Pain cognitions as predictors of the request for pain relief during the first stage of labor: a prospective study

Abstract

Background: It is thought that pain cognitions determine coping behavior and success in adapting to labor. The aim of this study was to examine whether pain cognitions assessed by the labor pain coping and cognition list (LPCCL) predict the request for pain relief during the first stage of labor and which pain cognition is the strongest predictor of a request for pain relief over and above, and independent of, other pain cognitions. Methods: Participants in this prospective study were 177 low-risk nulliparous pregnant women. Data were collected on two different occasions. The numerical pain intensity scale (NPS)-anticipated and the LPCCL were administered at 34–36 weeks’ gestation followed by the NPS-during labor. Results: Catastrophizing and external pain control predicted the request for pain relief during labor after adjustment for relevant demographic and clinical characteristics, respectively (adjusted odds ratio [OR] 2.61 [95% CI 1.45–4.68] and adjusted OR 1.90 [95% CI 1.16–3.10]). Catastrophizing was found to be the strongest and independent predictor among the pain cognitions while controlling for significant background variables (adjusted OR 2.61 p-value < 0.001). Conclusion: Catastrophizing seems to have a substantial impact on the request for pain relief in low-risk pregnant women.

Keywords::

• childbirth
• coping
• midwifery
• pain
• perinatal metal health

Acknowledgements

We thank all Dutch midwives from the primary care midwifery practices who participated in our study. Without their continuing data collection, at often inconvenient hours, this study would not have been possible. We would like to thank Albere Köke (clinimetrician from ‘Hoensbroeck’ Rehabilitation Center) for his help in the adaptation of the pain coping and cognition list into the labor situation and Ben van Cranenburgh (neuroscientist from Institute for applied neurosciences in Haarlem) for his inspiration.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Current knowledge on this subject

• Pain catastrophizing as a cognitive coping behavior has been researched extensively in chronic pain patients [31,33–37]. As far as we know, only three studies have examined catastrophizing in relation to childbirth [8,11,15].

What this study adds

• This study is an important step in providing systematically collected empirical data on pain cognitions in relation to pain coping behavior during labor. We attempted to provide more insight into the role of catastrophizing in the adaptation to labor pain. Moreover, this study touches upon a central area in midwifery care which has enough potential for the clinical setting to improve labor pain management.