title: An evaluation of pain and "fitness" during labor and its acceptability to women.
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.
authors.affiliation: Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany.
authors.forename: Mechthild M
authors.initials: MM
authors.lastname: Gross
authors.forename: Hartmut
authors.initials: H
authors.lastname: Hecker
authors.forename: Marc J N C
authors.initials: MJ
authors.lastname: Keirse
mesh_terms: D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology*; D008137:Longitudinal Studies; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D010809:Physical Fitness / Q000523:psychology*; D011247:Pregnancy; D013997:Time Factors