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Clinical question
Do women who experience labor as a threat to their own life or to their
infant's life have an increased risk of postpartum depression?
Bottom line
Catastrophizing pain during labor is associated with increased risk of
postpartum depression and poor social functioning; intensity of pain is not.
Watch for postpartum depression and poor social adjustment in women who
claim they were dying in labor.
Reference
Ferber SG, Granot M, Zimmer EZ. Catastrophizing labor pain compromises later
maternity adjustments. Am J Obstet Gynecol 2005; 192:826-31.
Study design: Cohort (prospective)
Setting: Inpatient (ward only)
Synopsis
Pain catastrophizing is defined as an exaggerated negative orientation to
painful stimuli. It includes 3 components: (1) rumination (focusing on the
pain); (2) magnification (tendency to exaggerate the consequences of pain);
and (3) helplessness. Pain catastrophizing during active labor was assessed
in a cohort of 82 Israeli women using a validated pain catastrophizing
scale. Pain intensity was assessed using a visual analog scale. These
measures were repeated after 2 days by asking women to recall their labor.
Six weeks later, depression was assessed using the Edinburgh Postnatal
Depression Scale and social functioning was assessed with the corresponding
domain of the Short Form 36 health survey questionnaire. Analysis was
controlled for maternal age, education, and parity. A high catastrophizing
score was associated with postpartum depression and with poor social
functioning. A high pain score was not. |