Psychosocial influences on women's experience of planned elective cesarean section.
OBJECTIVE
The successful management of pain from normal or interventional delivery is an important part of women's experience of childbirth. Our objective was to examine psychosocial factors (expectations, control beliefs, anxiety sensitivity) as measured in mothers and birth partners before an elective cesarean section. We focused on the impact that these variables have on maternal fear and pain during and after delivery.


METHODS
Sixty-five women booked for an awake cesarean section with a regional nerve block and their birth partners were recruited. Data were collected at three time points for the mothers, before, during the cesarean section and after delivery on the postnatal ward, and at two time points for the birth partners (before and during the cesarean section).


RESULTS
Maternal fear responses varied during the operation, in that fear was greatest at the point of administration of the nerve block. Within mothers, preoperative negative expectations were related to fear experiences during delivery, which was in turn related to their postoperative pain. Maternal anxiety sensitivity was found to mediate the relationship between negative expectations and fear, whereas birth partner's fear mediated between maternal fear and postoperative pain. Mothers' prenatal perceptions of control over drugs predicted their postoperative pain.


CONCLUSIONS
Maternal fear during cesarean section not only fluctuates, but may be influenced by psychosocial factors, including their birth partner. Psychosocial factors were also important predictors of postoperative experiences. Interventions that appropriately manage psychological and social factors during cesarean delivery may facilitate a more positive experience for mothers.
Keogh
Edmund
E
Department of Psychology, University of Bath, Bath,UK. e.m.keogh@bath.ac.uk
Hughes
Shelley
S
Ellery
Deborah
D
Daniel
Clare
C
Holdcroft
Anita
A
D001007:Anxiety / Q000523:psychology; D002585:Cesarean Section / Q000009:adverse effects / Q000523:psychology*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000523:psychology*; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D011247:Pregnancy; D012944:Social Support; D018454:Spouses / Q000523:psychology