title: The role of maternal attachment in the experience of labor pain: a prospective study.
abstract: OBJECTIVE
  To examine the influence of attachment dimensions and sociodemographic and physical predictors in the experience of labor pain.
  
  
  METHODS
  Eighty-one pregnant women were assessed during their third trimester of pregnancy and during labor. The perceived intensity of pain in the early stages of labor (3 cm of cervical dilatation) and before the administration of patient-controlled epidural analgesia was measured using a visual analog scale. Pain was also assessed indirectly based on anesthetic doses. Attachment was assessed using the Adult Attachment Scale-Revised.
  
  
  RESULTS
  Attachment anxiety and avoidance were positively and significantly correlated with labor pain and anesthetic consumption. In the multivariate models, attachment anxiety was a significant predictor of higher pain at 3 cm of cervical dilatation (β = 0.36, p = .042) and before the administration of patient-controlled epidural analgesia (β = 0.51, p = .002). Older age (β = 0.31, p = .005), a shorter duration of labor (β= -0.41, p = .001), and attachment avoidance (β = 0.41, p = .004) were significant predictors of higher anesthetic use.
  
  
  CONCLUSIONS
  The study findings suggest that perceived labor pain and anesthetic use are strongly associated with attachment, rather than demographic and physical factors. These data support the importance of understanding the experience of labor pain within an attachment theoretical framework.
authors.affiliation: From the Department of Anaesthesiology (J.M.C.-M.), Maternity Hospital Alfredo da Costa, Lisbon, Portugal; Faculty of Medicine (J.M.C.-M.), University of Porto, Porto, Portugal; Faculty of Psychology and Educational Sciences (M.P., M.M.-R.), University of Coimbra, Coimbra, Portugal; ISPA (H.M.), University Institute, Lisbon, Portugal; and Departments of Clinical Neurosciences and Mental Health (R.C.) and Anaesthesiology (J.T.), Hospital de São João, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Costa-Martins
authors.forename: Marco
authors.initials: M
authors.lastname: Pereira
authors.forename: Henriqueta
authors.initials: H
authors.lastname: Martins
authors.forename: Mariana
authors.initials: M
authors.lastname: Moura-Ramos
authors.forename: Rui
authors.initials: R
authors.lastname: Coelho
authors.forename: Jorge
authors.initials: J
authors.lastname: Tavares
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D016362:Analgesia, Obstetrical / Q000379:methods / Q000706:statistics & numerical data*; D016058:Analgesia, Patient-Controlled / Q000523:psychology / Q000706:statistics & numerical data*; 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; D009034:Mother-Child Relations / Q000523:psychology*; D015999:Multivariate Analysis; D009769:Object Attachment; D010147:Pain Measurement / Q000706:statistics & numerical data; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D011582:Psychological Theory; D012044:Regression Analysis; D012720:Severity of Illness Index; D013997:Time Factors