Symptom Experience in Late Pregnancy.

OBJECTIVE: To evaluate the frequency, severity, distress, and correlates of common and rare symptoms reported by nulliparous women during the last month of pregnancy. DESIGN: Secondary cross-sectional analysis of data obtained in a larger randomized clinical trial. SETTING: San Francisco Bay area. PARTICIPANTS: Nulliparous, ethnically diverse, predominantly low-income pregnant women 18 to 47 years of age (N = 151). METHODS: Participants at or beyond 36 weeks gestation used the Memorial Symptom Assessment Scale (MSAS) to provide self-reports of general symptom experience. Other symptom measures were also completed for comparison. Demographic characteristics, including gestational weight gain, were also collected. Gestational weight gain was categorized in relation to the Institute of Medicine's 2009 recommendations for weight gain during pregnancy. RESULTS: Women endorsed an average of 10.6 ± 5.6 symptoms on the MSAS. Prevalent symptoms (reported by at least half the sample) included lack of energy, pain, difficulty sleeping, worrying, irritability, drowsiness, shortness of breath, and nervousness. Among the women who reported these symptoms, relatively few described them as occurring with high frequency or severity or as causing much distress. One of the most prevalent symptoms (reported by 68% of women) was difficulty sleeping, which also had among the greatest ratings for frequency, severity, and distress. Although few maternal characteristics were associated with symptom experience, women who gained more weight than the Institute of Medicine's recommendation had worse MSAS total scores than women who gained the recommended amount or less. CONCLUSION: In nulliparas, symptom frequency, severity, and distress varied and were related to excessive gestational weight gain.

Sleep disruption and duration in late pregnancy is associated with excess gestational weight gain among overweight and obese women.

BACKGROUND: Poor sleep during pregnancy has been associated with poorer birth outcomes. High body mass index (BMI) is often associated with poor sleep, but little is known about the relationship between gestational weight gain and sleep in late pregnancy. The purpose of this study was to evaluate the relationships of both gestational weight gain and pre-pregnancy BMI to objective and subjective measures of sleep during late pregnancy. METHODS: Pregnant women (n=128) were recruited from prenatal clinics and childbirth classes primarily serving low-income women. Their sleep (disruption and duration) was objectively assessed in their last month of pregnancy with 72 hours of wrist actigraphy monitoring. Their perceived sleep quality was assessed with the Pittsburgh Sleep Quality Index. Pre-pregnancy and late pregnancy height and weight were assessed by self-report and used to calculate BMI and gestational weight gain, which were then grouped into standardized categories. RESULTS: Mean Pittsburgh Sleep Quality Index score was 6.8 ± 3.1 (range 2-16). Sixty percent had excess gestational weight gain and it was associated with poorer perceived sleep quality, but was unrelated to objective measures of sleep duration and disruption. Pre-pregnancy BMI was unrelated to all sleep parameters. However, analyses of the interaction of pre-pregnancy BMI and gestational weight gain indicated that excess weight gain was associated with shorter sleep duration and more sleep disruption, but only among women who were overweight before pregnancy. CONCLUSION: Pregnancy is an opportunity to promote long-term women's health with a better understanding of the relationship between weight management and healthy sleep habits.

Hypnotherapy for labor and birth.

Hypnotherapy is an integrative mind-body technique with therapeutic potential in various health care applications, including labor and birth. Evaluating the efficacy of this modality in controlled studies can be difficult, because of methodologic challenges, such as obtaining adequate sample sizes and standardizing experimental conditions. Women using hypnosis techniques for childbirth in hospital settings may face barriers related to caregiver resistance or institutional policies. The potential anxiolytic and analgesic effects of clinical hypnosis for childbirth merit further study. Nurses caring for women during labor and birth can increase their knowledge and skills with strategies for supporting hypnotherapeutic techniques.

The effects of childbirth self-efficacy and anxiety during pregnancy on prehospitalization labor.

OBJECTIVE: To describe levels of anxiety and self-efficacy for childbirth in nulliparous women during the late third trimester and to identify relationships among those variables, prehospitalization labor pain, management strategies, and hospital admission status. DESIGN: A longitudinal, descriptive study. PARTICIPANTS: Thirty-five English-speaking nulliparous women, 18 to 40 years of age, more than or equal to 38 week's gestation, with uncomplicated pregnancies. All participants had a significant other (husband or partner) and attended childbirth education programs. MAIN OUTCOME MEASURES: Spielberger Trait Anxiety Inventory, Prenatal Self-Evaluation Questionnaire, Childbirth Self-Efficacy Inventory, McGill Pain Questionnaire-Short Form, postpartum interviews, and medical records review. RESULTS: Prenatal anxiety was significantly related to self-efficacy for childbirth in late pregnancy, labor pain, number of hours at home in labor, and admitting cervical dilation. The number of management strategies used was related to pain scores during labor before hospital admission. Women who spent longer periods of time at home in labor arrived at the hospital with a greater cervical dilation. CONCLUSIONS: Antenatal characteristics influence intrapartal outcomes in nulliparas. Labor environment, at home and in the hospital, is recognized as an important component of the first childbirth experience.

Sleep disturbance in late pregnancy and early labor.

UNLABELLED: Sleep disturbance is a typical complaint during pregnancy, particularly in the third trimester. Previous studies of this phenomenon have not measured sleep in the last days of pregnancy as women transition into labor. Poor sleep can have potentially adverse effects on labor and delivery. OBJECTIVE: The purpose of this study was to evaluate the amount of sleep obtained in the 5 days preceding childbirth, and the relationship between sleep in this time frame and both pain and fatigue during early labor. METHODS: Thirty-five nulliparous women were recruited from childbirth preparation classes. Sleep was measured with wrist actigraphy continuously until hospital admission for delivery. Participants completed self-report measures of pain and fatigue in early labor prior to hospital admission. RESULT AND DISCUSSION: Most women experienced spontaneous labor onset during the night. Sleep quality deteriorated progressively over the last 5 days of pregnancy, and was the lowest on the night before hospital admission. This was the case even when labor was induced (40%). CONCLUSION: There was a significant relationship between the amount of sleep the night before hospitalization and pain perception in women with spontaneous labor onset. Results from this study can be used to advise women in late pregnancy about expected sleep patterns and measures to optimize sleep and rest.

Expectations, perceptions, and management of labor in nulliparas prior to hospitalization.

This ethnographic qualitative study was designed to explore the phenomenon of prehospitalization labor from the perspective of nulliparous women. Twenty-three women were interviewed in the early postpartum period using a semistructured interview guide. The participants recounted their experiences with labor onset recognition and management before being admitted to the hospital for birthing. Qualitative analyses included verbatim transcription of audiotaped interviews, line-by-line coding, and categorization of data into codes and categories. Interpretive analyses were validated with a collaborative research team and the participants themselves. The central theme that emerged from this study was confronting the relative incongruence between expectations and actual experiences. Supporting categories included: expectations about the labor experience, identifying labor onset, managing the physical and emotional responses to labor, supportive resources, and decision making about hospital admission. Early labor experiences in nulliparas offer insight into the contributions of both expectations and environment to adaptation in labor. Midwives and perinatal nurses are in a unique position to design interventions that support and reinforce laboring women's activities outside of the hospital setting.