The childbirth environment and maternal stress
Carr, Katherine Ann Comacho, 1949-
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A small n (n = 10) within subject design study was conducted to concurrently describe patterns of social interaction and maternal stress response during active labor. Multiple methods and repeated measures were utilized to capture the complex nature of this person-environment transaction. Physiologic measures, observational methods and a qualitative interview were used. Participants were married, Caucasian, English-speaking, middle class, healthy, low risk, functional primigravidae between the ages of 22 and 33 years, who labored and gave birth in a large, urban, Level III obstetrical unit. Maternal stress parameters measured at time 1 (T1) defined as 5-6 centimeters of cervical dilation and time 2 (T2), 90 minutes later or complete dilation included: state anxiety (Spielberger State Trait Anxiety Inventory), plasma cortisol, epinephrine and norepinephrine, report of pain (10 centimeter visual analogue pain scale). In addition, maternal heart rate (MHR) and fetal heart rate (FHR) were measured every minute for approximately 90 minutes from T1 to T2 via a Hewlett Packard 8040A Dual Capacity electronic fetal monitor and a computerized data acquisition system. Social interactions were assessed simultaneously with the Labor Social Environment Observational Code (LSEOC), which assessed who interacted with the laboring woman, what type of interaction occurred and maternal affect and contraction status associated with the interaction. Labor progress, procedures, use of medication and length of labor were also assessed using Friedman Graphic Analysis of Labor. A semi-structured qualitative interview was conducted within 24 hours after delivery to obtain the women's perceptions of the physical and psychosocial childbirth environment during labor.Analysis of data focused on within subject variance with attention to patterns within and across subjects. Data was presented descriptively and graphically. Time series analytic techniques were planned but not feasible due to low time zero correlations of pertinent variables.Social interaction data exhibited three childbirth environmental patterns; (1) the sustaining; (2) the protecting: engaged; and (3) the protecting: disengaged environments. Maternal stress parameters covaried with environmental type. Labor outcome was related to environmental type.The study is an initial examination of the labor social environment and its relationship with measures of maternal stress response. Studies in the past have focused on individual responses and have rarely, if ever, described them in an environmental content. Data from the study will be useful to perinatal nurses, childbirth educators and parents to help further understanding of the person/environment relationship during childbirth. Future nursing intervention and nursing research should focus on the manipulation of the social environment rather than the physical appointments in labor and delivery to improve childbirth outcomes.
- Nursing - Seattle