The Role of Maternal Attachment in the Experience of Labor Pain

Abstract

Objective: To examine the influence of attachment dimensions and sociodemographic and physical predictors in the experience of labour pain. Methods: Eighty-one pregnant women were assessed during their third trimester of pregnancy and during labour. The perceived intensity of pain in the early stages of labour (3 cm of cervical dilatation) and before the administration of patient-controlled epidural analgesia (PCEA) was measured using a visual analogue scale (VAS). Pain was also assessed based on the consumption of anaesthetics. Attachment was assessed using the Adult Attachment Scale -Revised (AAS-R). Results: Attachment anxiety and avoidance were positively and significantly correlated with labour pain and anaesthetic consumption. In the multivariate models, attachment anxiety was a significant predictor of higher pain at 3 cm of cervical dilatation (β = 0.36, p = .042) and before the administration of PCEA (β = 0.51, p = .002). Older age (β = 0.31, p = .005), a shorter duration of labour (β = -0.41, p = .001) and attachment avoidance (β = 0.41, p = .004) were significant predictors of higher anaesthetic consumption. Conclusions: The study findings suggest that perceived labour pain and anaesthetic consumption are strongly associated with attachment, rather than demographic and physical factors. These data support the importance of understanding the experience of labour pain within an attachment theoretical framework.

The influence of women’s attachment style on the chronobiology of labour pain, analgesic consumption and pharmacological effect

“…These results are consistent with prior studies suggesting an association between insecure attachment styles and higher pain intensity (Costa-Martins et al, 2014a;MacDonald & Kingsbury, 2006;McWilliams et al, 2000;Meredith et al, 2006b), thereby supporting attachment insecurity as a significant factor in vulnerability to pain. Additionally, insecurely attached women reported higher analgesic consumption and a higher ratio of PCEA demands/PCEA delivered, which reinforces the results obtained using the VAS and substantiates the literature suggesting the importance of psychological variables and individual characteristics in the prediction of analgesic consumption (Costa-Martins et al, 2014b;Ip et al, 2009). This higher pain, increased analgesic consumption and higher PCEA demands/PCEA delivered ratio among insecurely attached women may reflect not only these women's lower confidence in the PCEA technique but also their reduced ability to regulate negative emotions (Shaver & Mikulincer, 2007) and to efficiently cope with stressful experiences, such as pain (Meredith et al, 2006b).…”

“…These rhythms depend on external synchronisation, in which the influence of psychological dimensions is also important (Adam & Gunnar, 2001). In this context, associations between attachment and pain have been observed for different types of pain (Meredith et al, 2008;Meredith, 2013), including labour pain (Costa-Martins et al, 2014a, 2014b. Given this background, this study aimed to investigate the effects of attachment style and time of day on labour pain, analgesic consumption and pharmacological effect.…”

Comparison of effects of digital vaginal examination with transperineal ultrasound during labor on pain and anxiety levels: a randomized controlled trial

“…Anxiety during labor is associated with a longer duration of labor, increased pain perception, problems of maternal attachment to the newborn and increased rates of postpartum depression and post‐traumatic stress disorder. Alternative methods for tracking the progress of labor have been lacking until recent years.…”

Pain in labor assessed from two discomfort aspects: Physical pain intensity and psychological stress state

“…Pain in labor has been generally been understood as physical pain, so it has been subjectively assessed by VAS or NRS with scores representing “no pain” to “the worst pain imaginable.” However, about 35% of participants scored 80 or higher in 100 mm VAS at 3 cm of cervical dilatation and before administration of epidural analgesia . We preliminarily used the NRS‐10 ranging from 0 (no pain) to 10 (the worst pain imaginable) and could not assess the physical pain intensity in labor after the score reached 10.…”