title: Attachment styles, pain, and the consumption of analgesics during labor: a prospective observational study.
abstract: Individuals with less secure attachment styles have been shown to experience more pain than people with more secure attachment styles; however, attachment styles have not yet been examined in the context of labor pain and analgesic consumption. The purpose of this prospective observational study was to assess the influence of the mother's attachment style on the perception of labor pain, as assessed by a visual analog scale and analgesic consumption. Eighty-one pregnant women with a mean age of 32 years (standard deviation = 5.1) were assessed during the third trimester of pregnancy and during labor. The physical predictors of labor pain were recorded, and the adult attachment style was assessed with the Adult Attachment Scale-Revised. For labor analgesia, a low dose of patient-controlled epidural analgesia protocol (ropivacaine .6 mg/mL plus sufentanil .5 μg/mL) was used. Women with a secure attachment style reported significantly less labor pain (P < .001) and a significantly lower analgesic consumption during labor (P < .001) than insecurely attached women. These findings suggest that women's attachment style was associated with labor pain and analgesic consumption and support the relevance of the attachment theory as a promising conceptual framework for understanding labor pain.
  
  
  CONCLUSIONS
  This study showed that women with an insecure attachment style were more likely to report higher pain before patient-controlled epidural analgesia and higher analgesic consumption and to request supplemental analgesia during labor. The assessment of adult attachment has the potential to identify women at high risk of poorly coping with pain during childbirth.
authors.affiliation: Department of Anaesthesiology, Maternity Hospital Alfredo da Costa, University of Porto, Porto, Portugal. Electronic address: hcostamartins@gmail.com.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Costa-Martins
authors.affiliation: Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
authors.forename: Marco
authors.initials: M
authors.lastname: Pereira
authors.affiliation: Instituto Superior de Psicologia Aplicada, University Institute, Lisbon, Portugal.
authors.forename: Henriqueta
authors.initials: H
authors.lastname: Martins
authors.affiliation: Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
authors.forename: Mariana
authors.initials: M
authors.lastname: Moura-Ramos
authors.affiliation: Department of Clinical Neurosciences and Mental Health, Hospital de São João, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Coelho
authors.affiliation: Department of Anaesthesiology, Hospital de São João, University of Porto, Porto, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Tavares
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D048949:Labor Pain / Q000188:drug therapy* / Q000523:psychology*; D007743:Labor, Obstetric / Q000502:physiology / Q000523:psychology; D008875:Middle Aged; D008960:Models, Psychological; D009034:Mother-Child Relations / Q000523:psychology; D009769:Object Attachment; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine; D012959:Socioeconomic Factors; D017409:Sufentanil / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D017409:Sufentanil
keywords: Attachment styles; analgesic consumption; labor pain; patient-controlled epidural analgesia