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Background: Pregnancies complicated by perinatal mood disorders or a history of mental health disorder are at increased risk for complications including postpartum depression/anxiety. Patients’ perceived control over childbirth is known to be an important factor for development of postpartum depression/anxiety. It is unclear whether women with preexisting and/or current depression and/or anxiety have different perceptions of control during childbirth compared to those without these comorbidities. Objective: This study aimed to evaluate the association between a current and/or prior diagnosis of depression and/or anxiety and scores on the Labour Agentry Scale (LAS), a validated tool evaluating patient’s experience of control over their labor and delivery. Methods: This is a cross-sectional study of nulliparous patients admitted at term to a single center. Participants completed the LAS after delivery. A trained researcher performed detailed chart reviews for all participants. Participants were identified as having a current or historical diagnosis of depression/anxiety by self-report confirmed by chart review. Scores on the LAS were compared between those with versus without a diagnosis of depression/anxiety prior to admission for delivery. Results: 73 (44.8%) of the 149 participants held a current and/or prior diagnosis of depression and/or anxiety. Baseline demographics were similar between those with and without depression/anxiety. Mean scores on the LAS (range=91-201) were significantly lower for those with depression/anxiety than those without a prior diagnosis (150.0 vs 160.5, p<0.01). Even after controlling for mode of delivery, admission indication, anesthesia and foley balloon usage, participants with anxiety and depression had scores which were on average 10.4 points lower on the LAS (95% CI -19.25, -1.62). Conclusion: Participants with a current and/or prior diagnosis of depression and/or anxiety scored lower on the LAS as compared to those without psychiatric diagnoses. Patients with psychiatric diagnoses may benefit from increased education and support during childbirth.

Objective: Dispositional optimism (DO) is an understudied transdiagnostic resilience factor among peripartum individuals. Low DO is associated with increased fear and pain in labor and increased rates of emergent cesarean delivery, but it is unknown whether DO is associated with perceived control over the labor process. Study design: This a planned secondary analysis of a prospective observational cohort of term parturients (n=164) who were recruited in July and August 2021 during their delivery hospitalization at a single, tertiary medical center. Participants completed a baseline demographic survey prior to delivery and then completed evaluations of DO (Revised Life-Orientation Test, LOT-R) and control over the labor process (Labour Agentry Scale- LAS) during their postpartum hospitalization. DO was dichotomized into low and high by score of ≤ 14 or >14 on LOT-R, respectively, and labor agentry scores were compared between groups. Maternal demographics, pregnancy and delivery characteristics were compared by DO status. Multivariable regression was performed, adjusting for known confounders (induction, labor analgesia and mode of delivery). Results: Demographic, pregnancy and neonatal characteristics were similar between those with low compared to high DO. People with low DO had significantly higher rates of cesarean section (44 vs 24%, p=0.02) and overall had lower LAS scores (139.4 vs 159.4, P<0.001), indicating that they felt less control over their labor process than those with high DO. In the multivariable regression, those with low DO had higher odds of a low LAS score after controlling for induction, labor analgesia, and mode of delivery (aOR 1.29, 95% CI 1.20-1.39). Conclusions: People with low DO had significantly lower perceived control over their labor, even after controlling for differences in mode of delivery. Interventions to alter DO may be an innovative way to improve birth experience and its associated perinatal mental health morbidities.

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