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Pilewska-Kozak AB, Dziurka M, Bałanda-Bałdyga A, Monist MJ, Kopiel E, Jurek K, Łęcka AF, Dobrowolska B. Factors conditioning pain control and reduction in post-cesarean section parturients: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:382. [PMID: 38778256 PMCID: PMC11112804 DOI: 10.1186/s12884-024-06579-9] [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: 01/03/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Pain experienced by women in the perinatal period constitutes a complex and multifaceted phenomenon. The aim of the study was to assess conditions of pain locus of control and pain reduction in post-cesarean section parturients. MATERIALS AND METHODS A cross-sectional quantitative study with convenience sampling was performed among 175 hospitalized post-cesarean section women in hospitals in Eastern Poland in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. A self-design questionnaire regarding general information and obstetrics/gynaecology medical interview, The Pain Coping Strategies Questionnaire (CSQ) and The Beliefs about Pain Control Questionnaire (BPCQ) were used. The inclusion criteria were as follows (1) age of ⩾18 years old; (2) cesarean section (CS); (3) period from the 13th hour to the end of the 72nd hour after the procedure; and (4) informed consent. The data was analyzed with IBM SPSS Statistics. RESULTS Internal locus of control (M = 14.02) was provided the highest value by the parturients and followed by chance events (M = 12.61) and doctors' power (M = 12.18). Dominant coping with pain strategies in the post-cesarean parturients were coping self-statements (M = 19.06), praying or hoping (M = 18.86). The parturients assessed their pain coping (M = 3.31) strategies along with pain reduction (M = 3.35) at the moderate level. Higher pain control was correlated with cognitive pain coping strategies (β = 0.305; t = 4.632; p < 0.001), internal pain control β = 0.191; t = 2.894; p = 0.004), cesarean section planning (β = -0.240; t = -3.496; p = 0.001) and past medical history of CS (β = 0.240; t = 3.481; p = 0.001). The skill of reduction of pain was positively associated with cognitive pain coping strategies (β = 0.266; t = 3.665; p < 0.001) and being in subsequent pregnancy (β = 0.147; t = 2.022; p = 0.045). Catastrophizing and hoping were related to lower competences of coping with pain (B = - 0.033, SE = 0.012, β = - 0.206, T = -2.861). CONCLUSIONS The study allowed for identification and better comprehension of factors conditioning pain control and pain reduction in parturients after the cesarean section. Furthermore, a stronger belief that pain can be dealt with is found in the parturients characterized by cognitive pain coping strategies and internal pain locus of control. The skill of reduction of pain is related to cognitive coping strategy and procreation status.
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Affiliation(s)
- Anna Bogusława Pilewska-Kozak
- Department of Obstetrics and Gynaecology Nursing, Chair of Obstetrics and Gynecology, Faculty of Health Sciences, Medical University in Lublin, Lublin, Poland
| | - Magdalena Dziurka
- Department of Holistic Care and Nursing Management, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland.
| | - Agnieszka Bałanda-Bałdyga
- Integrated Medical Care Department, Medical Faculty, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Poland
| | - Marta Joanna Monist
- 2nd Chair and Clinic of Gynecology, Faculty of Medicine, Medical University in Lublin, Lublin, Poland
| | - Ewelina Kopiel
- The Neonatal Unit of the University Clinical Hospital, No. 1 in Lublin, Lublin, Poland
| | - Krzysztof Jurek
- Sociology of Culture, Religion and Social Participation Institute of Sociological Sciences, The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Anna Francesca Łęcka
- Saint Lazarus Hospice, The Society of Friends to People in Disease, Cracow, Poland
| | - Beata Dobrowolska
- Department of Holistic Care and Nursing Management, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
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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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3
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Affiliation(s)
- F Arran Seiler
- From the Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Muhaidat N, AlQuabeh B, AbdulGhani W. Insights into women's experiences of giving birth during the coronavirus disease-19 pandemic in Jordan, a cross-sectional survey. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231199038. [PMID: 37732465 PMCID: PMC10515599 DOI: 10.1177/17455057231199038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 07/30/2023] [Accepted: 08/11/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Since 2019, the coronavirus disease-19 pandemic and its consequences from restrictions to risks have impacted our lives in all aspects. Pregnant women are especially vulnerable to the changes that were implemented as a result of the shift in healthcare priorities and the medical and social implications of the lockdown. OBJECTIVES This study aimed to assess the experience of giving birth during the pandemic, how this is affected by acquiring coronavirus disease-19 infection, and its effect on postnatal mood. DESIGN A cross-sectional study was conducted which involved 490 women who gave birth during the pandemic across the Hashemite Kingdom of Jordan. METHODS An electronic questionnaire was distributed among women experiencing childbirth during this period in Jordan by advertising it on social media platforms targeting pregnant women and mothers. The sample size was statistically determined to be representative of the population. Statistical analysis was performed using Statistical Package for the Social Sciences for Windows v.27. RESULTS The study demonstrated that getting infected with the virus throughout the pregnancy did not affect the childbirth experience with respect to the parameters measured, but other factors during the pandemic such as the type of hospital and mode of delivery did. Positive interaction with staff in the delivery suite was a major determinant of a positive birth experience. Women associated low mood post-delivery with giving birth in pandemic circumstances, and it affected first-time mothers more than multiparous women. CONCLUSION Although the acquisition of coronavirus disease-19 infection did not have a significant impact on women's childbirth experience, several pandemic-related factors did. Given the importance of a woman's perception and evaluation of events surrounding her birth experience in determining her postnatal physical and psychological well-being, having to give birth during the pandemic circumstances, especially for first-time mothers, can have potentially detrimental consequences that may affect her health and reproductive choices in the future. The results of this study offer a better understanding of the effect of pandemic and lockdown circumstances on the perceived experience of mothers during childbirth and postnatally and factors that should be taken into consideration when planning healthcare provision to this population in future similar conditions.
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Affiliation(s)
- Nadia Muhaidat
- Department of Obstetrics and Gynecology, School of Medicine, The University of Jordan, Amman, Jordan
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Kountanis JA, Kirk R, Handelzalts JE, Jester JM, Kirk R, Muzik M. The associations of subjective appraisal of birth pain and provider-patient communication with postpartum-onset PTSD. Arch Womens Ment Health 2022; 25:171-180. [PMID: 34250546 DOI: 10.1007/s00737-021-01154-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Abstract
Childbirth-related PTSD is generally believed to result from multiple factors, including negative objective and subjective experiences and patient predisposing factors. There is conflicting evidence regarding whether severe childbirth pain affects development of PTSD. We hypothesize that a woman's retrospective subjective appraisal of birth pain is a greater predictor of postpartum-onset PTSD than medically documented measures of pain, and that a positive subjective experience communicating with medical providers during labor also reduces risk for postpartum-onset PTSD. A sample of 112 women, who screened positive for psychopathology within a year postpartum, were interviewed probing for their subjective labor experiences. Interviews were coded for subjective labor pain perception and quality of provider communication. Regression analyses tested associations between subjective labor pain perception and quality of provider communication with postpartum PTSD. Pain scores recorded during labor were not significantly associated to probable PTSD at any recorded time point up to 12 months postpartum. Positive perception of birth pain was associated with reduced risk of probable PTSD at 6 weeks postpartum (aOR = 0.34, p = 0.03). Positive provider communication was associated with reduced risk of probable PTSD at 6 months (aOR = 0.29, p = 0.02) and 12 months (aOR = 0.2, p = 0.03) postpartum. Pain recorded during childbirth is not necessarily a negative experience leading to trauma. For some women, even severe pain may be seen positively, and lacks traumatizing elements. Interventions to positively shift women's childbirth pain appraisal and educate medical workforce in patient-provider communication may reduce rates of postpartum PTSD. ClinicalTrials.gov Indentifier: NCT03004872.
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Affiliation(s)
- Joanna A Kountanis
- Department of Anesthesiology, University of Michigan Health, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Department of Obstetrics and Gynecology, University of Michigan Health, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Robyn Kirk
- Kirk Consultancy, Edinburgh, Scotland
- School of Nursing, University College, London, UK
| | - Jonathan E Handelzalts
- Department of Psychiatry, University of Michigan Health, 4250 Plymouth Rd, Rachel Upjohn Building, Ann Arbor, MI, 48109, USA
- School of Behavioral Sciences, The Academic College of Tel Aviv Yaffo, Tel Aviv-Yafo, Israel
| | - Jennifer M Jester
- Department of Psychiatry, University of Michigan Health, 4250 Plymouth Rd, Rachel Upjohn Building, Ann Arbor, MI, 48109, USA
| | - Ros Kirk
- Kirk Consultancy, Edinburgh, Scotland
| | - Maria Muzik
- Department of Obstetrics and Gynecology, University of Michigan Health, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
- Department of Psychiatry, University of Michigan Health, 4250 Plymouth Rd, Rachel Upjohn Building, Ann Arbor, MI, 48109, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI, 48109, USA.
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Junge C, von Soest T, Weidner K, Seidler A, Eberhard-Gran M, Garthus-Niegel S. Labor pain in women with and without severe fear of childbirth: A population-based, longitudinal study. Birth 2018; 45:469-477. [PMID: 29630751 DOI: 10.1111/birt.12349] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND This prospective study aims to investigate whether severe fear of childbirth increases pain perceptions during birth and whether co-occurring maternal health and birth factors as well as length and weight of the child explain the association. METHODS The study sample comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort. Data from the hospital birth's record and questionnaires at weeks 17-19 and 32 of pregnancy and 8 weeks postpartum were used (n = 1649). Analysis of variance and analysis of covariance were conducted to examine whether ratings of labor pain differed significantly between women with and without severe fear of childbirth and which factors explained the difference. RESULTS Women with severe fear of childbirth experienced significantly more labor pain than women without severe fear of childbirth (P < .01). However, when controlling for symptoms of maternal depression and anxiety, use of epidural/spinal anesthetic or nitrous oxide gas, and menstrual pain, this difference was no longer significant (P = .09). DISCUSSION Although the results show that labor pain is related to multiple physiological and psychological factors in a complex manner, symptoms of maternal depression and anxiety seem to play a central role for the experience of labor pain, and should therefore be focused on by health practitioners.
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Affiliation(s)
- Carolin Junge
- Norwegian Institute of Public Health, Oslo, Norway.,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Malin Eberhard-Gran
- Norwegian Institute of Public Health, Oslo, Norway.,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Susan Garthus-Niegel
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
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Changes in birth-related pain perception impact of neurobiological and psycho-social factors. Arch Gynecol Obstet 2017; 297:591-599. [PMID: 29196870 DOI: 10.1007/s00404-017-4605-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyse post-partum short- and long-term pain sensitivity and the influence of endogenous pain inhibition as well as distinct psycho-social factors on birth-related pain. METHODS Pain sensitivity was assessed in 91 primiparous women at three times: 2-6 weeks before, one to 3 days as well as ten to 14 weeks after childbirth. Application of a pressure algometer in combination with a cold pressor test was utilised for measurement of pain sensitivity and assessment of conditioned pain modulation (CPM). Selected psycho-social factors (anxiety, social support, history of abuse, chronic pain and fear of childbirth) were evaluated with standardised questionnaires and their effect on pain processing then analysed. RESULTS Pressure pain threshold, cold pain threshold and cold pain tolerance increased significantly directly after birth (all p < 0.001). While cold pain parameters partly recovered on follow-up, pressure pain threshold remained increased above baseline (p < 0.001). These pain-modulating effects were not found for women with history of abuse. While CPM was not affected by birth, its extent correlated significantly (r = 0.367) with the drop in pain sensitivity following birth. Moreover, high trait anxiety predicted an attenuated reduction in pain sensitivity (r = 0.357), while there was no correlation with fear of childbirth, chronic pain and social support. CONCLUSION Pain sensitivity showed a decrease when comparing post-partum with prepartum values. The extent and direction of CPM appear to be a trait variable that predicted post-partum hypalgesia without being changed itself. Post-partum hypalgesia was reduced in women with a history of abuse and high trait anxiety, which suggests that individual differences in CPM affect childbirth experience.
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8
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Reply. Pain 2017; 158:991-992. [PMID: 28414708 DOI: 10.1097/j.pain.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Akca A, Corbacioglu Esmer A, Ozyurek ES, Aydin A, Korkmaz N, Gorgen H, Akbayir O. The influence of the systematic birth preparation program on childbirth satisfaction. Arch Gynecol Obstet 2017; 295:1127-1133. [DOI: 10.1007/s00404-017-4345-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/07/2017] [Indexed: 12/01/2022]
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10
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Richardson MG, Lopez BM, Baysinger CL, Shotwell MS, Chestnut DH. Nitrous Oxide During Labor. Anesth Analg 2017; 124:548-553. [DOI: 10.1213/ane.0000000000001680] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Vixner L, Schytt E, Mårtensson LB. Associations between maternal characteristics and women's responses to acupuncture during labour: a secondary analysis from a randomised controlled trial. Acupunct Med 2016; 35:180-188. [PMID: 27986648 PMCID: PMC5466917 DOI: 10.1136/acupmed-2016-011164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 12/02/2022]
Abstract
Background Patient characteristics are modulators of pain experience after acupuncture treatment for chronic pain. Whether this also applies to labour pain is unknown. Aim To examine for associations between maternal characteristics and response to acupuncture in terms of labour pain intensity in close proximity to the treatment (within 60 min) and over a longer time period (up to 240 min), and whether or not epidural analgesia is used, before and after adjustment for obstetric status upon admission to the labour ward. Methods Cohort study (n=253) using data collected for a randomised controlled trial. Associations were examined using linear mixed models and logistic regression analyses. Tests of interactions were also applied to investigate whether maternal characteristics were influenced by treatment group allocation. Results In close proximity to the treatment, advanced age and cervical dilation were associated with lower pain scores (mean difference (MD) −13.2, 95% CI −23.4 to −2.9; and MD −5.0, 95% CI −9.6 to −0.5, respectively). For the longer time period, labour pain was negatively associated with age (MD −11.8, 95% CI −19.6 to −3.9) and positively associated with dysmenorrhoea (MD 5.5, 95% CI 1.6 to 9.5). Previous acupuncture experience and advanced cervical dilatation were associated with higher and lower use of epidural analgesia (OR 2.7, 95% CI 1.3 to 5.9; and OR 0.3, 95% CI 0.1 to 0.5, respectively). No interactions with treatment allocation were found. Conclusions This study did not identify any maternal characteristics associated with women's responses to acupuncture during labour. Trial registration number NCT01197950; Post-results.
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Affiliation(s)
- Linda Vixner
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Karolinska Institutet, Stockholm, Sweden.,School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Erica Schytt
- Centre for Clinical Research Dalarna, Falun, Sweden.,Bergen University Collage, Bergen, Norway
| | - Lena B Mårtensson
- School of Health and Education, University of Skövde, Skövde, Sweden
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Pettersson FD, Hellgren C, Nyberg F, Åkerud H, Sundström-Poromaa I. Depressed mood, anxiety, and the use of labor analgesia. Arch Womens Ment Health 2016; 19:11-6. [PMID: 26392364 DOI: 10.1007/s00737-015-0572-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 09/13/2015] [Indexed: 11/30/2022]
Abstract
Relatively little is known about mental health and labor pain. The aim of this study was to assess if self-rated antenatal depressed mood and anxiety are associated with pain-related behaviors and self-reported labor pain. We also wanted to replicate our previous finding of altered labor pain behavior in carriers of a specific guanosine triphosphate cyclohydrolase 1 gene (GCH1) haplotype. Ninety-nine women in gestational weeks 37 to 40 filled out questionnaires on depression and anxiety symptoms and later rated their labor pain by use of visual analog scales. Each subject was also genotyped for GCH1. Following adjustment for relevant confounders, women who arrived early to the delivery unit (cervical dilation <5 cm) had a significantly higher antenatal Montgomery-Åsberg Depression Rating Scale (MADRS-S) score, p < 0.05, than late arrivers (cervical dilation >5 cm). Women with increased Spielberger State-Trait Anxiety Inventory (STAI-T) scores reported higher self-rated pain prior to labor analgesia, p < 0.05, than women with low STAI-T scores. No association between the GCH1 pain-protective haplotype and cervical dilation was found, but a previously demonstrated association with increased use of second-line analgesia was confirmed. Depressed mood during pregnancy is associated with early arrival to the delivery department, whereas antenatal anxiety is associated with increased self-rated pain prior to labor analgesia.
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Affiliation(s)
| | - Charlotte Hellgren
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Division of Biological Research on Drug Dependence, Uppsala University, Uppsala, Sweden
| | - Helena Åkerud
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
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Power S, Bogossian FE, Strong J, Sussex R. The Elicited Verbal Pain Language of Childbirth: A Closer Look at Pain Assessment Through a Critical and Interpretive Review of the Literature. INTERNATIONAL JOURNAL OF CHILDBIRTH 2016. [DOI: 10.1891/2156-5287.6.3.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE:To provide a critical and interpretive review of the literature to investigate examples of pain assessment tools used in a childbirth context. Through these examples of pain assessment, the concept of elicited verbal pain language is introduced and explored.METHODS:Electronic search strategies were used to identify primary research regarding maternal reports of pain (during labor, postpartum and retrospectively), which were captured by standardized pain assessment tools.FINDINGS:The review revealed the physiological (the sensory and affective dimensions of pain, the intensity of pain, and the influence of parity on pain perception), psychological (the influence of maternal attitude, mood, and memory on pain perception), and ethnocultural (the impact of the ethnocultural context on pain perception) components of the pain experience. The strengths and limitations of pain assessment tools are highlighted. There were similarities in the reviewed studies’ approaches to pain assessment despite the cross-cultural representation of birth. Possible implications for cross-cultural pain assessment and communication are outlined.CONCLUSION:The question remains regarding the appropriateness of implementing standardized pain assessment tools across birth context. An ongoing critique of pain assessment may inform the provision of better care overall for birthing women in multicultural societies.
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Bergh IHE, Johansson A, Bratt A, Ekström A, Mårtensson LB. Assessment and documentation of women's labour pain: A cross-sectional study in Swedish delivery wards. Women Birth 2015; 28:e14-8. [PMID: 25686875 DOI: 10.1016/j.wombi.2015.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 01/27/2015] [Accepted: 01/31/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND A woman's pain during labour plays a dominant role in childbirth. The midwife's role is to assess the degree of pain experienced during labour. When professionals respond to labour pain with acknowledgement and understanding, the woman's sense of control and empowerment is increased, which could contribute to a positive experience of childbirth. The aim of this study is to describe how labour pain in Swedish delivery wards is assessed and documented. METHODS This quantitative descriptive study was designed as a national survey performed through telephone interviews with the representatives of 34 delivery wards in Sweden. RESULTS AND CONCLUSION The majority of the participating delivery wards assessed and documented women's labour pain, but in an unstructured manner. The wards differed in how the assessments and documentation were performed. In addition, almost all the delivery wards that participated in the survey lacked guidelines for the assessment and documentation of the degree of pain during labour. The findings also showed that the issue of labour pain was sometimes discussed in the delivery wards, but not in a structured or consistent way.
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Affiliation(s)
- Ingrid H E Bergh
- School of Health and Education, University of Skövde, P.O. Box 408, SE-541 28 Skövde, Sweden.
| | - Anna Johansson
- Department of Obstetrics, University Hospital of Örebro, SE-703 62 Örebro, Sweden.
| | - Annelie Bratt
- Department of Obstetrics and Gynecology, Skaraborgs Hospital, SE-541 85 Skövde, Sweden.
| | - Anette Ekström
- School of Health and Education, University of Skövde, P.O. Box 408, SE-541 28 Skövde, Sweden.
| | - Lena B Mårtensson
- School of Health and Education, University of Skövde, P.O. Box 408, SE-541 28 Skövde, Sweden.
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Chaillet N, Belaid L, Crochetière C, Roy L, Gagné GP, Moutquin JM, Rossignol M, Dugas M, Wassef M, Bonapace J. Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis. Birth 2014; 41:122-37. [PMID: 24761801 DOI: 10.1111/birt.12103] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the effects of nonpharmacologic approaches to pain relief during labor, according to their endogenous mechanism of action, on obstetric interventions, maternal, and neonatal outcomes. DATA SOURCE Cochrane library, Medline, Embase, CINAHL and the MRCT databases were used to screen studies from January 1990 to December 2012. STUDY SELECTION According to Cochrane criteria, we selected randomized controlled trials that compared nonpharmacologic approaches for pain relief during labor to usual care, using intention-to-treat method. RESULTS Nonpharmacologic approaches, based on Gate Control (water immersion, massage, ambulation, positions) and Diffuse Noxious Inhibitory Control (acupressure, acupuncture, electrical stimulation, water injections), are associated with a reduction in epidural analgesia and a higher maternal satisfaction with childbirth. When compared with nonpharmacologic approaches based on Central Nervous System Control (education, attention deviation, support), usual care is associated with increased odds of epidural OR 1.13 (95% CI 1.05-1.23), cesarean delivery OR 1.60 (95% CI 1.18-2.18), instrumental delivery OR 1.21 (95% CI 1.03-1.44), use of oxytocin OR 1.20 (95% CI 1.01-1.43), labor duration (29.7 min, 95% CI 4.5-54.8), and a lesser satisfaction with childbirth. Tailored nonpharmacologic approaches, based on continuous support, were the most effective for reducing obstetric interventions. CONCLUSION Nonpharmacologic approaches to relieve pain during labor, when used as a part of hospital pain relief strategies, provide significant benefits to women and their infants without causing additional harm.
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Affiliation(s)
- Nils Chaillet
- Department of Obstetrics and Gynaecology, University of Sherbrooke, Sherbrooke, QC, Canada
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Mårtensson LB, Ek K, Ekström A, Bergh IHE. Midwifery students' conceptions of worst imaginable pain. Women Birth 2014; 27:104-7. [PMID: 24602607 DOI: 10.1016/j.wombi.2014.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/30/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Visual Analogue Scale (VAS) is one of the most widely used pain assessment scales in clinical practice and research. However, the VAS is used less frequently in midwifery than in other clinical contexts. The issue of how people interpret the meaning of the VAS endpoints (i.e. no pain and worst imaginable pain) has been discussed. The aim of this study was to explore midwifery students' conceptions of 'worst imaginable pain'. METHODS A sample of 230 midwifery students at seven universities in Sweden responded to an open-ended question: 'What is the worst imaginable pain for you?' This open-ended question is a part of a larger study. Their responses underwent manifest content analysis. RESULTS Analysis of the midwifery students' responses to the open-ended question revealed five categories with 24 sub-categories. The categories were Overwhelming pain, Condition-related pain, Accidents, Inflicted pain and Psychological suffering. CONCLUSIONS The midwifery students' conceptions of 'worst imaginable pain' are complex, elusive and diverse.
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Affiliation(s)
- Lena B Mårtensson
- School of Health and Education, University of Skövde, Box 408, SE-541 28 Skövde, Sweden.
| | - Kristina Ek
- School of Health and Education, University of Skövde, Box 408, SE-541 28 Skövde, Sweden.
| | - Anette Ekström
- School of Health and Education, University of Skövde, Box 408, SE-541 28 Skövde, Sweden.
| | - Ingrid H E Bergh
- School of Health and Education, University of Skövde, Box 408, SE-541 28 Skövde, Sweden.
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17
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Likis FE, Andrews JC, Collins MR, Lewis RM, Seroogy JJ, Starr SA, Walden RR, McPheeters ML. Nitrous oxide for the management of labor pain: a systematic review. Anesth Analg 2014; 118:153-67. [PMID: 24356165 DOI: 10.1213/ane.0b013e3182a7f73c] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We systematically reviewed evidence addressing the effectiveness of nitrous oxide for the management of labor pain, the influence of nitrous oxide on women's satisfaction with their birth experience and labor pain management, and adverse effects associated with nitrous oxide for labor pain management. METHODS We searched the MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for articles published in English. The study population included pregnant women in labor intending a vaginal birth, birth attendees or health care providers who may be exposed to nitrous oxide during labor, and the fetus/neonate. RESULTS We identified a total of 58 publications, representing 59 distinct study populations: 2 studies were of good quality, 11 fair, and 46 poor. Inhalation of nitrous oxide provided less effective pain relief than epidural analgesia, but the quality of studies was predominately poor. The heterogeneous outcomes used to assess women's satisfaction with their birth experience and labor pain management made synthesis of studies difficult. Most maternal adverse effects reported in the literature were unpleasant side effects that affect tolerability, such as nausea, vomiting, dizziness, and drowsiness. Apgar scores in newborns whose mothers used nitrous oxide were not significantly different from those of newborns whose mothers used other labor pain management methods or no analgesia. Evidence about occupational harms and exposure was limited. CONCLUSIONS The literature addressing nitrous oxide for the management of labor pain includes few studies of good or fair quality. Further research is needed across all of the areas examined: effectiveness, satisfaction, and adverse effects.
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Affiliation(s)
- Frances E Likis
- From the *Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center; †Department of Medicine, Vanderbilt University Medical Center; ‡Department of Obstetrics and Gynecology, Vanderbilt University Medical Center; §Vanderbilt University School of Nursing; ‖Division of Obstetric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center; ¶Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, Tennessee
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Spaich S, Welzel G, Berlit S, Temerinac D, Tuschy B, Sütterlin M, Kehl S. Mode of delivery and its influence on women's satisfaction with childbirth. Eur J Obstet Gynecol Reprod Biol 2013; 170:401-6. [DOI: 10.1016/j.ejogrb.2013.07.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/08/2013] [Accepted: 07/30/2013] [Indexed: 11/16/2022]
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Abstract
The study of pain goes well beyond the study of anatomy and physiology. To fully understand a phenomenon such as pain, one must consider the realm in which it exists - the conscious mind. This paper aims to explore the concept of the conscious mind and its relevance to the human experience of labour pain. Understanding the interactions between the mind, brain, body, social environment and natural world on the experience of pain enables a more comprehensive conception of labour pain. Reaffirming that pain is an embodied subjective experience is important during this current era in pain science research that seems to lean towards neuroreductionism and conceptualises pain as a pathological by-product of disease. Labour pain, however, is a clear demonstration that pain is not always a signal of bodily disorder. The experience of pain is generated by the brain and is realised through the conscious mind. Thus, the study of pain - particularly complex pains such as labour pain - should focus not just on the physical body and neural processes in the brain but must aim to include, and be capable of capturing, all elements that constitute it; the mind, brain, body and the environment.
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Affiliation(s)
- Laura Y Whitburn
- School of Public Health and Human Biosciences, LaTrobe University, Victoria, Australia.
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20
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Bergh IH, Ek K, Mårtensson LB. Midwifery students attribute different quantitative meanings to “hurt”, “ache” and “pain”: A cross-sectional survey. Women Birth 2013; 26:143-6. [DOI: 10.1016/j.wombi.2012.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 08/18/2012] [Accepted: 11/05/2012] [Indexed: 10/27/2022]
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Haines HM, Rubertsson C, Pallant JF, Hildingsson I. The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth. BMC Pregnancy Childbirth 2012; 12:55. [PMID: 22727217 PMCID: PMC3449179 DOI: 10.1186/1471-2393-12-55] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 06/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women's fears and attitudes to childbirth may influence the maternity care they receive and the outcomes of birth. This study aimed to develop profiles of women according to their attitudes regarding birth and their levels of childbirth related fear. The association of these profiles with mode and outcomes of birth was explored. METHODS Prospective longitudinal cohort design with self report questionnaires containing a set of attitudinal statements regarding birth (Birth Attitudes Profile Scale) and a fear of birth scale (FOBS). Pregnant women responded at 18-20 weeks gestation and two months after birth from a regional area of Sweden (n = 386) and a regional area of Australia (n = 123). Cluster analysis was used to identify a set of profiles. Odds ratios (95% CI) were calculated, comparing cluster membership for country of care, pregnancy characteristics, birth experience and outcomes. RESULTS Three clusters were identified - 'Self determiners' (clear attitudes about birth including seeing it as a natural process and no childbirth fear), 'Take it as it comes' (no fear of birth and low levels of agreement with any of the attitude statements) and 'Fearful' (afraid of birth, with concerns for the personal impact of birth including pain and control, safety concerns and low levels of agreement with attitudes relating to women's freedom of choice or birth as a natural process). At 18 -20 weeks gestation, when compared to the 'Self determiners', women in the 'Fearful' cluster were more likely to: prefer a caesarean (OR = 3.3 CI: 1.6-6.8), hold less than positive feelings about being pregnant (OR = 3.6 CI: 1.4-9.0), report less than positive feelings about the approaching birth (OR = 7.2 CI: 4.4-12.0) and less than positive feelings about the first weeks with a newborn (OR = 2.0 CI 1.2-3.6). At two months post partum the 'Fearful' cluster had a greater likelihood of having had an elective caesarean (OR = 5.4 CI 2.1-14.2); they were more likely to have had an epidural if they laboured (OR = 1.9 CI 1.1-3.2) and to experience their labour pain as more intense than women in the other clusters. The 'Fearful' cluster were more likely to report a negative experience of birth (OR = 1.7 CI 1.02- 2.9). The 'Take it as it comes' cluster had a higher likelihood of an elective caesarean (OR 3.0 CI 1.1-8.0). CONCLUSIONS In this study three clusters of women were identified. Belonging to the 'Fearful' cluster had a negative effect on women's emotional health during pregnancy and increased the likelihood of a negative birth experience. Both women in the 'Take it as it comes' and the 'Fearful' cluster had higher odds of having an elective caesarean compared to women in the 'Self determiners'. Understanding women's attitudes and level of fear may help midwives and doctors to tailor their interactions with women.
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Affiliation(s)
- Helen M Haines
- Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, 751 85, Uppsala, Sweden.
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22
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Pettersson FD, Grönbladh A, Nyberg F, Sundström-Poromaa I, Åkerud H. The A118G Single-Nucleotide Polymorphism of Human µ-Opioid Receptor Gene and Use of Labor Analgesia. Reprod Sci 2012; 19:962-7. [DOI: 10.1177/1933719112438970] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Alfhild Grönbladh
- Division of Biological Research on Drug Dependence, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Fred Nyberg
- Division of Biological Research on Drug Dependence, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | | | - Helena Åkerud
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Lang AJ, Sorrell JT, Rodgers CS, Lebeck MM. Anxiety sensitivity as a predictor of labor pain. Eur J Pain 2012; 10:263-70. [PMID: 15987671 DOI: 10.1016/j.ejpain.2005.05.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Accepted: 05/08/2005] [Indexed: 11/30/2022]
Abstract
Psychosocial factors have been implicated in the pain experience during childbirth, which can have both short- and long-term consequences on the mother's health and her relationship with her infant. The present study evaluated important demographic, social, and psychological factors as predictors of multiple dimensions of labor pain among 35 mothers during childbirth. The results indicated that anxiety sensitivity (AS), as measured by the Anxiety Sensitivity Index, shared a significant relation with maximum pain during labor as well as sensory and affective components of pain as measured by the McGill Pain Questionnaire. AS predicted both maximum pain during labor and sensory aspects of pain above and beyond demographic and social factors as well as other theoretically important psychological factors (e.g., depression and state anxiety). These data replicate previous research that has demonstrated the significant impact of AS on pain responding in other areas (e.g., chronic pain) and extend knowledge in this literature to demonstrate the important role that AS serves among women and their experience of labor pain. Clinical implications are highlighted and discussed.
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Affiliation(s)
- Ariel J Lang
- University of California San Diego and the VA San Diego Healthcare System, San Diego, CA, United States.
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Jangsten E, Bergh I, Mattsson LÅ, Hellström AL, Berg M. Afterpains: a comparison between active and expectant management of the third stage of labor. Birth 2011; 38:294-301. [PMID: 22112329 DOI: 10.1111/j.1523-536x.2011.00487.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Management of the third stage of labor, the period following the birth of the infant until delivery of the placenta, is crucial. Active management using synthetic oxytocin has been advocated to decrease blood loss. It has been suggested, but not studied, that oxytocin may increase afterpains. The aim of this study was to compare women's experience of pain intensity when the third stage of labor was managed actively and expectantly and their experience of afterpains. METHODS A single-blind, randomized, controlled trial was performed at two delivery units in Sweden in a population of healthy women with normal, singleton pregnancies, gestational age of 34 to 43 weeks, cephalic presentation, and expected vaginal delivery. Women (n=1,802) were randomly allocated to either active management or expectant management of the third stage of labor. Afterpains were assessed by Visual Analog Scale (VAS) and the Pain-o-Meter (POM-WDS) 2 hours after delivery of the placenta and the day after childbirth. RESULTS At 2 hours after childbirth, women in the actively managed group had lower VAS pain scores than expectantly managed women (p=0.014). Afterpains were scored as more intense the day after, compared with 2 hours after, childbirth in both groups. Multiparas scored more intense afterpains, compared with primiparas, irrespective of management (p<0.001). CONCLUSIONS Active management of the third stage of labor does not provoke more intense afterpains than expectant management.
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Affiliation(s)
- Elisabeth Jangsten
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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25
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Landolt AS, Milling LS. The efficacy of hypnosis as an intervention for labor and delivery pain: a comprehensive methodological review. Clin Psychol Rev 2011; 31:1022-31. [PMID: 21762655 DOI: 10.1016/j.cpr.2011.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/26/2011] [Accepted: 06/01/2011] [Indexed: 10/18/2022]
Abstract
This paper presents a comprehensive methodological review of research on the efficacy of hypnosis for reducing labor and delivery pain. To be included, studies were required to use a between-subjects or mixed model design in which hypnosis was compared with a control condition or alternative intervention in reducing labor pain. An exhaustive search of the PsycINFO and PubMed databases produced 13 studies satisfying these criteria. Hetero-hypnosis and self-hypnosis were consistently shown to be more effective than standard medical care, supportive counseling, and childbirth education classes in reducing pain. Other benefits included better infant Apgar scores and shorter Stage 1 labor. Common methodological limitations of the literature include a failure to use random assignment, to specify the demographic characteristics of samples, and to use a treatment manual.
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Christiaens W, Verhaeghe M, Bracke P. Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands. BMC Health Serv Res 2010; 10:268. [PMID: 20831798 PMCID: PMC2944275 DOI: 10.1186/1472-6963-10-268] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 09/10/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in 2 maternity care models. Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process. METHODS Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Two questionnaires were filled out by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. However, only women having a hospital birth without obstetric intervention (N = 327) were included in this analysis. A logistic regression analysis has been performed. RESULTS Labour pain acceptance and personal control in pain relief render pain medication use during labour less likely, especially if they occur together. Apart from this general result, we also find large country differences. Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts. This country difference cannot be explained by labour pain acceptance, since - in contrast to our working hypothesis - Dutch and Belgian women giving birth in a hospital setting are characterised by a similar labour pain acceptance. Our findings suggest that personal control in pain relief can partially explain the country differences in coping with labour pain. For Dutch women we find that the use of pain medication is lowest if women experience control over the reception of pain medication and have a positive attitude towards labour pain. In Belgium however, not personal control over the use of pain relief predicts the use of pain medication, but negative attitudes towards labour. CONCLUSIONS Apart from individual level determinants, such as length of labour or pain acceptance, our findings suggest that the maternity care context is of major importance in the study of the management of labour pain. The pain medication use in Belgian hospital maternity care is high and is very sensitive to negative attitudes towards labour pain. In the Netherlands, on the contrary, pain medication use is already low. This can partially be explained by a low degree of personal control in pain relief, especially when co-occurring with positive pain attitudes.
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Affiliation(s)
| | | | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
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27
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Dabo F, Grönbladh A, Nyberg F, Sundström-Poromaa I, Akerud H. Different SNP combinations in the GCH1 gene and use of labor analgesia. Mol Pain 2010; 6:41. [PMID: 20633294 PMCID: PMC2912270 DOI: 10.1186/1744-8069-6-41] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 07/15/2010] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to investigate if there is an association between different SNP combinations in the guanosine triphosphate cyclohydrolase (GCH1) gene and a number of pain behavior related outcomes during labor. A population-based sample of pregnant women (n = 814) was recruited at gestational week 18. A plasma sample was collected from each subject. Genotyping was performed and three single nucleotide polymorphisms (SNP) previously defined as a pain-protective SNP combination of GCH1 were used. Results Homozygous carriers of the pain-protective SNP combination of GCH1 arrived to the delivery ward with a more advanced stage of cervical dilation compared to heterozygous carriers and non-carriers. However, homozygous carriers more often used second line labor analgesia compared to the others. Conclusion The pain-protective SNP combination of GCH1 may be of importance in the limited number of homozygous carriers during the initial dilation of cervix but upon arrival at the delivery unit these women are more inclined to use second line labor analgesia.
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Affiliation(s)
- Fatimah Dabo
- Department of Women's and Children's health, Uppsala University, Uppsala, Sweden
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28
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Dabo F, Nyberg F, Qin Zhou, Sundström-Poromaa I, Akerud H. Plasma Levels of β-Endorphin During Pregnancy and Use of Labor Analgesia. Reprod Sci 2010; 17:742-7. [DOI: 10.1177/1933719110370059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Fatimah Dabo
- From the Department of Women's and Children's Health, Uppsala University, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Division of Biological Research on Drug Dependence, Uppsala University, Sweden
| | - Qin Zhou
- Department of Pharmaceutical Biosciences, Division of Biological Research on Drug Dependence, Uppsala University, Sweden
| | | | - Helena Akerud
- Department of Women's and Children's Health, Uppsala University, Sweden,
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van Bussel J, Spitz B, Demyttenaere K. Childbirth expectations and experiences and associations with mothers’ attitudes to pregnancy, the child and motherhood. J Reprod Infant Psychol 2010. [DOI: 10.1080/02646830903295026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Floris L, Mermillod B, Chastonay P. Traduction et validation en langue française d’une échelle multidimensionnelle évaluant le degré de satisfaction, lors de l’accouchement. Rev Epidemiol Sante Publique 2010; 58:13-22. [DOI: 10.1016/j.respe.2009.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 08/28/2009] [Accepted: 09/01/2009] [Indexed: 11/28/2022] Open
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Bergh IHE, Stener-Victorin E, Wallin G, Mårtensson L. Comparison of the PainMatcher and the Visual Analogue Scale for assessment of labour pain following administered pain relief treatment. Midwifery 2009; 27:e134-9. [PMID: 19501433 DOI: 10.1016/j.midw.2009.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 02/08/2009] [Accepted: 03/15/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE during childbirth, it is necessary to assess and monitor experienced pain and to evaluate the effect of pain relief treatment. The aim of this study was to compare the PainMatcher (PM) with the Visual Analogue Scale (VAS) for the assessment of labour pain and the effect of pain relief treatment. DESIGN randomised controlled trial. SETTING labour ward with approximately 2500 childbirths per year in western Sweden. PARTICIPANTS 57 women with labour pain treated with acupuncture or sterile water injections scored their electrical pain threshold and pain intensity with the PM. Pain intensity was also assessed with the VAS. Electrical pain threshold and pain intensity were assessed immediately after a uterine contraction before and 30, 60, 90, 120, 150 and 180 minutes after treatment. MEASUREMENTS AND FINDINGS the results showed a weak correlation (r=0.13, p<0.05) between the pain intensity scores on the PM and the VAS. The PM detected changes (decrease) in pain intensity to a lower degree than the VAS. Surprisingly, in over 10% of sessions, women scored their pain intensity during a uterine contraction lower than their electrical pain threshold with the PM. However, electrical pain thresholds with the PM correlated well throughout all measurements. CONCLUSIONS the PM is a reliable tool for the assessment of electrical pain threshold; however, the VAS is more sensitive than the PM for recording changes in pain intensity when assessing the effects of treatment on labour pain. IMPLICATIONS FOR PRACTICE the PM and the VAS are not interchangeable in the case of labour pain, and there is still a need for research in this area to find a more suitable assessment instrument for the evaluation of labour pain.
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Affiliation(s)
- Ingrid H E Bergh
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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32
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Lally JE, Murtagh MJ, Macphail S, Thomson R. More in hope than expectation: a systematic review of women's expectations and experience of pain relief in labour. BMC Med 2008; 6:7. [PMID: 18366632 PMCID: PMC2358911 DOI: 10.1186/1741-7015-6-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 03/14/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childbirth is one of the most painful events that a woman is likely to experience, the multi-dimensional aspect and intensity of which far exceeds disease conditions. A woman's lack of knowledge about the risks and benefits of the various methods of pain relief can heighten anxiety. Women are increasingly expected, and are expecting, to participate in decisions about their healthcare. Involvement should allow women to make better-informed decisions; the National Institute for Clinical Excellence has stated that we need effective ways of supporting pregnant women in making informed decisions during labour. Our aim was to systematically review the empirical literature on women's expectations and experiences of pain and pain relief during labour, as well as their involvement in the decision-making process. METHODS A systematic review was conducted using the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Bath Information and Database Service (BIDS), Excerpta Medica Database Guide (EMBASE), Midwives Information and Resource (MIDIRS), Sociological Abstracts and PsychINFO. Studies that examined experience and expectations of pain, and its relief in labour, were appraised and the findings were integrated into a systematic review. RESULTS Appraisal revealed four key themes: the level and type of pain, pain relief, involvement in decision-making and control. Studies predominantly showed that women underestimated the pain they would experience. Women may hope for a labour free of pain relief, but many found that they needed or benefited from it. There is a distinction between women's desire for a drug-free labour and the expectation that they may need some sort of pain relief. Inaccurate or unrealistic expectations about pain may mean that women are not prepared appropriately for labour. Many women acknowledged that they wanted to participate in decision-making, but the degree of involvement varied. Women expected to take control in labour in a number of ways, but their degree of reported control was less than hoped for. CONCLUSION Women may have ideal hopes of what they would like to happen with respect to pain relief, control and engagement in decision-making, but experience is often very different from expectations. Antenatal educators need to ensure that pregnant women are appropriately prepared for what might actually happen to limit this expectation-experience gap and potentially support greater satisfaction with labour.
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Affiliation(s)
- Joanne E Lally
- Institute of Health and Society, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Madeleine J Murtagh
- Institute of Health and Society, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Sheila Macphail
- Women's Services, 3rd Floor Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - Richard Thomson
- Institute of Health and Society, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
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Bergh I, Jakobsson E, Sjöström B. Worst experiences of pain and conceptions of worst pain imaginable among nursing students. J Adv Nurs 2008; 61:484-91. [DOI: 10.1111/j.1365-2648.2007.04506.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Svärdby K, Nordström L, Sellström E. Primiparas with or without oxytocin augmentation: a prospective descriptive study. J Clin Nurs 2007; 16:179-84. [PMID: 17181680 DOI: 10.1111/j.1365-2702.2005.01481.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to determine during which phase of delivery augmentation is started when used and to establish any correlation that might exist between the oxytocin infusion and the evaluations by primiparas themselves of their labour pain, strength of contractions and fatigue. In addition, we wanted to determine any differences in duration between labour with and labour without augmentation. We finally wanted to measure the incidence of instrumental deliveries, perineal trauma and neonatal outcome among the augmented vs. the non-augmented groups. BACKGROUND The most commonly diagnosed complication in primiparas is ineffective contractions or protracted labour, otherwise known as dystocia, which literally means arrested or prolonged labour. Different treatments have been tried during the active phase of labour as well as the second stage of labour. The most common treatment today is amniotomy, often used in combination with an intravenous oxytocin infusion. MATERIALS AND METHODS The study was conducted at the hospital in Ostersund in central Sweden from August 1998 to September 1999. Consecutive primiparas giving birth at full-term were selected to the study. The inclusion criteria were an uncomplicated pregnancy and a spontaneous single delivery with head presentation. The total number of participants was 164. RESULTS The results showed that 50 of 164 primiparas needed no augmentation, while 88 were augmented during the active phase and 26 during the second stage of labour. The duration of the active phase [median (md) 4 hours 45 minutes, 6 hours 49 minutes and 6 hours 20 minutes respectively for the different groups, P = 0.03], the time between full dilation of the cervix and the start of the second stage (md 20 minutes, 30 minutes and 60 minutes respectively, P = 0.012) and the duration of the second stage of labour (md 40 minutes, 44 minutes and 60 minutes respectively, P = 0.04) were significantly longer in the augmented groups. Operative deliveries, too, were more frequent in the augmented groups. There was a significantly higher rate of perineotomies in the group augmented during the second stage of labour. There were, however, no differences in Apgar score <7 at 1 minute. pH in the umbilical cord and the base deficit were higher in the group which were augmented during the second stage of labour (P = 0.02 and P = 0.06 respectively). Women describing their impression of the experience as a whole generally gave it a high rating, but women who were augmented during the second stage of labour gave the experience a significantly lower score (P = 0.01). CONCLUSION Augmentation is used in unusually prolonged deliveries. We did not find that augmentation involved a higher frequency of perineal trauma, although it was correlated with a higher frequency of operative deliveries. There was no correlation between the oxytocin infusion and the primiparas' descriptions of the strength of contractions, pain and fatigue, although greater use of epidurals was observed in women with augmented labour. The number of nulliparas in this study was too small to analyse the incidence of ruptures in the sphincter or draw conclusions about differences between the groups with regard to Apgar scores or metabolic acidosis. RELEVANCE TO CLINICAL PRACTICE In clinical practice, good routines concerning oxytocin augmentation are crucial. Interventions as oxytocin augmentation seem to cause harm to mother and child. To evaluate interventions continuously in obstetric care is therefore important.
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Svärdby K, Nordström L, Sellström E. Primiparas with or without oxytocin augmentation: a prospective descriptive study. J Clin Nurs 2006. [DOI: 10.1111/j.1365-2702.2006.01481.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Börjesson K, Ruppert S, Wager J, Bågedahl-Strindlund M. Personality disorder, psychiatric symptoms and experience of childbirth among childbearing women in Sweden. Midwifery 2006; 23:260-8. [PMID: 17123672 DOI: 10.1016/j.midw.2006.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/14/2006] [Accepted: 05/04/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE to investigate the importance of having a personality disorder or psychiatric symptoms during pregnancy for women's experience of childbirth. DESIGN a prospective study of women consecutively recruited during mid-pregnancy. On study entry, the women completed self-rating scales for personality disorders, global functioning level and psychiatric symptoms. Two weeks after the birth, the women completed a questionnaire about their childbirth experiences. Obstetric and neonatal data were collected from maternity ward records. Multivariate logistic regression was used to estimate the likelihood for negative birth experiences. SETTING antenatal clinics in Stockholm, Sweden. PARTICIPANTS 625 primiparous women. FINDINGS 40 out of 624 (6.4%) women fulfilled the criteria for personality disorder, and 28 out of 625 (4.5%) women were defined as psychiatric cases. No significant differences were found between women with personality disorders, or defined as psychiatric cases, and women without any mental problems regarding their global experience of birth. Women defined as psychiatric cases were more anxious (z=-2.5, p=0.04) during labour than women without mental problems. The strongest predictors of having had a negative global experience of birth were instrumental vaginal delivery (OR 3.2, 95% CI 2.1-5.1) and epidural analgesia (OR 2.4, 95% CI 1.5-3.9). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE obstetric factors, such as instrumental delivery, seem to be more important than mental problems during pregnancy for women's global experience of birth. Women with psychiatric symptoms during pregnancy need extra support during labour.
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Affiliation(s)
- K Börjesson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry M57, Karolinska University Hospital/Huddinge, SE-141 86, Stockholm, Sweden.
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Abstract
BACKGROUND Labor experiences involve many dimensions that change during labor but are rarely measured contemporaneously and longitudinally. We examined pain and "fitness" aspects of women's labor experience and assessed the acceptability to participants. METHODS Thirty nulliparas and 20 multiparas in term labor indicated pain and fitness every 45 minutes in contraction-free intervals on visual analog scales from 0 to 10. Fitness implied both physical and psychological strength. Data were analyzed cross-sectionally and longitudinally, with adjustment for analgesia and time dependency. Women received feedback and evaluated their participation on the first day postpartum. RESULTS Measurements of pain and fitness ranged from 2 to 22 per woman (mean +/- SD: 7.4 +/- 4.4). Pain scores showed various patterns, mostly increasing from 1.4 (+/- 1.9) at the first to 6.6 (+/- 3.8) at the last measurement in nulliparas and from 1.3 (+/- 2.1) to 6.2 (+/- 4.0) in multiparas. One half of the women declined steadily in fitness throughout labor, occasionally after a slight increase early on. Multiparas entered labor more fit (5.9 +/- 3.0) than nulliparas (3.9 +/- 2.7), but showed a sharper decline so that the difference leveled out just before birth. Although fitness at any one time did not reflect pain levels, fitness and pain were inversely related, especially in nulliparas (p = 0.003). Analgesia affected pain scores but affected fitness only a little. Women's responses were mainly positive, especially in appreciating the feedback. Nevertheless, 32 percent of women skipped one or more measurements, often toward the end or when too close to a contraction. CONCLUSIONS Pain and "fitness" are two distinctly different dimensions of labor experience. Repeated longitudinal measurements of elements of well-being are clearly feasible and acceptable to laboring women. They may be useful to assess how labor events and interventions affect women's well-being.
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Affiliation(s)
- Mechthild M Gross
- Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany
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Eberhard J, Stein S, Geissbuehler V. Experience of pain and analgesia with water and land births. J Psychosom Obstet Gynaecol 2005; 26:127-33. [PMID: 16050538 DOI: 10.1080/01443610400023080] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Labor is one of the most painful experiences in a woman's life. Does water birth influence the pain experienced? Data from an ongoing, longitudinal, prospective observational study that spans 9 years and includes questionnaires from 12,040 births were used to evaluate pain perception (visual analogue scale (VAS)) and analgesic use. Three birthing methods were compared: water birth, bed birth and Maia stool birth. Based on the VAS, the data show that the different birthing methods do not influence the intensity of pain throughout the different stages of labor. The only significant difference noted was that bed births are more painful in the early first stage, and less painful at the end of the second stage. This later difference may be due to increased use of epidural anesthesia in women choosing a bed birth. Women who choose bed births are significantly less likely than others to have an analgesic-free birth. For primiparas, there is also a small but significant difference showing that water births are less likely to require analgesics compared to Maia stool births. No such difference is seen in women who have given birth previously. We conclude that women who choose bed births perceive more pain in the early first stage of labor, leading them to be more likely to choose an epidural anesthesia in the late first stage, or to use other types of analgesics. Women who choose water births or Maia stool births are more likely to get through labor without using any analgesics.
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Affiliation(s)
- Jakob Eberhard
- Department of Obstetrics and Gynaecology, Cantonal Hospital, Frauenfeld, Switzerland
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Abstract
AIMS To explore use of, and women's satisfaction with, intrapartum pain management at Royal Hospital for Women (RHW), Sydney, Australia. METHODS From October 2002 to January 2003 women aged over 16 who had been in labour at RHW were given a questionnaire to complete in the first week post-partum regarding their intrapartum pain management. Supplementary information was obtained from patient records. RESULTS A total of 496 women participated (69% response rate), including 95 birth centre clients. The mean age was 32 years and 73% percent had a normal vaginal delivery. At least one form of pain management ('natural', nitrous oxide, pethidine, epidural, local infiltration of the perineum) was used by 463 (93%) women, with 74% using two or more methods. Labour pain was 'worse' or 'much worse' than expected for 55%. Seventy-two percent were 'very' or 'quite' satisfied with overall pain management. Epidural analgesia had the highest utility scores (89%'very useful') and likelihood of use in subsequent labours (67%), and pethidine the lowest. Factors affecting analgesic use included cervical dilation on admission, labour length, English-speaking background, delivery suite versus birth centre care, parity, and syntocinon use. CONCLUSIONS Women at RHW use a variety of pain management methods in labour and most use multiple methods. Labour was rated more painful than expected by a majority; however, most were satisfied with their pain management. Labour length and cervical dilation on admission were most predictive of pain management use.
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Affiliation(s)
- Amanda Henry
- Royal Hospital for Women, Randwick, New South Wales, Australia.
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Callister LC, Khalaf I, Semenic S, Kartchner R, Vehvilainen-Julkunen K. The pain of childbirth: perceptions of culturally diverse women. Pain Manag Nurs 2003; 4:145-54. [PMID: 14663792 DOI: 10.1016/s1524-9042(03)00028-6] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pain experiences of culturally diverse childbearing women are described based on a secondary analysis of narrative data from phenomenologic studies of the meaning of childbirth. Study participants were interviewed in the hospital after giving birth or in their homes within the first weeks after having a baby. Transcripts of interviews with childbearing women who lived in North and Central America, Scandinavia, the Middle East, the People's Republic of China, and Tonga were analyzed. Participants described their attitudes toward, perceptions of, and the meaning of childbirth pain. Culturally bound behavior in response to childbirth pain was also articulated. A variety of coping mechanisms were used by women to deal with the pain. Understanding the meaning of pain, women's perceptions of pain, and culturally bound pain behaviors is fundamental in order for nurses to facilitate satisfying birth experiences for culturally diverse women.
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Low LK, Martin K, Sampselle C, Guthrie B, Oakley D. Adolescents' experiences of childbirth: contrasts with adults. J Midwifery Womens Health 2003; 48:192-8. [PMID: 12764304 DOI: 10.1016/s1526-9523(03)00091-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Most of what is known about the meaning women assign to the experience of childbirth in the United States is based primarily on studies of Euro American, highly educated, married women of middle to higher income levels. Yet almost half a million adolescents give birth annually. This exploratory, qualitative study was conducted with 25 adolescents in an alternative school, partnered with the juvenile justice system, who had given birth. An open-ended question format was used for the interviews, and analysis was conducted by using extended case methodology. The study revealed a number of differences between the existing literature reports about women's interpretations of birth and the meanings assigned to childbirth experiences by the adolescents in this study. A key difference was the relationship between the pain of childbirth and responsibility for their child. The results provide an entrée into understanding unique characteristics of giving birth as an adolescent and potential roles health care providers can play to promote a positive experience.
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Affiliation(s)
- Lisa Kane Low
- Department of Obstetrics/Gynecology, University of Michigan, Ann Arbor, USA
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Parratt J. The impact of childbirth experiences on women's sense of self: a review of the literature. AUSTRALIAN JOURNAL OF MIDWIFERY : PROFESSIONAL JOURNAL OF THE AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED 2003; 15:10-6. [PMID: 12593243 DOI: 10.1016/s1031-170x(02)80007-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper presents a review of the literature that informed research undertaken to determine what features of childbirth have a positive effect on women's sense of self. The literature looked at control: of women or with women, trusting relationships, balancing self-empathy, self understanding through an instinctual response, altered concious states, childbirth and mother/baby relationships.
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Wiklund I, Matthiesen AS, Klang B, Ransjö-Arvidson AB. A comparative study in Stockholm, Sweden of labour outcome and women's perceptions of being referred in labour. Midwifery 2002; 18:193-9. [PMID: 12381423 DOI: 10.1054/midw.2002.0310] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to study the outcome of labour and women's perceptions of being referred after onset of labour. DESIGN a comparative study carried out between October 1998 and April 1999. SETTING prospective parents in Stockholm, Sweden are offered a choice of which of the five hospitals in which they want to give birth. In reality, there is a lack of maternity beds in Stockholm to implement this policy and therefore nearly 10% of labouring women are being referred during labour. PARTICIPANTS the study population was selected from one of the five hospitals. Included in the study were 266 labouring women, with a 37-42 weeks uncomplicated pregnancy, fetus presenting by the vertex and spontaneous onset of labour. During pregnancy, all the women had chosen the same labour ward where they planned to deliver. However, at the onset of labour half of the women, case group I (n = 133) were referred to another maternity unit due to lack of space in the labour ward. For every referred woman a control woman matched for age, parity and date of delivery was selected, with the same inclusion criteria, except being referred, control group II (n = 133). METHODS a questionnaire with closed and open questions was posted to the women after birth and used to collect quantitative and qualitative data on the outcome of labour and the women's perceptions of referral during labour. FINDINGS routines such as epidural analgesia (EDA) (p<0.002), episiotomies (p<0.015) and morphine/pethidine during labour (p<0.023) were more common in the referred group. The women in the referred group considered to a higher extent that referral during labour had affected their emotional state (p<0.001). Women in both groups had been worried during pregnancy by the thought of having to be referred when labour had started and the referral had caused practical problems, stress and a feeling of not being welcome in the referral labour ward. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE referral during established normal labour may affect labour outcome, and the possibility that they may be referred worries women during pregnancy. Maternity policies and practices should be organised so that caring goals, such as continuity of care and women's' participation in birth planning, can be met.
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Affiliation(s)
- Ingela Wiklund
- Department of Obstetrics and Gynaecology, Danderyd Hospital S- 182 88, Stockholm, Sweden. ingela/
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Söderquist J, Wijma K, Wijma B. Traumatic stress after childbirth: the role of obstetric variables. J Psychosom Obstet Gynaecol 2002; 23:31-9. [PMID: 12061035 DOI: 10.3109/01674820209093413] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In a sample of 1550 recently delivered women, traumatic stress after childbirth was studied in relation to obstetric variables. A post-traumatic stress disorder (PTSD) symptom profile and traumatic stress symptoms were assessed by means of the Traumatic Event Scale (TES). Obstetric data comprised delivery mode, duration of the second stage of labor (the time from cervical dilation of 10 cm to partus) and the use of analgesia/anesthesia. Traumatic stress symptoms and having a PTSD symptom profile were both significantly related to the experience of an emergency cesarean section or an instrumental vaginal delivery. It is of clinical importance, however, that most women with a PTSD symptom profile were found in the normal vaginal delivery group (NVD). This implies that a normal vaginal delivery can be experienced as traumatic, just as an emergency cesarian section is not necessarily traumatic. Traumatic stress symptoms were neither substantially correlated to the duration of the second stage of labor, nor to the use of analgesia/anesthesia.
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Affiliation(s)
- J Söderquist
- Division of Obstetrics and Gynaecology, Department of Health and Environment, University Hospital, S-581 83 Linköping, Sweden.
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Abstract
BACKGROUND Women's ability and accuracy in recalling labor pain are widely debated, even though clinicians commonly use such retrospective information in their practice. The objectives of this paper are to review the literature to establish if labor pain is forgotten, if recall is accurate, factors that affect the accuracy of recall, and consequences of recall. METHODS An electronic search of Medscape, Psychlit, Bath Information and Data Services, and CINAHL between 1990 and 1999 was undertaken using the key words "labor" and "labour," "pain," and "memory." Each key word produced thousands of hits, but the combination of all three was surprisingly unsuccessful. This review, therefore, used a manual and print search and a detailed knowledge of work in this and related fields. RESULTS The literature was relatively limited, and many studies demonstrated methodological problems. Inductive and deductive analysis suggested that women do not completely forget labor pain, and recall is often vivid but not always entirely accurate. CONCLUSIONS Memories of labor pain can evoke intense negative reactions in a few women, but are more likely to give rise to positive consequences related to coping, self-efficacy, and self-esteem.
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Affiliation(s)
- C A Niven
- Department of Nursing and Midwifery, University of Stirling, Scotland, United Kingdom
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Olsson P, Jansson L, Norberg A. A qualitative study of childbirth as spoken about in midwives' ante- and postnatal consultations. Midwifery 2000; 16:123-34. [PMID: 11151548 DOI: 10.1054/midw.1999.0201] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe conversational topics concerning childbirth and illuminate the meanings of childbirth within the discourse of ante- and postnatal midwifery consultations. DESIGN Video-recordings of midwives' consecutive encounters with women/couples, from early pregnancy until after birth. The encounters were analysed using content analysis and a phenomenological hermeneutic approach. SETTING Swedish midwifery clinics at primary health care centres. PARTICIPANTS Five midwives, five women and three men. FINDINGS Bio-medical aspects of childbirth were given much importance in the consultations relative to the activities and lived experiences of the women and their partners. Two main features of the meanings of childbirth were found in the consultations; one in which childbirth was understood as a spontaneous and risky process needing to be controlled and to which the woman had to adapt; the other was characterised by being woman centred, pointing to her power and abilities in a process during which she is cared for and which leads to a satisfying result. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE A mechanistic and medicalised understanding of childbirth seems to dominate this discourse but the 'natural childbirth perspective' also appears. This study could serve as a basis for reflection on the content and meanings of childbirth in ante- and postnatal midwifery care.
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Affiliation(s)
- P Olsson
- Department of Nursing, 5-901 87 Umeå University, Umeå, Sweden
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Abstract
Several analgesic options are available for patients during labor. Selection of the appropriate technique must be individualized. Education and preparation begins during prenatal care. If medications are to be used, the risks and benefits to the mother and infant must be considered. Continued patient-doctor communication throughout labor is essential. Patient preferences, tempered by sound medical judgement, should guide the selection of the optimal modality for pain control during labor.
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Affiliation(s)
- M B Stephens
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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Chapman CR, Nakamura Y. A passion of the soul: an introduction to pain for consciousness researchers. Conscious Cogn 1999; 8:391-422. [PMID: 10600241 DOI: 10.1006/ccog.1999.0411] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pain is an important focus for consciousness research because it is an avenue for exploring somatic awareness, emotion, and the genesis of subjectivity. In principle, pain is awareness of tissue trauma, but pain can occur in the absence of identifiable injury, and sometimes substantive tissue injury produces no pain. The purpose of this paper is to help bridge pain research and consciousness studies. It reviews the basic sensory neurophysiology associated with tissue injury, including transduction, transmission, modulation, and central representation. In addition, it highlights the central mechanisms for the emotional aspects of pain, demonstrating the physiological link between tissue trauma and mechanisms of emotional arousal. Finally, we discuss several current issues in the field of pain research that bear on central issues in consciousness studies, such as sickness and sense of self.
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Affiliation(s)
- C R Chapman
- Department of Anesthesiology, University of Washington, Seattle, Washington 98195, USA.
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