Nancy K. Lowe

The nature of labor pain

A somewhat paradoxic aspect of childbirth is the association of this physiologic process with acute pain. The experience of pain during labor is the result of complex processing of multiple physiologic and psychosocial factors on a womans individual interpretation of nociceptive labor stimuli. The nature of labor pain, particularly its physiologic and psychologic influences, is reviewed in the context of a multidimensional framework of the pain experience and an understanding of the origin of labor pain stimuli, of potential adverse effects of the pain response, and of the concepts of suffering and comfort.

Self-efficacy for labor and childbirth fears in nulliparous pregnant women.

In this secondary analysis, the relationship between self-efficacy for labor and childbirth fears in healthy nulliparous women was investigated during the third trimester of pregnancy. The sample consisted of 280 predominantly white, well-educated, middle-class nulliparae enrolled in childbirth classes. Consistent with Banduras self-efficacy theory, outcome expectancies for childbirth were unrelated to childbirth fears while self-efficacy expectancies were significantly correlated with childbirth fears. When the sample was divided into a low-fear and a high-fear group, significant differences were found between groups on a number of psychological variables. The women in the high-fear group were characterized by significantly higher learned helplessness, chance health locus of control and powerful others health locus of control, and significantly lower self-esteem and generalized self-efficacy. The most common fears of the high-fear women were of losing control during delivery, of the birth itself, of something being wrong with the baby and of painful contractions.

Confirming the theoretical structure of the McGill pain questionnaire in acute clinical pain

&NA; Based upon a tripartite theoretical model of pain, the Pain Rating Index (PRI) of the McGill Pain Questionnaire (MPQ) continues to be one of the most frequently used instruments to measure clinical pain. Although a number of exploratory factor analytic studies have failed to consistently support the theoretical structure of the instrument, one previous confirmatory factor analytic study of chronic pain did statistically support the a priori model. Because it has been suggested that acute pain may not involve the same dimensions as chronic pain, this study provided a direct test of the theoretical structure of the MPQ through multi‐sample confirmatory factor analysis (CFA) using data provided by women experiencing pain during labor (n = 185) and women experiencing acute postoperative pain (n = 192). Results of the LISREL CFA analysis indicated that the a priori, 3‐factor, oblique model originally proposed by Melzack provided the most parsimonious representation of the data across the 2 samples of acute pain.

Individual variation in childbirth pain

The study explored the impact of 6 predictor variables on pain experienced by 50 women during early, active, transitional, and second stage labor. Childbirth preparation, parity, state anxiety, confidence in ability to cope with labor, concern regarding the outcome of labor for self and baby, and fear of pain were the predictor variables. Confidence in ability to cope with labor, state anxiety, and fear of pain explained a substantial amount of the variance in early and active labor pain reported by the women, but not transitional or second stage pain. Childbirth preparation and parity explained a significant but small amount of the variance in second stage labor pain.

Over-the-counter medications and self-care.

More than 100,000 over-the-counter (OTC) products are now sold in drugstores, convenience stores, gas stations, and supermarkets. In 1997, the OTC retail market was responsible for an estimated

Critical predictors of sensory and affective pain during four phases of labor

20.6 billion in health care savings. This article discusses the methods by which drugs are approved for OTC use by the Food and Drug Administration. The article also reviews trends and issues related to self-care with OTC medications, including cost-effectiveness, managed care, advertising, and safety. The clinician should assume that OTC use is a common patient self-care behavior; therefore, information regarding the patients OTC use should be collected during the history taking. Other implications of OTC use for primary care providers are proposed.

Differences in first and second stage labor pain between nulliparous and multiparous women

This descriptive study explored the impact of five psychological and seven physiological predictor variables on sensory and affective pain during early, active, transitional and second-stage labor. Confidence in ability to handle labor, cervical dilatation and fetal station accounted for approximately 33% of the variance in sensory and affective early labor pain, while confidence, severity of menstrual pain and parity explained 21% of sensory and 39% of affective active labor pain. For transitional labor, approximately 24% of sensory pain was explained by menstrual pain, confidence and length of labor, while confidence and menstrual pain contributed 31% of explained variance for affective pain. Concern regarding the outcome of labor and fear of pain explained a small but significant portion of second-stage labor pain.

Military women’s perspectives on health care during deployment

This descriptive clinical study investigated differences in pain reported during four phases of labor by nulliparous as compared to multiparous parturients. Sixty-five nulliparas and 100 multiparas participated by responding to the Short-form McGill Pain Questionnaire during early (0-3 cm), active (4-7 cm), transitional (8-10 cm), or second stage labor. Sensory pain was significantly greater in nulliparous than multiparous women during early and active labor, and significantly less during second stage. Significantly higher affective pain scores were reported by nulliparas during active and transitional labor with no differences by parity identified for early or second stage labor. These preliminary findings are interpreted in relationship to clinical and theoretical differences in the physiology and psychology of labor for first-time as compared to veteran parturients.ZusammenfassungDiese deskriptive klinische Studie untersuchte die Unterschiede in den wahrend der vier Phasen der Geburt von Nullipari im V...

A critical review of visual analogue scales in the measurement of clinical phenomena

Approximately 367,000 women serve in the U.S. military and regularly deploy with their units to austere military environments. A survey was used to describe 841 military womens perceptions about the health care provider that is available them during deployment and their perceptions of barriers to adequate diagnosis and treatment of gynecologic infections in these austere environments. The study findings have implications for military provider training, sick call policy, predeployment training, and development of self-care alternatives for military women during deployment.