Catastrophizing mediates the relationship between fear of pain and preference for elective caesarean section

Abstract

Background Fear of childbirth is associated with preference for an elective caesarean section (ECS); however, the role of fear of pain and pain catastrophizing (the tendency to predict the worst case scenario) have not been investigated. The aim of current study was to investigate whether fear of pain and catastrophizing were independent predictors of preference for ECS. We hypothesized that pain catastrophizing and negative affectivity would mediate the relationship between fear of pain and preference for ECS. Methods Three hundred pregnant women between 4 and 36 weeks of gestation were asked to indicate whether they would prefer to deliver their baby through an ECS or a vaginal delivery. They were also asked to complete a battery of questionnaires assessing demographic details, mood, fear of childbirth, fear of pain and catastrophizing. Consistent with cultural norms, more than half of the women preferred an ECS (58%). Results Women who chose ECS were more likely to seek private obstetric care, have had a previous caesarean section and have higher levels of fear of childbirth, fear of pain, more catastrophic cognitions and lower mood. Catastrophizing, but not negative affectivity, mediated the relationship between fear of pain and preference for ECS, as predicted. Conclusions Fear of both childbirth and pain were both independent predictors of preference for ECS. Catastrophizing mediated the relationship between fear of pain and preference for ECS. Interventions that target these factors may reduce the trend towards increasing numbers of ECS internationally.

Potential mechanisms in fear of birth: The role of pain catastrophizing and intolerance of uncertainty

“…Pain catastrophizing refers to “an exaggerated negative ‘mental set’ brought to bear during actual or anticipated pain experience.” With regard to childbirth, the tendency to exaggerate the negative aspects of pain has been associated with higher ratings of both anticipated and experienced pain during childbirth . Pain catastrophizing has also been found to mediate the relationship between fear of pain and preference for cesarean delivery . Although pain catastrophizing is specifically focusing on pain‐related cognitions, catastrophic beliefs in general have been suggested as a transdiagnostic mechanism across mental disorders …”

“…34 Pain catastrophizing has also been found to mediate the relationship between fear of pain and preference for cesarean delivery. 35 Although pain catastrophizing is specifically focusing on pain-related cognitions, catastrophic beliefs in general have been suggested as a transdiagnostic mechanism across mental disorders. 20 To our knowledge, none of these variables has previously been studied in relation to fear or anxiety of giving birth.…”

Heterogeneity in childbirth related fear or anxiety

“…The concept of pain catastrophizing has been investigated in relation to childbirth in a few studies, suggesting a positive correlation with fear of being overwhelmed by pain during childbirth (Van den Bussche, Crombez, Eccleston & Sullivan, 2007), and the experience of pain intensity during delivery (Flink, Mroczek, Sullivan & Linton, 2009). Pain catastrophizing has also been found predictive of choosing elective Caesarean section as mode of birth (Dehghani, Sharpe & Khatibi, 2014). However, to our knowledge, pain catastrophizing as an element of childbirth related fear or anxiety has not been studied.…”

Maternal quality of life in routine labor epidural analgesia versus labor analgesia on request: results of a randomized trial

“…For many pregnant women, the fear of labor pain is also of major concern, resulting in severe fear of childbirth in 6-10% [17]. This fear of pain can even result in a request for an elective cesarean section [18].…”