liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Fear pain stress hormones during labor
Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of the thesis were to develop a measure of fear during labor and to investigate women's experiences of fear and pain during labor and delivery as well as their levels of stress hormones. We also wanted to explore the associations between fear, pain, stress hormones and the duration of labor. Finally, we aimed to examine the relationships between pre-and postpartum fear, and fear and pain during labor.

The measurement of fear was developed in two substudies. First we composed a list of 60 fear-related items and their contrasts and tested it in a group of 92 women in labor. After psychometrical analyses, 10 items were selected for the final scale. The scale was then tested in another group of 57 women in labor. Via semi-structured interviews the content of the items was documented and analyzed.

Fifty-five nulliparous women participated in the investigation of women's experiences of fear, pain, levels of stress hormones and duration of labor. During gestation weeks 37-39, we measured levels of fear of childbirth, urinary catecholamines and salivary cortisol. During labor, hourly measurements were performed of fear, pain and levels of stress hormones. Finally, at two hours, two days and five weeks postpartum, fear of childbirth and stress hormones were measured.

The questionnaire that measures fear during labor was called the Delivery Fear Scale (DFS). The DFS has an alpha coefficient of .8 and has good psychometric qualities in both nulliparous and parous women. It takes women in labor between 30 and 90 seconds to listen to and answer all the statements. We found that nulliparous women had higher fear during phase 1 of labor (cervix dilatation 3-Scm) than parous women. Fear during phase 1 of labor predicted the total amount of pain relief received during labor, but not the duration of remaining part of labor, nor the occurrence of instrumental vaginal delivery or emergency cesarean section.

The results from the subsequently studies showed that there was an increase of the levels in stress hormones from pregnancy to labor. Epinephrine and cortisol increased more than 500% and norepinephrine approximately 50%. In women without EDA fear and cortisol increased throughout labor. In women with EDA cortisol did not increase, fear, pain and catecholamine levels first decreased after the administration of EDA but at the end of labor fear and pain increased. In phase 1, fear, but not pain, was more intensive in women who later subsequently received EDA than in those who did not. Fear and pain correlated positively during labor. A high level of epinephrine was associated with a shorter duration of phase 1 of labor. Postpartum fear of childbirth was higher in women who had received EDA during labor than in those who had not. Pre- and postpartum fear of childbirth correlated positively with fear but not with pain during phase 1 of labor.

In conclusion, DFS is a new measure of fear during labor with good psychometric qualities. Childbirth is a stressful event associated with exceptionally high levels of stress hormones. In this study women's experiences of fear and pain were associated throughout labor. The administration of EDA heavily influenced the course of fear, pain and stress hormones. Women who later received EDA had higher scores of fear but not of pain early during labor than those who did not receive EDA. Late pregnant women who fear childbirth are prone to have a fearful delivery, as reported during the actual labor and postpartwn.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2002. , 71 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 730
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26645Local ID: 11210ISBN: 91-7373-173-0 (print)OAI: oai:DiVA.org:liu-26645DiVA: diva2:247194
Public defence
2002-05-17, Hörsal Planck, Fysikhuset, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-13Bibliographically approved
List of papers
1. Development of the delivery fear scale
Open this publication in new window or tab >>Development of the delivery fear scale
2002 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 23, no 2, 97-107 p.Article in journal (Refereed) Published
Abstract [en]

This article reviews the development of the Delivery Fear Scale (DFS) to measure fear during labor and delivery.

In an initial study, 92 women in labor answered a list of 60 items, expressing fear-related appraisals and their contrasts that were characteristic of women in labor. Ten items were then selected by means of an item-total analysis. In a second study, the final list of ten items was tested psychometrically and a semi-structured interview was performed on 45 women in labor, to explore the women s descriptions of the content of each of the ten items. According to the content analysis of the interviews, the dominating connotation of the ten items is fear based on the appraisal of being captured. The studies show that the DFS is a questionnaire that almost effortlessly can be completed within 60-90 seconds during any moment of labor and delivery. The scale has a good reliability: Cronbach‘s alpha was 0.88 in both studies.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26351 (URN)10.3109/01674820209042791 (DOI)10884 (Local ID)10884 (Archive number)10884 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-13Bibliographically approved
2. Fear during labor
Open this publication in new window or tab >>Fear during labor
2001 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 80, no 4, 315-320 p.Article in journal (Refereed) Published
Abstract [en]

Background. The aims of the present study were to compare primiparous and multiparous women’s experiences of fear of delivery during an early stage of active labor (cervix dilatation 3–5 centimeters) and to study whether fear of delivery, measured during the early stage of active labor, was a predictor of the amount of pain relief received during the remaining part of labor (cervix dilatation 5 cm – partus), of the duration of the remaining part of labor, and of the occurrence of instrumental vaginal delivery and emergency cesarean section.

Method. Thirty-five primiparous and 39 multiparous women answered the Delivery Fear Scale (DFS) once during the early stage of labor and before they had received any pain relief.

Results. Primiparous women reported higher levels of fear than multiparous women did. Fear during the first phase of labor predicted only the total amount of pain relief received during labor.

Conclusion. The clinical implications of the study are that the delivery staff should consider women’s fear during labor and pay attention especially to primiparous women’s increased risk of higher levels of fear during an early stage of active labor, as compared with multiparous women’s. The challenge for staff of a delivery ward is to support the woman in labor in a way that decreases fear, which in turn might reduce the woman’s need of pain relief.

Keyword
Delivery, Fear, Labor, Primiparous women
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25745 (URN)10.1034/j.1600-0412.2001.080004315.x (DOI)10177 (Local ID)10177 (Archive number)10177 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-13Bibliographically approved
3. Catecholamine and cortisol reaction to childbirth
Open this publication in new window or tab >>Catecholamine and cortisol reaction to childbirth
Show others...
2001 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 8, no 1, 50-65 p.Article in journal (Refereed) Published
Abstract [en]

One way to study the stressfulness of childbirth is to examine the output of stress hormones. In this study, urinary catecholamines and salivary cortisol from 50 primiparous women were collected for 1 day during gestational weeks 37 to 39, hourly during labor and delivery, and 2 hr and 2 days postpartum. All three stress hormones increased statistically significantly from pregnancy to labor. The increase in adrenaline and cortisol was more than 500%, and the increase in noradrenaline was about 50%. After labor, the output decreased but not statistically significantly below the levels during late pregnancy. Hormone levels during late pregnancy, during labor and delivery, and during the period postpartum mostly did not correlate systematically. However, noradrenaline and adrenaline, as well as adrenaline and cortisol, were positively correlated during labor. After administration of epidural analgesia, there was a moderate but significant decrease in noradrenaline and adrenaline, whereas cortisol did not change. In conclusion, the results of this study support the assumption that childbirth is a very stressful event and that the stress responses vary considerably among women. The substantial increase of adrenaline and cortisol compared with noradrenaline indicates that mental stress is more dominant than physical stress during labor.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25744 (URN)10.1207/S15327558IJBM0801_04 (DOI)10176 (Local ID)10176 (Archive number)10176 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-13Bibliographically approved
4. Fear, pain and stress hormones during childbirth
Open this publication in new window or tab >>Fear, pain and stress hormones during childbirth
2005 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 26, no 3, 153-165 p.Article in journal (Refereed) Published
Abstract [en]

Aims. To investigate the course of fear, pain and stress hormones during labor, and the associations between fear, pain, stress hormones and duration of labor in nulliparous women with and without epidural analgesia (EDA).

Method.  One day during gestation weeks 37–39, urinary and salivary samples were collected to measure catecholamines and cortisol. Hourly during labor, the participants answered the Delivery Fear Scale and a pain intensity scale, and urinary and salivary samples were collected to measure stress hormones.

Results. The course of fear, pain and stress hormones differed throughout labor in women with and without EDA. Pain and cortisol increased throughout labor in women without EDA. Women who received EDA had more fear, but not more pain, before the administration of the EDA than women who did not receive EDA. Pain, fear and catecholamines decreased when women received EDA, but fear and pain increased again later in labor. Fear and pain correlated, as well as levels of fear in the different phases of labor. During phase one of labor epinephrine and duration of the phase were negatively correlated.

Conclusion.  The course of fear, pain and concentrations of stress hormones differed, highly influenced by the administration of EDA. Fear and pain correlated more pronounced than stress hormones and fear, pain and duration of labor.

Keyword
childbirth, fear, pain, catecholamines, cortisol, epidural analgesia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-29305 (URN)10.1080/01443610400023072 (DOI)14594 (Local ID)14594 (Archive number)14594 (OAI)
Note

On the day of the defence day the status of this article was submitted.

Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-13Bibliographically approved
5. Pre- and postpartum fear of childbirth and fear and pain during labor
Open this publication in new window or tab >>Pre- and postpartum fear of childbirth and fear and pain during labor
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: The aims of the present study were 1) to investigate the associations between fear of childbirth during pregnancy and postpartum and fear and pain during labor (phase 1: cervix dilatation 3-5 cm), and 2) to explore possible differences regarding fear of childbirth during pregnancy and postpartum between women who did or did not receive epidural analgesia (EDA) during labor.

Method. During gestation weeks 37-39, in 47 nulliparous women fear of childbirth was measured by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A. Early during labor (labor phase I = cervix dilatation 3-5cm) the women's fear (Delivery Fear Scale) and their experiences of pain (a pain intensity scale) were measured hourly. Finally, fear after childbirth (W-DEQ version B) was measured two hours, two days, and five weeks after delivery.

Results. Fear of childbirth during pregnancy and in the three postpartum measures was positively related to fear during labor, phase I. Pain during phase 1 of labor was neither associated with fear of childbirth measured during late pregnancy, nor with postpartum fear. There were no differences in fear of childbirth during late pregnancy between those women who received EDA and those who did not. Postpartum fear was higher in those women who had received EDA.

Conclusion. Late pregnant women who fear childbirth are prone to have a fearful delivery, as reported during the actual labor and postpartum.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81399 (URN)
Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2012-09-13Bibliographically approved

Open Access in DiVA

No full text

Authority records BETA

Alehagen, Siw

Search in DiVA

By author/editor
Alehagen, Siw
By organisation
Obstetrics and gynecologyFaculty of Health Sciences
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 488 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf