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Pain management and medical interventions during childbirth among perinatal distressed women and women dissatisfied in their partner relationship: A prospective cohort study
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Univ Akureyri, Iceland.
Landspitali Univ Hosp, Iceland;Univ Iceland, Iceland.
Univ Iceland, Iceland.
Univ Akureyri, Iceland.
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2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 69, p. 1-9Article in journal (Refereed) Published
Abstract [en]

Objective: The purpose of this study was to investigate possible associations between distress in pregnant women and their use of pain management and medical interventions. Furthermore, we assessed the effects of reported dissatisfaction in relationship with their partner, or weak social support. Design: This was a prospective cohort study. Setting: Women were invited to participate while attending prenatal care at participating Icelandic health care centres. Birth outcome data were obtained from the hospitals where these women gave birth. Participants: Women in this study participated in a research project where 2523 women were screened three times during pregnancy for anxiety and depression. Women who had positive results at screening were invited to a semi-structured interview during pregnancy as well as every fourth woman who had negative results. Five hundred and sixty-two women participated in the interviews and the final sample was 442 women. Measurements: Distress was defined as symptoms of anxiety, stress and depression. The Edinburgh Post-partum Depression Scale (EPDS) and the Depression, Anxiety and Stress Scales (DASS) were used for screening purposes. During the interview, the women answered the Dyadic Adjustment Scale (DAS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Adverse Experienced Interview (AEI). The main outcome variables that were obtained from the women's childbirth records were: (1) use of pain management, categorized as: epidural analgesia, non-pharmacological pain management, nitrous oxide, pharmacological medication, or no pain management; (2) medical interventions categorized as: induction, stimulation, and episiotomy; and (3) mode of childbirth. A logistic regression analysis, adjusted for significant covariates, was conducted. Findings: A significant association was found between perinatal distress at 16 weeks gestation and use of epidural as single pain management. Overall, distressed women were 2.6 times more likely than non-distressed women to use epidural as a single pain management. They were also less likely to go through childbirth without use of any pain management method. Women who were dissatisfied in their relationship were significantly more likely to undergo induction of childbirth, an episiotomy and/or a vacuum extraction than those who were satisfied in their relationship, regardless if they were distressed or not. No association was found between social support and the outcome variables. Key conclusions: Women with perinatal distress were more likely to use an epidural than non-distressed women. The use of an epidural might help them manage pain and uncertainties related to childbirth. Women who were dissatisfied in their partner relationship may be more likely to undergo induction of childbirth, episiotomy and/or vacuum extraction. Implication for practice: Midwives need to acknowledge the possible association of distress and use of an epidural during childbirth and screen for distress early in pregnancy. It is important to offer counselling and help during pregnancy for expectant parents who are distressed or dissatisfied in their relationship. (C) 2018 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2019. Vol. 69, p. 1-9
Keywords [en]
Perinatal distress, Interventions, Childbirth, Pain, Emotions
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
URN: urn:nbn:se:lnu:diva-79732DOI: 10.1016/j.midw.2018.10.018ISI: 000454129800001PubMedID: 30390461Scopus ID: 2-s2.0-85055731159OAI: oai:DiVA.org:lnu-79732DiVA, id: diva2:1281679
Available from: 2019-01-23 Created: 2019-01-23 Last updated: 2019-08-29Bibliographically approved
In thesis
1. Effects of perinatal distress, satisfaction in partner relationship and social support on pregnancy and outcome of childbirth
Open this publication in new window or tab >>Effects of perinatal distress, satisfaction in partner relationship and social support on pregnancy and outcome of childbirth
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The aim of this thesis was to achieve a deeper understanding of the situation among women experiencing perinatal distress during pregnancy and childbirth and the effects that dissatisfaction in partner relationship and weak social support from family and friends could have on pregnancy and childbirth.

Methods: Following screening for perinatal distress, 562 expecting mothers came for a semi-structured interview. This screening, done with the Depression Anxiety Stress Scales and the Edinburgh Postpartum Depression Scale, categorized 360 (64.1%) women into the perinatal distressed group (PDG) and 202 (35.9%) into the non-distressed group (NDG). During the interview women answered the Dyadic Adjustment Scale and the Multidimensional Scale of Perceived Social Support. Data were collected with these instruments for study I. Additional data for the three other studies were gathered from the women´s pregnancy records (II), electronic medical records (II, III), and childbirth records (IV). Results of the four studies were obtained by using descriptive statistics; parametric and nonparametric statistics and regression modeling.

Results: Women in the PDG were significantly more likely than the NDG to be dissatisfied in their partner relationship, continue smoking during pregnancy, be dissatisfied with division of household tasks and child-rearing, have elementary or lower education, and to be students or unemployed. They were also significantly more likely to experience fatigue, vomiting and pelvic girdle pain during pregnancy. Women in the PDG who received weak family support reported nausea and heartburn more frequently than those with strong family support. Women in the PDG utilized more antenatal care service and were allocated more part time as well as earlier sick leaves during pregnancy, than those in the NDG. Women in the PDG were significantly more likely to use epidural anesthesia as a single pain management during labor.

Conclusion: Perinatal distress affects pregnancy and childbirth. It is more common among women who are dissatisfied in their partner relationship and with the division of household tasks and child-rearing. Perception of weak social support also affects pregnancy among distressed women. Distressed women along with their partners and families should be offered support and consultation to relieve distress and strengthen their bonds during pregnancy and childbirth.  

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2019. p. 84
Series
Linnaeus University Dissertations ; 352
Keywords
perinatal distress, partner relationship, social support, pregnancy, sick leave certificates, childbirth, midwifery, self-reported scales, DASS, EPDS, DAS, MSPSS
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-82697 (URN)978-91-88898-61-6 (ISBN)978-91-88898-60-9 (ISBN)
Public defence
2019-05-29, Lapis, Vi1158, Hus Vita, Kalmar, 10:00 (English)
Opponent
Supervisors
Available from: 2019-08-05 Created: 2019-05-22 Last updated: 2019-08-30Bibliographically approved

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Jonsdottir, Sigridur SiaSwahnberg, Katarina

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