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We sought to determine whether women's attitudes and concerns, confidence in ability to control pain, and practice of pain-control techniques would predict pain and coping or distress-related thought during labor. During the third trimester of their pregnancies, 115 women completed the prenatal self-evaluation inventory and measures of confidence and practice of pain-control techniques. During the latent (less than or equal to 3 cm), active (4-7 cm), and transition (greater than or equal to 7 cm) phases of labor, interviews were conducted to assess levels of pain and the content of women's cognitive activity on a continuum that ranged from coping-related thought to distress-related thought. Women's confidence in their ability to use relaxation techniques and their reported practice of pain-control strategies did predict lower levels of pain and greater coping-related thought during latent labor, but failed to account for pain or coping-distress in active or transition phases of labor. High scores on the Prenatal Self-Evaluation Inventory fear of pain and helplessness scale predicted high levels of distress during latent labor. Two other scales, concern for self and baby and acceptance of pregnancy, were significant predictors of pain and distress in active and transitional labor. The results suggest that, with the shift from latent to active labor, women's fundamental concerns and anxieties become manifest, and may take precedence over the skills acquired through childbirth education in moderating experienced pain and distress.

This study examined the dynamic interplay between subjective pain, pain behavior and cognitive activity during the latent (less than or equal to 3 cm), mid-active (5-7 cm) and transition (greater than or equal to 8 cm) phases of labor in 115 nulliparous women. Subjects received no analgesia during the latent phase and either no analgesia or epidural analgesia during the active and/or transition phase. Data were analyzed according to phase and analgesic condition. For subjects with no epidural analgesia, both the Present Pain Intensity (PPI) and the Present Behavioral Intensity (PBI) scores were correlated within and between phases. In contrast, Coping/Distress scores were weakly correlated between the latent and active labor phases and were unrelated between the active and transition phases. PPI and Coping/Distress scores were highly correlated within the latent phase but were independent within the active and transition phases of labor. PBI and Coping/Distress scores were moderately correlated within the latent and active phases and were unrelated during the transition phase. Epidural techniques reduced subjective pain and pain behavior significantly but had no apparent effect on the coping or distress-related cognitive activity characteristic of active labor. We concluded that coping and distress-related cognitive activity in labor may follow a phase-specific pattern which is relatively independent of pain or pain relief after labor has become active.

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