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

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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 & Perioperative Medicine, Oregon Health & Science University, Portland, OR USA 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 (P=0.0021). 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. 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, hours postpartum and 4-8 weeks postpartum. Chart reviews were conducted hours postpartum to collect subject demographics, obstetric data and anesthesia data. Funded by the Foundation for Anesthesia Education and Research (FAER) AssessmentNMeanMedianRangeNotes Baseline depression (5.7) >12 depressed symptoms Labor Pain Catastrophizing (4.8) item scale hrs pp Pain Intensity (2.3) VAS short form McGill questionnaire Maternal Social Support (3.0) MSS friends, family, partner Childbirth Satisfaction (19.2) overall CBS including self, cg, partner TABLE 1: DESCRIPTIVE STATISTICS VariableStandard ErrorT ValueP > |T| High Labor Pain Catastrophizing Maternal Social Support Baseline Depression Pain Intensity Epidural Anesthesia Cesarean Section TABLE 2: MULTIVARIATE ANALYSIS (F VALUE = 4.14; P > F = , DEPENDENT VARIABLE IS CHILDBIRTH SATISFACTION)