Pain Catastrophizing and Childbirth Satisfaction in a Group of Nulliparous Women Aaron Reposar, Beth D. Darnall, PhD, Katherine Volpe, Hong Li, MD, MPH Department of Anesthesiology

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Pain Catastrophizing and Childbirth
Satisfaction in a Group of Nulliparous
WomenAaron Reposar, Beth D. Darnall, PhD,
Katherine Volpe, Hong Li, MD, MPHDepartment of
Anesthesiology Perioperative Medicine, Oregon
Health Science University, Portland, OR USA
TABLE 1 DESCRIPTIVE STATISTICS
BACKGROUND Pain catastrophizing is a
psychological construct wherein patients ruminate
on their pain, magnify their pain and feel a
strong sense of helplessness (Quartana et al.,
2009). Additionally, pain catastrophizing is
associated with a variety of poor outcomes for
pain and medical conditions including heightened
disability, frequent visits to healthcare
providers, exaggerated negative moods and
declining social support networks (Quartana et
al., 2009). Previous pain catastrophizing
research focused on chronic pain yet little
research has described this construct in the
acute pain setting. However, a hallmark acute
pain study found that high pain catastrophizers
experienced a higher super-threshold pain level
and a greater temporal summation of pain (Edwards
et al., 2005). We aimed to determine whether
pain catastrophizing predicts decreased
childbirth satisfaction in nulliparous women when
compared to cesarean section, depressed mood,
epidural anesthesia, maternal social support and
pain intensity. METHODS Self-report measures on
labor pain catastrophizing (LPC), pain intensity
(PI), depressed mood (DM), maternal social
support (MSS) and childbirth satisfaction (CBS)
were gathered at the initial visit, 12-24 hours
postpartum and 4-8 weeks postpartum. Chart
reviews were conducted 12-24 hours postpartum to
collect subject demographics, obstetric data and
anesthesia data.
ANALYTIC APPROACH Correlations between age,
depressed mood, labor pain catastrophizing, pain
intensity, maternal social support and childbirth
satisfaction were examined using Spearman
correlation coefficients. Multivariate analysis
was performed to assess the effect of labor pain
catastrophizing on childbirth satisfaction while
controlling for confounding factors. The median
value for labor pain catastrophizing (12 4.8)
separated study subjects into low and high labor
pain catastrophizers. RESULTS When
controlling for pain intensity, baseline
depression, maternal social support and epidural
anesthesia, high labor pain catastrophizing
predicted poorer childbirth satisfaction
(P0.0021). CONCLUSIONS High labor pain
catastrophizing is a significant predictor of
poorer childbirth satisfaction when controlling
for baseline depression, epidural anesthesia,
pain intensity and maternal social support. High
LPC mothers may experience a greater loss of
personal control which predicts poorer childbirth
satisfaction. Thus, reducing the tendency to
pain catastrophize in nulliparous women may
maintain person control in labor and delivery and
thereby increase childbirth satisfaction. Future
studies involve identifying women at risk for LPC
and treatment guidelines.
Assessment N Mean Median Range Notes
Baseline depression 62 8.8 (5.7) 8 0-27 gt12 depressed symptoms
Labor Pain Catastrophizing 65 10.9 (4.8) 12 1-20 5 item scale 12-24 hrs pp
Pain Intensity 64 7.5 (2.3) 8 0-10 VAS short form McGill questionnaire
Maternal Social Support 61 27.2 (3.0) 28 16-30 MSS friends, family, partner
Childbirth Satisfaction 65 144.7 (19.2) 149 89-176 overall CBS including self, cg, partner
TABLE 2 MULTIVARIATE ANALYSIS (F VALUE 4.14
P gt F 0.0012, DEPENDENT VARIABLE IS CHILDBIRTH
SATISFACTION)
Variable Standard Error T Value P gt T
High Labor Pain Catastrophizing 5.46465 -3.24 0.0021
Maternal Social Support 4.76445 -0.62 0.5373
Baseline Depression 0.46683 0 0.9978
Pain Intensity 0.10356 0.86 0.3926
Epidural Anesthesia 5.10471 -1.06 0.2924
Cesarean Section 4.89959 -2.86 0.0061
Funded by the Foundation for Anesthesia
Education and Research (FAER)