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Psychosomatic Medicine 68:167-174 (2006)
© 2006 American Psychosomatic Society

ORIGINAL ARTICLES

Psychosocial Influences on Women’s Experience of Planned Elective Cesarean Section

Edmund Keogh, PhD, Shelley Hughes, MSc, Deborah Ellery, PhD, Clare Daniel, D. Clin Psy and Anita Holdcroft, MD

From the Department of Psychology, University of Bath, Bath, UK (E.K.); Goldsmiths College, London, UK (S.H., D.E.); and Imperial College London, London, UK (C.D., A.H.).

Address correspondence and reprint requests to Edmund Keogh, Department of Psychology, University of Bath, Bath, BA2 7AY, United Kingdom. E-mail: e.m.keogh{at}bath.ac.uk

Objective: The successful management of pain from normal or interventional delivery is an important part of women’s experience of childbirth. Our objective was to examine psychosocial factors (expectations, control beliefs, anxiety sensitivity) as measured in mothers and birth partners before an elective cesarean section. We focused on the impact that these variables have on maternal fear and pain during and after delivery.

Methods: Sixty-five women booked for an awake cesarean section with a regional nerve block and their birth partners were recruited. Data were collected at three time points for the mothers, before, during the cesarean section and after delivery on the postnatal ward, and at two time points for the birth partners (before and during the cesarean section).

Results: Maternal fear responses varied during the operation, in that fear was greatest at the point of administration of the nerve block. Within mothers, preoperative negative expectations were related to fear experiences during delivery, which was in turn related to their postoperative pain. Maternal anxiety sensitivity was found to mediate the relationship between negative expectations and fear, whereas birth partner’s fear mediated between maternal fear and postoperative pain. Mothers’ prenatal perceptions of control over drugs predicted their postoperative pain.

Conclusions: Maternal fear during cesarean section not only fluctuates, but may be influenced by psychosocial factors, including their birth partner. Psychosocial factors were also important predictors of postoperative experiences. Interventions that appropriately manage psychological and social factors during cesarean delivery may facilitate a more positive experience for mothers.

Key Words: cesarean section • pain • anxiety sensitivity • birth partner • social support • fear

Abbreviations: ASI = Anxiety Sensitivity Index; SF-MPQ = Short form McGill Pain Questionnaire; VAS = visual analogue scale; VerbAS = verbal analogue scale; CS = cesarean section; MPQ-S = Sensory scale of the short form McGill Pain Questionnaire; MPQ-A = Affective scale of the short form McGill Pain Questionnaire




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