title: Pain, Anxiety, and Fatigue During Labor: A Prospective, Repeated Measures Study.
abstract: BACKGROUND
  Pain, anxiety, and fatigue are known to significantly influence labor; however, the interacting relationships among the three symptoms have not been empirically shown.
  
  
  OBJECTIVE
  The aim of this study was to investigate the interrelationships among intrapartum pain, anxiety, and fatigue relative to the mode of delivery, with or without epidural analgesia (EDA).
  
  
  METHODS
  A prospective, repeated measures design was adopted, and women with uncomplicated pregnancies at term (N = 186) were enrolled. Self-reported visual analog scales were used to assess pain, anxiety, and fatigue during the four phases of labor, as determined by cervical dilation (e.g., Phase 1 = 2-4 cm, Phase 2 = 4-6 cm, Phase 3 =10 cm, and Phase 4 = immediately after delivery of the placenta). Of the 186 participants, 48 received EDA when their cervical dilation was 3-4 cm.
  
  
  RESULTS
  Throughout the process of labor, pain, anxiety, and fatigue were significantly correlated, no matter whether participants had received EDA, especially during Phases 1 and 3. For the participants undergoing EDA, the level of fatigue decreased more slowly than the levels of pain and anxiety. The participants who received EDA had significantly greater pain and fatigue in Phase 1 of labor than those who did not receive EDA. Mode of delivery was correlated with age, parity, and pain level in Phase 2 of labor and anxiety level in Phase 2 of labor.
  
  
  CONCLUSIONS
  Intrapartum pain, anxiety, and fatigue were strongly interrelated. Intrapartum pain management (EDA) led to a significant decline in anxiety and fatigue. Furthermore, fatigue accumulated during the course of labor and was not easily diminished. These findings provide a reference for maternity nurses to develop strategies for managing multiple symptoms.
authors.affiliation: 1PhD, RN, Professor, School of Nursing, China Medical University, and Adjunct Advisor, Department of Nursing, China Medical University Hospital 2PhD, RN, Assistant Professor, School of Nursing, College of Medicine, National Taiwan University, and Adjunct Supervisor, Department of Nursing, National Taiwan University Hospital 3PhD, RN, Professor, School of Nursing, Chung Shan Medical University 4MSN, RN, Instructor, School of Nursing, China Medical University 5PhD, RN, Professor, Director of Department of Nursing, Hungkuang University.
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Tzeng
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Yang
authors.forename: Pi-Chao
authors.initials: PC
authors.lastname: Kuo
authors.forename: Ya-Chuan
authors.initials: YC
authors.lastname: Lin
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chen
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000523:psychology; D001007:Anxiety / Q000209:etiology* / Q000523:psychology*; D005221:Fatigue / Q000209:etiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D007745:Labor Onset / Q000523:psychology*; D048949:Labor Pain / Q000150:complications* / Q000523:psychology*; D008875:Middle Aged; D009321:Natural Childbirth / Q000523:psychology; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult