Does cognitive flexibility affect the course of labor? A prospective study

Abstract

ObjectiveTo evaluate cognitive flexibility and labor and delivery outcomes.MethodsA prospective study was conducted of nulliparas with singleton term pregnancy, admitted for labor to a tertiary referral center from 1 January to 31 July, 2017. After epidural anesthesia, parturients completed the validated Psychological Flexibility Questionnaire (20 questions that evaluate a person's level of cognitive flexibility) before delivery. They were asked to grade (from 1 to 10) their hope for vaginal delivery (Hope score). Within 2 hours after delivery, they graded (1–10) the similarity between their delivery and their expectations (Expectation score). Outcomes of the flexible versus less flexible group were compared.ResultsAmong the flexible (n=120) versus less flexible (n=40) group, vaginal delivery was more common (74.2% vs 20.8%) than vacuum extraction (20.8% vs 35%) or cesarean delivery (5% vs 12.5%) (P=0.031). High Expectation score and delivery without grade III–IV perineal tear (P=0.032) were correlated. Groups were similar regarding Expectation (P=0.163) and Hope scores (P=0.591). The mode of delivery of parturients was not correlated with their mothers’ (P=0.836) or sisters’ (P=0.758).ConclusionHigh cognitive flexibility increases the likelihood of vaginal delivery. These findings support the mind–body correlation. Maternal cognitive perceptions can influence labor and delivery and should be considered when counseling patients during labor.

The mindset of birth predicts birth outcomes: Evidence from a prospective longitudinal study

“…More recent studies also investigated more cognition-based approaches: Haines et al (2012) showed that birth-related attitudes (e.g., safety concerns, personal impact) predicted labour and birth outcomes such as having an epidural. A study conducted by Asali et al (2019) indicated that women scoring higher in psychological flexibility (e.g., being optimistic about future challenges) were more likely to give birth vaginally than women scoring low on this. Natural versus medical birth beliefs also seem to play a role.…”

“…A growing number of studies are suggesting that psychological factors are not limited to outcomes of childbirth such as well‐being or bonding with the baby. Psychological factors themselves might also be predictors of labour and birth outcomes such as needing epidurals (e.g., Haines et al., 2012) or C‐sections (e.g., Asali et al., 2019). The list of studied predictors of birth outcomes is long.…”

“…A study conducted by Asali et al. (2019) indicated that women scoring higher in psychological flexibility (e.g., being optimistic about future challenges) were more likely to give birth vaginally than women scoring low on this. Natural versus medical birth beliefs also seem to play a role.…”

“…The list of studied predictors of birth outcomes is long. It includes attitudes (Haines et al., 2012), beliefs (Preis et al., 2018), emotions (Handelzalts et al., 2015; Ryding et al., 1998), expectations (Bar‐On et al., 2013; Soliday et al., 2013), cognitive flexibility (Asali et al., 2019), and personality traits (Johnston & Brown, 2012). Nevertheless, although the measured constructs were psychological variables and many of the studies were conducted by psychologists, only a minority of those studies are published in psychological journals.…”