Fear, pain and stress hormones during childbirth.
OBJECTIVE
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).


METHODS
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.


CONCLUSIONS
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.
Alehagen
Siw
S
Division of Caring Science, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden. siw.alehagen@imv.liu.se
Wijma
Barbro
B
Lundberg
Ulf
U
Wijma
Klaas
K
D000328:Adult; D015360:Analgesia, Epidural / Q000523:psychology; D016362:Analgesia, Obstetrical / Q000523:psychology; D002395:Catecholamines / Q000097:blood*; D005239:Fear / Q000502:physiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007231:Infant, Newborn; D048949:Labor Pain / Q000503:physiopathology* / Q000523:psychology; D007747:Labor Stage, First / Q000097:blood / Q000187:drug effects / Q000523:psychology; D007748:Labor Stage, Second / Q000097:blood / Q000187:drug effects / Q000523:psychology; D007749:Labor Stage, Third / Q000097:blood / Q000187:drug effects / Q000523:psychology; D010147:Pain Measurement / Q000523:psychology; D036801:Parturition / Q000502:physiology* / Q000523:psychology; D011247:Pregnancy; D012463:Saliva / Q000378:metabolism; D013223:Statistics as Topic
D002395:Catecholamines; D006854:Hydrocortisone