Study On The Prenatal Psychological Stress And Postpartum Depression And Neuraxial Labor Analgesia Decreasing Stress And Promote Safe Childbirth

Part?Influence of Antenatal Anxiety and Fear of Childbirth on Birth ProcessObjective:To explorethe influence of antenatal anxiety(ANA)and fear of childbirth(FOC)on birth process of primipara.Methods:The study was antepartum part of a longitudinal,prospective investigation of perinatal psychological stress(Part I).All participants were randomly selected from parturients received antenatal care at the Tongling Maternity and Child Health Care Hospitalbetween July 2016 and December 2016.Subjects were interviewed and the questionnaires were completed at 35-40 week of gestation.Symptoms of ANAwas assessed by Self-rating Anxiety Scale(SAS).FOC was assessed by the Numerical Rating Scale(NRS).A questionnaire was designed to investigate the socio-psychological characteristics correlated with ANA and FOC.Blood samples which were used for plasmacortisol(COR)concentration measurements were collected.Information on birth process was taken from medical records.Results:The data was statistically analysed from 286 women with complete information.26.9%(77 of 286)of the women scared childbirth(NRS?6)and 18.2%(52 of 286)had antenatal anxiety(SAS?50).In the third trimester of pregnancy,the women with FOC would prefer to perform cesarean section(P<0.001).More women with FOC requestedneuraxial labor analgesia(P = 0.035),and more pre-laborcesareansection performed(P=0.016),and not in-labor cesarean delivery.The women with ANA had a increased risk of cesarean section compared with women without ANA(P=0.003),primarily had more in-labor cesarean section(P=0.021).No matter whether or not analgesia,FOC and ANA had no significant influence on labor duration.The level of COR was higher in women with ANA(P=0.016).Multivariate binary logistic regression identified that lack of knowledge about childbirth(OR=2.06,95%CI1.16-3.68)and expectancy of intolerable labor pain(OR=9.95,95%CI5.41-18.33)increased the risk of FOC,living condition(OR=3.52,95%CI1.85-6.73)and mood during pregnancy(OR=3.68,95%CI1.65-8.21)were independently associated with ANA.Conclusions:Antenatal psychological stress,FOC and ANA,had some influence on the process of childbirth.There were some psychosocial factors associated with higher risk of antenatal psychological stress.Part ?Effect of Neuraxial Labor Analgesia on Maternal Stress during ChildbirthObjective: The aim of this study was to investigate whether the neuraxial labor analgesia can decrease the level of stress hormones in maternal plasma such as cortisol(COR),beta endorphin(?-EP),epinephrine(EPI)and norepinephrine(NOR)with relieving labor painor not.Methods:The study was an intrapartum part of a longitudinal,prospective investigation of perinatal psychological stress.It was a case-control study.Among 98 eligible nulliparous women with a singleton fetus in cephalic presentation who had vaginal delivered at term,62 received CSEA and 36 received no labor analgesia.Parturients who received CSEA technology at a cervical dilatation of 2–3 cmwere allocated to the CSEA groupafter informed consent for neuraxial labor analgesia.Blood samples for COR,?-EP,EPI,NOR plasma concentration measurements were collected at3 stages: immediately before analgesia(Stage 1,cervical dilatation of 2–3 cm),at cervical dilatation of 5–8 cm(Stage 2,at least 1 hours after analgesia for analgesia women),and pushing period at full cervical dilatation(Stage 3).Labor pain was assessed by the Numerical Rating Scale(NRS)before and after analgesia.Clinical information were extracted from the delivery records of all eligible womenResults:Neuraxial labor analgesiaeffectively relieved pain during delivery.NRS for labor pain was significantly lower in women with labor analgesia than without analgesia(P<0.001).Both the first and second stage were sigificantly prolonged in women with labor analgesia(P<0.001,P=0.002).EPI level was higher in women with requesting for labor analgesia at Stage 1(P=0.037).At Stage2 and Stage3,?-EP,EPI,and NOR levelwas significantly lower in women received labor analgesia than women without analgesia(P<0.05).From Stage 1 to Stage 2,all hormones level showed a significant decrease with use of neuraxial labor analgesia(P<0.05)although there were mild increasefor all at Stage 3.The absence of labor analgesia was associated with irregular change for hormones,while EPI keep on a significantly rise during labor(P = 0.042).Additionally,EPIlevel at Stage 1 was positively correlatedwith fear of childbirth(P=0.001).Conclusion:Neuraxial labor analgesia effectively reduces maternalstress hormones levelduring labor,probably by eliminatingmaternal stress associated with labor pain.Part? The Role of Neuraxial Labor Analgesia in the Development of Postpartum DepressionObjective: To test the hypothesis that sufficient pain relief of neuraxial labor analgesiaduring labor decreases the risk of postpartum depression(PPD).Methods: The study was postnatal part of a longitudinal,prospective investigation of perinatal psychological stress.168 nulliparous women with vaginal delivery received postpartum follow-up at 6 weeks after delivery,124 received CSEA and 44 received no labor analgesia.Parturients who received CSEA technology at a cervical dilatation of 2–3 cm were allocated to the CSEA groupafter informed consent for neuraxial labor analgesia.All women received questionnaire for Delivery Satisfaction at 4 days after childbirth and filled in the Edinburgh Postnatal Depression Scale(EPDS)at 6 weeks after childbirth.Blood samples for cortisol(COR),estradiol(E2),progesterone(PROG)plasma concentration measurements were collected at4 days after childbirth.A cut-off point of 10 or more was used to identify PPD.Results:20.83%(35 of 168)of the women had postpartum depression(EPDS?10),in which 10.71%(18/168)were severe(EPDS?13).Postpartum depression occurred in 16.9%(21 of 124)of parturients who received labor analgesia and in 31.83%(14 of 44)of those who did not.Use of neuraxial labor analgesia was associated with a decreased risk of postpartum depression(P=0.037).Delivery Satisfaction was not influenced by the use of neuraxial labor analgesia(P > 0.05).Antenatal anxiety was positively correlated with postpartum depression(P = 0.004).Presence of antenatal anxiety increased the prevalence of PPD regardless of use of labor analgesia(P=0.045,P=0.014).There was no significant correlation between the levels of COR and PROG at 4 days after childbirthwith analgesia or PPD.Women with PPD had lower mean E2 level(38 vs 54pg/ml,P=0.003)at 4 days after childbirth.Conclusion: The presence of labor epidural analgesia seems to decrease the risk of postpartum depression,but not enough for active delivery experience.