant women but also in their partners. TRIAL REGISTRATION Dutch Trial Register (NTR): NTR4302 , registration date the 3rd of December 2013.
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Affiliation(s)
- Irena K. Veringa
- Research Institute Child Development and Education (RICDE), Faculty of Social and Behavioral Sciences, Research Priority Area Yield, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
| | - Esther I. de Bruin
- Research Institute Child Development and Education (RICDE), Faculty of Social and Behavioral Sciences, Research Priority Area Yield, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
- UvA minds, academic outpatient child and adolescent treatment center of the University of Amsterdam, Plantage Muidergracht 14, 1018 TV Amsterdam, The Netherlands
| | - Nancy Bardacke
- Osher Center for Integrative Medicine and Department of Nurse-Midwifery, University of California-San Francisco (UCSF), UCSF box 1726, San Francisco, CA 94143-1726 USA
| | - Larissa G. Duncan
- Department of Human Development and Family Studies and Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI 53706 USA
| | - Francisca J. A. van Steensel
- Research Institute Child Development and Education (RICDE), Faculty of Social and Behavioral Sciences, Research Priority Area Yield, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
- UvA minds, academic outpatient child and adolescent treatment center of the University of Amsterdam, Plantage Muidergracht 14, 1018 TV Amsterdam, The Netherlands
| | - Carmen D. Dirksen
- Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Susan M. Bögels
- Research Institute Child Development and Education (RICDE), Faculty of Social and Behavioral Sciences, Research Priority Area Yield, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
- UvA minds, academic outpatient child and adolescent treatment center of the University of Amsterdam, Plantage Muidergracht 14, 1018 TV Amsterdam, The Netherlands
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Bonouvrié K, van den Bosch A, Roumen FJME, van Kuijk SM, Nijhuis JG, Evers SMAA, Wassen MMLH. Epidural analgesia during labour, routinely or on request: a cost-effectiveness analysis. Eur J Obstet Gynecol Reprod Biol 2016; 207:23-31. [PMID: 27816738 DOI: 10.1016/j.ejogrb.2016.07.488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 07/19/2016] [Accepted: 07/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of routine labour epidural analgesia (EA), from a societal perspective, as compared with labour analgesia on request. STUDY DESIGN Women delivering of a singleton in cephalic presentation beyond 36+0 weeks' gestation were randomly allocated to routine labour EA or analgesia on request in one university and one non-university teaching hospital in the Netherlands. Costs included all medical, non-medical and indirect costs from randomisation to 6 weeks postpartum. Effectiveness was defined as a non-operative, spontaneous vaginal delivery without EA-related maternal adverse effects. Incremental cost-effectiveness ratio (ICER) was defined as the ratio of the difference in costs and the difference in effectiveness between both groups. Data were analysed according to intention to treat and divided into a base case analysis and a sensitivity analysis. RESULTS Total delivery costs in the routine EA group (n=233) were higher than in the labour on request group (n=255) (difference -€ 322, 95% CI -€ 60 to € 355) due to more medication costs (including EA), a longer stay in the labour ward, and more operations including caesarean sections. Total postpartum hospital costs in the routine EA group were lower (difference -€ 344, 95% CI -€ 1338 to € 621) mainly due to less neonatal admissions (difference -€ 472, 95% CI -€ 1297 to € 331), whereas total postpartum home and others costs were comparable (difference -€ 20, 95% CI -€ 267 to € 248, and -€ 1, 95% CI -€ 67 to € 284, respectively). As a result, the overall mean costs per woman were comparable between the routine EA group and the analgesia on request group (€ 8.708 and € 8.710, respectively, mean difference -€ 2, 95% CI -€ 1.012 to € 916). Routine labour EA resulted in more deliveries with maternal adverse effects, nevertheless the ICER remained low (€ 8; bootstrap 95% CI -€ 6.120 to € 8.659). The cost-effectiveness acceptability curve indicated a low probability that routine EA is cost-effective. CONCLUSION Routine labour EA generates comparable costs as analgesia on request, but results in more operative deliveries and more EA-related maternal adverse effects. Based on cost-effectiveness, no preference can be given to routine labour EA as compared with analgesia on request.
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Affiliation(s)
- Kimberley Bonouvrié
- Department of Obstetrics and Gynaecology, Grow School of Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Anouk van den Bosch
- Department of Obstetrics and Gynaecology, Grow School of Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frans J M E Roumen
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Sander M van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan G Nijhuis
- Department of Obstetrics and Gynaecology, Grow School of Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Caphri School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Martine M L H Wassen
- Department of Obstetrics and Gynaecology, Grow School of Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
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Bansal D, Gudala K, Lavudiya S, Ghai B, Arora P. Translation, Adaptation, and Validation of Hindi Version of the Pain Catastrophizing Scale in Patients with Chronic Low Back Pain for Use in India. PAIN MEDICINE 2016; 17:1848-1858. [PMID: 26893110 DOI: 10.1093/pm/pnv103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/07/2015] [Accepted: 12/13/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES : This study translates the Pain Catastrophizing Scale (PCS) into Hindi and examines the psychometric properties of the translated version (Hindi PCS [Hi-PCS]) in patients with chronic low back pain (CLBP). METHODS : Forward and backward translations were performed from English to Hindi according to standard methodology. A final version was evaluated by a committee of clinical experts and Hi-PCS was then pilot-tested in 10 patients with CLBP. Cross-cultural validation of the resulting adapted Hi-PCS was done by administering Hi-PCS at baseline to 100 patients with CLBP (≥ 12 weeks pain) who were able to read and write in Hindi, and re-administering Hi-PCS after 3 days. Construct validity was assessed using factor analysis. Psychometric properties including internal consistency; test-retest reliability; and convergent validity with pain severity, functional disability, and health-related quality of life (HRQoL) were also assessed. RESULTS : Principal component analysis observed a three-factor structure, which explained 58% of the variance. Confirmatory factor analysis elicited the best fit as judged by the model fit indices. Hi-PCS as a whole was deemed to be internally consistent (Cronbach's α = 0.76). Intraclass correlation coefficient for the Hi-PCS is 0.923 (95% CI: 0.875-0.953). Hi-PCS was moderately correlated with pain intensity (r = 0.651) and functional disability (r = 0.352), and negatively correlated with QoL (r = -0.380). CONCLUSIONS : PCS translation and cross-cultural adaptation to Hindi demonstrated good factor structure along adequate psychometric properties and could be recommended for use in CLBP research in India.
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Affiliation(s)
- Dipika Bansal
- *Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, SAS Nagar (Mohali), India
| | - Kapil Gudala
- *Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, SAS Nagar (Mohali), India
| | - Sreenu Lavudiya
- *Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, SAS Nagar (Mohali), India
| | - Babita Ghai
- Department of Anaesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Arora
- *Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, SAS Nagar (Mohali), India
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Vargens OMC, Nunes S, da Silva LD, Progianti JM. Pain Relief Effect of Cryotherapy in Parturients. INTERNATIONAL JOURNAL OF CHILDBIRTH 2016. [DOI: 10.1891/2156-5287.6.3.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION: Pain in childbirth and strategies for relieving it have been a subject of interest to researchers for many years. The use of cold (cryotherapy), as a pain relief technique generally, is quite well known and studied. However, few studies have addressed the use of cryotherapy as a strategy for relieving the pain of childbirth.OBJECTIVE: To evaluate the effects of cryotherapy in relieving childbirth pain.METHOD: Pilot intervention study using prospective data in a single intervention group, the outcome being the pain relief in women in labor. The sample comprised 36 parturients at the Hospital Maternidade Carmela Dutra, Rio de Janeiro, Brazil. Cryotherapy was applied to the parturients’ thoracolumbar region at cervical dilation of 5, 7, and/or 9 cm, using an icepack belt. In all, 48 applications were made. The responses regarding the action of cryotherapy on pain were recorded on a specific form. The Numeric Rating Scale (NRS) was used. Following a form, the parturients’ behavior during the application of cryotherapy was also observed.RESULTS: It was found that 91.67% (outcome) of the women reported pain relief and better conditions in which to experience childbirth. The behavior of 75% of the women in labor was calm and participatory; some slept (5.56%), others took short naps (19.44%).CONCLUSION: Cryotherapy proved effective in relieving pain in childbirth. Because characteristically, cryotherapy does not interfere in the physiological process of childbirth, it can be used in care for women in labor.
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Herrera-Gómez A, García-Martínez O, Ramos-Torrecillas J, De Luna-Bertos E, Ruiz C, Ocaña-Peinado F. Retrospective study of the association between epidural analgesia during labour and complications for the newborn. Midwifery 2015; 31:613-6. [DOI: 10.1016/j.midw.2015.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/24/2015] [Accepted: 02/28/2015] [Indexed: 10/23/2022]
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Carvalho B, Zheng M, Aiono-Le Tagaloa L. A Prospective Observational Study Evaluating the Ability of Prelabor Psychological Tests to Predict Labor Pain, Epidural Analgesic Consumption, and Maternal Satisfaction. Anesth Analg 2014; 119:632-640. [DOI: 10.1213/ane.0000000000000357] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Women׳s experiences of labour pain and the role of the mind: An exploratory study. Midwifery 2014; 30:1029-35. [DOI: 10.1016/j.midw.2014.04.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/23/2014] [Accepted: 04/19/2014] [Indexed: 01/09/2023]
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Wilson SH, Elliott MP, Wolf BJ, Hebbar L. A prospective observational study of ethnic and racial differences in neuraxial labor analgesia request and pain relief. Anesth Analg 2014; 119:105-109. [PMID: 24854871 DOI: 10.1213/ane.0000000000000260] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND As ethnic and racial diversity increases, it is important that anesthesia providers understand the expectations and concerns of this changing population regarding labor analgesia. Our objective was to evaluate ethnic/racial differences in labor analgesia characteristics with regard to the timing of request for neuraxial analgesia. METHODS Three hundred ninety-seven parturients were enrolled in this prospective observational cohort study. Term laboring parturients who planned vaginal delivery and requested neuraxial labor analgesia were eligible for inclusion. Data collected included cervical dilation at the time of neuraxial analgesia request, self-identified ethnicity/race, parity, education, insurance status, pain score before and after the initiation of neuraxial analgesia, and mode of delivery. The primary outcome was cervical dilation at the time of neuraxial analgesia request. Ethnicity/race classification was determined by asking the patient, "How would you define your ethnicity?" Patients were categorized into the ethnic/racial groups of non-Hispanic White, African American, Hispanic, or other. Univariate associations between cervical dilation and categorical variables were examined. Multivariate analysis was performed for the primary outcome of cervical dilation at the time of initiation of neuraxial analgesia. RESULTS At the time of neuraxial analgesia placement, the mean difference in cervical dilation of Hispanic parturients was 0.8 cm compared to non-Hispanic Whites (95% confidence interval [CI], 0.1-1.4; P = 0.047). After controlling for education, reason for placement, labor augmentation, and mode of delivery in a multivariate model, Hispanic parturients had 0.5 cm greater cervical dilation compared to non-Hispanic Whites, which was not significant (95% confidence interval, -0.1 to 1.1; P = 0.089). CONCLUSIONS Our data indicate that ethnicity/race plays a small role in acceptance and request for neuraxial labor analgesia.
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Affiliation(s)
- Sylvia H Wilson
- From the Departments of Anesthesia and Perioperative Medicine, and Public Health Service, Medical University of South Carolina, Charleston, South Carolina
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Dammer U, Weiss C, Raabe E, Heimrich J, Koch MC, Winkler M, Faschingbauer F, Beckmann MW, Kehl S. Introduction of Inhaled Nitrous Oxide and Oxygen for Pain Management during Labour - Evaluation of Patients' and Midwives' Satisfaction. Geburtshilfe Frauenheilkd 2014; 74:656-660. [PMID: 25100880 DOI: 10.1055/s-0034-1368606] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 10/25/2022] Open
Abstract
Aim: Effective pain management during labour is important because pain affects the birth experience. Epidural analgesia is effective but often it may not be possible; however, inhaled analgesia offers another option. Use of inhaled nitrous oxide and oxygen for pain management in labour is well established in obstetrics but is still not used much in Germany. This study aimed to investigate the acceptance of the inhaled analgesia of inhaled nitrous oxide and oxygen by midwives and pregnant women during labour. Material and Methods: In this observational study carried out between April and September 2013, a total of 66 pregnant women received inhaled nitrous oxide and oxygen during labour on request and after prior assessment of suitability. After the birth, all of the women and the responsible midwives were interviewed about their experience and satisfaction with the inhaled analgesia. Results: A statistically significant reduction of pain was achieved with nitrous oxide and oxygen. The inhaled analgesia was mostly used by women who refused epidural analgesia. The likelihood of using inhaled nitrous oxide and oxygen again was reported as higher for patients who tolerated it well (p = 0.0129) and used it in the second stage of labour (p = 0.0003) and when bearing down (p = 0.0008). Conclusion: Inhaled nitrous oxide and oxygen is an effective method for pain management during labour and is accepted well by women in labour and by midwives.
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Affiliation(s)
- U Dammer
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - C Weiss
- Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim
| | - E Raabe
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - J Heimrich
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M Winkler
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | | | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - S Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
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Klomp T, de Jonge A, Hutton EK, Lagro-Janssen ALM. Dutch women in midwife-led care at the onset of labour: which pain relief do they prefer and what do they use? BMC Pregnancy Childbirth 2013; 13:230. [PMID: 24325387 PMCID: PMC4029565 DOI: 10.1186/1471-2393-13-230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 11/29/2013] [Indexed: 11/17/2022] Open
Abstract
Background Pain experienced during labour is more extreme than many other types of physical pain. Many pregnant women are concerned about labour pain and about how they can deal with this pain effectively. The aim of this study was to examine the associations among low risk pregnant women’s characteristics and their preferred use and actual use of pain medication during labour. Methods Our study is part of the DELIVER study: a dynamic prospective multi-centre cohort study. The data for this study were collected between September 2009 and March 2011, from women at 20 midwifery practices throughout the Netherlands. Inclusion criteria for women were: singleton pregnancies, in midwife–led care at the onset of labour and speaking Dutch, English, Turkish or Arabic. Our study sample consisted of 1511 women in primary care who completed both questionnaire two (from 34 weeks of pregnancy up to birth) and questionnaire three (around six week post partum). These questionnaires were presented either online or on paper. Results Fifteen hundred and eleven women participated. Prenatally, 15.9% of women preferred some method of medicinal pain relief. During labour 15.2% of the total sample used medicinal pain relief and 25.3% of the women who indicated a preference to use medicinal pain relief during pregnancy, used pain medication. Non-Dutch ethnic background and planned hospital birth were associated with indicating a preference for medicinal pain relief during pregnancy. Primiparous and planned hospital birth were associated with actual use of the preferred method of medicinal pain relief during labour. Furthermore, we found that 85.5% of women who indicated a preference not to use pain medication prenatally, did not use any medication. Conclusions Only a small minority of women had a preference for intrapartum pain medication prenatally. Most women did not receive medicinal pain relief during labour, even if they had indicated a preference for it. Care providers should discuss the unpredictability of the labour process and the fact that actual use of pain medication often does not match with women’s preference prenatally.
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Affiliation(s)
- Trudy Klomp
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Centre Amsterdam, D4445, Van der Boechorststraat 7, Amsterdam, NL 1081BT, Netherlands.
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Steel A, Adams J, Sibbritt D, Broom A, Gallois C, Frawley J. Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women. Health Expect 2013; 18:1633-44. [PMID: 24304970 DOI: 10.1111/hex.12155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite high rates of women's use of intrapartum pain management techniques, little is known about the factors that influence such use. OBJECTIVE Examine the determinants associated with women's use of labour pain management. DESIGN Cross-sectional survey of a substudy of women from the 'young' cohort of the Australian Longitudinal Study of Women's Health (ALSWH). SETTING AND PARTICIPANTS Women aged 31-35 years who identified as being pregnant or recently given birth in the 2009 ALSWH survey (n = 2445) were recruited for the substudy. The substudy survey was completed by 1835 women (RR = 79.2%). MAIN VARIABLES STUDIED Determinants examined included pregnancy health and maternity care [including complementary and alternative medicine (CAM)] for their most recent pregnancy and any previous pregnancies. Participants' attitudes and beliefs related to both CAM and maternity care were also included in the analysis. MAIN OUTCOME MEASURES The outcome measures examined were the use of both pharmacological and non-pharmacological pain management techniques (NPMT). RESULTS Differences were seen in the effects of demographics, health service utilization, health status, use of CAM, and attitudes and beliefs upon use of intrapartum pain management techniques across all categories. The only variable that was identified as a determinant for use of all types of pain management techniques was a previous caesarean section (CS). DISCUSSION AND CONCLUSIONS The effect of key determinants on women's use of pain management techniques differs significantly, and, other than CS, no one determinant is clearly influential in the use of all pain management options.
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Affiliation(s)
- Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, UTS, Ultimo, NSW, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, UTS, Ultimo, NSW, Australia
| | - David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, UTS, Ultimo, NSW, Australia
| | - Alex Broom
- School of Social Science, University of Queensland, St Lucia, QLD, Australia
| | - Cindy Gallois
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - Jane Frawley
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, UTS, Ultimo, NSW, Australia
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Jung H, Kwak KH. Neuraxial analgesia: a review of its effects on the outcome and duration of labor. Korean J Anesthesiol 2013; 65:379-84. [PMID: 24363839 PMCID: PMC3866332 DOI: 10.4097/kjae.2013.65.5.379] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/03/2013] [Indexed: 11/27/2022] Open
Abstract
Labor pain is one of the most challenging experiences encountered by females during their lives. Neuraxial analgesia is the mainstay analgesic for intrapartum pain relief. However, despite the increasing use and undeniable advantages of neuraxial analgesia for labor, there have been concerns regarding undesirable effects on the progression of labor and outcomes. Recent evidence indicates that neuraxial analgesia does not increase the rate of Cesarean sections, although it may be associated with a prolonged second stage of labor and an increased rate of instrumental vaginal delivery. Even when neuraxial analgesia is administered early in the course of labor, it is not associated with an increased rate of Cesarean section or instrumental vaginal delivery, nor does it prolong the labor duration. These data may help physicians correct misconceptions regarding the adverse effects of neuraxial analgesia on labor outcome, as well as encourage the administration of neuraxial analgesia in response to requests for pain relief.
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Affiliation(s)
- Hoon Jung
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyung-Hwa Kwak
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Dehghani M, Sharpe L, Khatibi A. Catastrophizing mediates the relationship between fear of pain and preference for elective caesarean section. Eur J Pain 2013; 18:582-9. [DOI: 10.1002/j.1532-2149.2013.00404.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 11/06/2022]
Affiliation(s)
- M. Dehghani
- Family Research Institute; Shahid Beheshti University; G.C. Tehran Iran
| | - L. Sharpe
- Clinical Psychology Unit; University of Sydney; Australia
| | - A. Khatibi
- Research Group on Health Psychology; KU Leuven; Belgium
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Klomp T, Manniën J, de Jonge A, Hutton EK, Lagro-Janssen ALM. What do midwives need to know about approaches of women towards labour pain management? A qualitative interview study into expectations of management of labour pain for pregnant women receiving midwife-led care in the Netherlands. Midwifery 2013; 30:432-8. [PMID: 23790961 DOI: 10.1016/j.midw.2013.04.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 04/11/2013] [Accepted: 04/28/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE to investigate factors important to women receiving midwife-led care with regard to their expectations for management of labour pain. DESIGN semi-structured ante partum interviews and analyses using constant comparison method. PARTICIPANTS fifteen pregnant women between 36 and 40 weeks gestation receiving midwife-led care. SETTING five midwifery practices across the Netherlands between June 2009 and July 2010. MAIN OUTCOME women's expectations regarding management of labour pain. RESULTS we found three major themes to be important in women's expectations for management of labour pain: preparation, support and control and decision-making. In regards to all these themes, three distinct approaches towards women's planning for pain management in labour were identified: the 'pragmatic natural', the 'deliberately uninformed' and the 'planned pain relief' approach. CONCLUSION midwives need to recognise that women take different approaches to pain management in labour in order to adapt care to the individual woman.
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Affiliation(s)
- Trudy Klomp
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081 BT Amsterdam, the Netherlands.
| | - Judith Manniën
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081 BT Amsterdam, the Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081 BT Amsterdam, the Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081 BT Amsterdam, the Netherlands; Midwifery Education Program, McMaster University Hamilton, Ontario, Canada
| | - Antoine L M Lagro-Janssen
- Department of Primary Care and Community Care, Women's Studies Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
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Jeschke E, Ostermann T, Dippong N, Brauer D, Pumpe J, Meissner S, Matthes H. Identification of maternal characteristics associated with the use of epidural analgesia. J OBSTET GYNAECOL 2013; 32:342-6. [PMID: 22519477 DOI: 10.3109/01443615.2012.661491] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The present survey aims to identify predictors associated with the use of epidural analgesia (EA). Therefore, from October 2007 to June 2008, a survey was conducted in 193 pregnant women (mean age 31.7 years (SD 4.9); 64.8% primipara) attending a German general hospital with a specialisation in integrative medicine. Questionnaires, including Antonovsky's sense of coherence (SOC) were delivered antepartum. Delivery data were recorded within the hospital quality management programme. The adjusted odds ratio (OR) for EA use was significantly greater than one for women who had previously used EA (adjusted OR =4.1; CI: 1.03-16.31) and for the desire for a delivery without pain (adjusted OR =3.05; CI: 1.36-6.83). The likelihood of EA use decreased in multipara (adjusted OR =0.05; CI: 0.01-0.22). SOC was not found to be an independent predictor for EA use. However, women with high SOC more often preferred a delivery without EA (p for trend =0.037). In conclusion, first time labour, the desire for a delivery without pain and previous use of EA are independent predictors for the use of EA in labour. Further studies should clarify the predictive role of SOC in pregnancy.
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Affiliation(s)
- E Jeschke
- Havelhoehe Research Institute, Kladower Damm, Berlin
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41
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Wassen M, Miggiels L, Devlieger R, Gyselaers W, Mertens H, Hasaart T, Wijnen E, Reu PD, Roumen F, Nijhuis J, Smits L, Scheepers H. Women's prelabour preference for epidural analgesia: a cross-sectional study among women from the Netherlands and Belgium. J Psychosom Obstet Gynaecol 2013; 34:22-8. [PMID: 23394410 DOI: 10.3109/0167482x.2012.760541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study describes variables related to women's prelabour preference for epidural analgesia (PEA) in two neighbouring countries with a comparable socio-economic and cultural background. METHODS Dutch women in midwifery (n = 164) or obstetrical care (n = 162), and Belgian women (n = 188) of ≥36 weeks gestation with a singleton in cephalic presentation completed questionnaires on demographic factors, received labour analgesia information, perceived attitude of the caregiver towards epidural analgesia (EA), pain catastrophising and coping with labour pain. Multiple logistic regression analysis was performed with PEA as dependent variable. RESULTS PEA was 9.9% in Dutch midwifery care, 25.5% in Dutch obstetrical care and 38.3% in Belgian care (p value < 0.001). In the Netherlands, maternal age of 35 years or older (OR 4.95; 95% confidence interval (CI) 2.03-12.08), positive attitude of the caregiver towards EA (OR 5.83; 95% CI 2.57-13.23) and a lower degree of coping (OR 3.61; 95% CI 2.24-5.82) were independently associated with PEA. In Belgium, only a lower degree of coping was associated with PEA (OR 4.06; 95% CI 2.45-6.73). CONCLUSIONS In both countries, women with a lower degree of coping had a higher PEA. Care setting in the Netherlands was not an independent variable.
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Affiliation(s)
- Martine Wassen
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, the Netherlands.
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Petersen A, Penz SM, Gross MM. Women's perception of the onset of labour and epidural analgesia: a prospective study. Midwifery 2012; 29:284-93. [PMID: 23079870 DOI: 10.1016/j.midw.2012.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 08/02/2012] [Accepted: 08/08/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE childbearing women and their midwives differ in their diagnoses of the onset of labour. The symptoms women use to describe the onset of labour are associated with the process of labour. Perinatal factors and women's attitudes may be associated with the administration of epidural analgesia. Our study aimed to assess the correlation between women's perception of the onset of labour and the frequency and timing of epidural analgesia during labour. DESIGN prospective cohort study. SETTING 41 maternity units in Lower Saxony, Germany. PARTICIPANTS 549 nulliparae (as defined in the "Methods" section) and 490 multiparae giving birth between April and October 2005. Women were included after 34 completed weeks of gestation with a singleton in vertex presentation and planned vaginal birth. MEASUREMENTS the association between women's symptoms at the onset of labour and the administration of epidural analgesia - frequency, timing in relation to onset of labour and cervical dilatation - was assessed. The analysis was performed by Kaplan-Meiers estimation, logistic regression and Cox regression. FINDINGS a total of 174 nulliparae and 49 multiparae received epidural analgesia during labour. Nulliparae received it at a median time of 5.47hrs (range: 0.25-51.17hrs) after onset of labour, at a median cervical dilatation of 3.3cm (range: 1.0-10.0cm). In multiparae, epidural analgesia was applied at a median time of 3.79hrs (range: 0.42-28.55hrs) after onset of labour; the median cervical dilatation was 3.0cm (range: 1.0-8.0cm). Women who were admitted with advanced cervical dilatation received epidural analgesia less often. Women who defined their onset of labour earlier than it was diagnosed by their midwives received epidural analgesia earlier. Gastrointestinal symptoms and irregular pain at the onset of labour were associated with later administration of epidural analgesia. Induction of labour was associated with a reduced interval from the onset of labour to epidural analgesia. KEY CONCLUSIONS women's self-diagnosis of the onset of labour and their perception of their labour duration when meeting their midwives has some impact on their admission to the labour ward and the timing of epidural analgesia. IMPLICATIONS FOR PRACTICE consideration of women's own perceptions and expectations regarding the onset and process of labour is necessary for individual care during labour.
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Affiliation(s)
- Antje Petersen
- Midwifery Research and Education Unit, Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany.
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Jiménez-Puente A, Benítez-Parejo N, Del Diego-Salas J, Rivas-Ruiz F, Maañón-Di Leo C. Ethnic differences in the use of intrapartum epidural analgesia. BMC Health Serv Res 2012; 12:207. [PMID: 22818255 PMCID: PMC3411410 DOI: 10.1186/1472-6963-12-207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 07/20/2012] [Indexed: 12/22/2022] Open
Abstract
Background Obstetric epidural analgesia (EA) is widely applied, but studies have reported that its use may be less extensive among immigrant women or those from minority ethnic groups. Our aim was to examine whether this was the case in our geographic area, which contains an important immigrant population, and if so, to describe the different components of this phenomenon. Methods Cross-sectional observational study. Setting: general acute care hospital, located in Marbella, southern Spain. Analysis of computer records of deliveries performed from 2004 to 2010. Comparison of characteristics of deliveries according to the mothers’ geographic origins and of vaginal deliveries noting whether EA was received, using univariate and bivariate statistical analysis and multiple logistic regression (MLR). Results A total of 21,034 deliveries were recorded, and 37.4% of these corresponded to immigrant women. EA was provided to 61.1% of the Spanish women and to 51.5% of the immigrants, with important variations according to geographic origin: over 52% of women from other European countries and South America received EA, compared with around 45% of the African women and 37% of the Asian women. These differences persisted in the MLR model after adjusting for the mother's age, type of labor initiation, the weight of the neonate and for single or multiple gestation. With the Spanish patients as the reference category, all the other countries of origin presented lower probabilities of EA use. This was particularly apparent for the patients from Asia (OR 0.38; 95%CI 0.31-0.46), Morocco (OR 0.49; 95%CI 0.43-0.54) and other Africa (OR 0.55; 95%CI 0.37-0.81). Conclusions We observed a different use of EA in vaginal deliveries, according to the geographic origin of the women. The explanation for this involves a complex set of factors, depending both on the patient and on the healthcare staff.
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Dieterich M, Müller-Jordan K, Stubert J, Kundt G, Wagner K, Gerber B. Pain management after cesarean: a randomized controlled trial of oxycodone versus intravenous piritramide. Arch Gynecol Obstet 2012; 286:859-65. [PMID: 22622852 DOI: 10.1007/s00404-012-2384-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 05/08/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Primary objective was to assess whether oral analgesia with oxycodone offers superior pain relief after cesareans than patient controlled analgesia (PCA). Secondary outcomes were additional pain medication, time to first mobilization, therapeutic side effects, postoperative restrictions, overall satisfaction and costs. MATERIALS AND METHODS Randomized controlled trial at a University Hospital conduct between July 2009 and November 2009. Of the 1,112 patients, 257 met the inclusion criteria and 239 agreed to participate. Patients were randomly assigned to either receive intravenous piritramide PCA (2 mg piritramide/ml 0.9 % saline) or oral oxycodone (20 mg). Pain was assessed on a visual analog pain scale (VAS) at 2, 12, 24, 32, 40, 48 and 72 h after cesarean. RESULTS No differences in VAS scores were observed within the general study population. Pain scores of oxycodone versus PCA were comparable at 24 h. Patients randomized to PCA demonstrated increased demand for rescue medication 48 h after cesarean (p = 0.057). In the PCA group, patients with previous cesarean had increased operative times, a trend towards increased VAS scores after 48 h (p = 0.081) and increased VAS scores in comparison to patients who did not have cesarean before (p = 0.044). For this subgroup, no difference was seen in the oxycodone patients (p = 0.883). CONCLUSION General satisfaction with both treatment regimes was high. The results support the potential use of oral pain regimes and emphasis the importance of a multimodal approach to treat post-cesarean pain. Oral oxycodone is a not expensive, convenient and comparable analgesic to PCA devices with opioids after cesarean. Trial registration at clinicaltrials.gov identifier: NCT 01115101.
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Affiliation(s)
- Max Dieterich
- Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany.
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Abstract
The belief that hospital birth for low risk pregnancies has better outcomes than planned, attended homebirth is an urban legend. The choice of low-risk women to deliver in hospital is a result of the dominant and irrational human propensities to gossip, to follow the crowd and to cling to irrational hope. Rational analysis shows that planned homebirth with experienced trained attendants has the best outcomes for both mother and newborn for low risk pregnancy.
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Williams ADC, Morris J, Stevens K, Gessler S, Cella M, Baxter J. What influences midwives in estimating labour pain? Eur J Pain 2012; 17:86-93. [DOI: 10.1002/j.1532-2149.2012.00154.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2012] [Indexed: 12/30/2022]
Affiliation(s)
- A.C. de C. Williams
- Research Department of Clinical, Education and Health Psychology; University College London; UK
| | - J. Morris
- Research Department of Clinical, Education and Health Psychology; University College London; UK
| | | | - S. Gessler
- UCL Elizabeth Garrett Anderson Institute for Women's Health; University College London Hospitals NHS Trust; UK
| | - M. Cella
- Research Department of Clinical, Education and Health Psychology; University College London; UK
| | - J. Baxter
- Women and Children's Division; Buckinghamshire Healthcare NHS Trust; Stoke Mandeville Hospital; Aylesbury; UK
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Lancaster SM, Schick UM, Osman MM, Enquobahrie DA. Risk factors associated with epidural use. J Clin Med Res 2012; 4:119-26. [PMID: 22505985 PMCID: PMC3320121 DOI: 10.4021/jocmr810w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2012] [Indexed: 11/10/2022] Open
Abstract
Background Identify variables associated with intrapartum epidural use. Methods Odds ratios were calculated to quantify associations between selected variables and epidural use using a population-based case-control study of Washington State birth certificate data from 2009. Results Non-Whites had 10 - 45% lower odds of epidural use relative to Whites. Foreign-born women had 25 - 45% lower odds of epidural use compared to their US-born counterparts, except for Asians. Women who smoked or induced labor had higher roughly 2-fold higher odds of epidural use compared with non-smokers or women giving birth spontaneously, respectively. Women without a high school diploma or equivalent had lower odds of epidural use relative to those who graduated. Delivering at perinatal units, rural hospitals, or non-profit hospitals had ~50% lower odds of epidural use compared with secondary/teritiary perinatal units, urban hospitals or for-profit hospitals, respectively. Conclusion Several individual and health service-related variables were associated with epidural use. These findings elucidate the clinical relevance of epidural use, and dispariaties in its utilization and in quality of care during delivery. Keywords Epidural use; Foreign birth; Labor; Racial disparities
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Affiliation(s)
- Samuel M Lancaster
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Flink IK, Mroczek MZ, Sullivan MJ, Linton SJ. Pain in childbirth and postpartum recovery - The role of catastrophizing. Eur J Pain 2012; 13:312-6. [DOI: 10.1016/j.ejpain.2008.04.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 03/26/2008] [Accepted: 04/17/2008] [Indexed: 11/29/2022]
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Veringa I, Buitendijk S, de Miranda E, de Wolf S, Spinhoven P. Pain cognitions as predictors of the request for pain relief during the first stage of labor: a prospective study. J Psychosom Obstet Gynaecol 2011; 32:119-25. [PMID: 21824042 DOI: 10.3109/0167482x.2011.599898] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is thought that pain cognitions determine coping behavior and success in adapting to labor. The aim of this study was to examine whether pain cognitions assessed by the labor pain coping and cognition list (LPCCL) predict the request for pain relief during the first stage of labor and which pain cognition is the strongest predictor of a request for pain relief over and above, and independent of, other pain cognitions. METHODS Participants in this prospective study were 177 low-risk nulliparous pregnant women. Data were collected on two different occasions. The numerical pain intensity scale (NPS)-anticipated and the LPCCL were administered at 34-36 weeks' gestation followed by the NPS-during labor. RESULTS Catastrophizing and external pain control predicted the request for pain relief during labor after adjustment for relevant demographic and clinical characteristics, respectively (adjusted odds ratio [OR] 2.61 [95% CI 1.45-4.68] and adjusted OR 1.90 [95% CI 1.16-3.10]). Catastrophizing was found to be the strongest and independent predictor among the pain cognitions while controlling for significant background variables (adjusted OR 2.61 p-value < 0.001). CONCLUSION Catastrophizing seems to have a substantial impact on the request for pain relief in low-risk pregnant women.
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Affiliation(s)
- Irena Veringa
- Division of Obstretics, Gynecology and Reproductive Medicine, University of Amsterdam Medical Centre, Netherlands.
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50
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Yano T, Iwasaki T, Naruo H, Tsuneyoshi I. Comparison of predicted and perceived pain from epidural and spinal puncture in patients undergoing elective caesarean section. Anaesth Intensive Care 2011; 39:646-9. [PMID: 21823384 DOI: 10.1177/0310057x1103900418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The intensity of pain expected by patients before an epidural and/or a spinal puncture is uncertain. The main purpose of this study was to identify and compare the intensity of pain predicted and perceived by patients having an epidural and a spinal procedure. After screening for relevant exclusion criteria, 50 women who were undergoing elective caesarean section under combined spinal-epidural anaesthesia (double-segment technique) were enrolled in the study. Infiltration anaesthesia prior to needle insertion was performed for the epidural but not the spinal puncture. Pain assessments, using a 100 mm visual analogue pain scale, were made before (predicted pain) and after (perceived pain) the epidural and the spinal puncture. Predicted pain for epidural and spinal insertion (epidural 60.6 +/- 20.5 mm, spinal: 55.1 +/- 24 mm) was significantly higher than the pain perceived (epidural 36.3 +/- 20 mm, spinal 46.1 +/- 23.2 mm) (epidural P < 0.001, spinal P = 0.031). Patients who were scheduled for an elective caesarean section under combined spinal-epidural anaesthesia predicted 1.2- to 1.7-fold stronger pain intensity than they perceived during the procedure. Patients should be informed that a regional anaesthetic, especially epidural, procedure is often less painful than the patient's expectation.
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Affiliation(s)
- T Yano
- Department of Anaesthesiology, National Hospital Organisation Miyakonojo Hospital, Miyazaki, Japan.
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