The prevalence of pain catastrophising in pregnancy and its influence on latent phase hospital admission The RETHINK Study.

Abstract

Background: Women experiencing an uncomplicated pregnancy are at increased risk of interventions if admitted to hospital during the latent phase of labour. Women expecting their first child (nulliparous) are more likely to be admitted during the latent phase than women who have had one (primiparous) or more babies (multiparous). Pain and fear are cited as significant factors in early hospital admissions. Some women may have exaggerated, negative cognitions for their pain experience, which have been referred to as pain catastrophising. To date there have been no studies that have sought to use a screening tool to identify pain catastrophising in pregnancy and to understand if a positive screening result influences when nulliparous women seek hospital admission in labour. Study aim: The primary aim of this study was to determine the prevalence of pain catastrophising in a population of nulliparous women who were experiencing an uncomplicated pregnancy, and to determine whether pain catastrophising had an impact on their timing of admission to hospital when they were in labour. Method: This was a longitudinal cohort study. Nulliparous women, experiencing an uncomplicated pregnancy in England, were recruited between 25-33 weeks gestation. Participants completed two online questionnaires, (1) on recruitment, (2) at three weeks postnatal. The antenatal questionnaire included the Pain Catastrophizing Scale (PCS) and the Wijma Delivery Expectancy Questionnaire (WDEQ-A) to detect fear of childbirth (FOC). Results: A total of 389 eligible participants entered the study. Pain catastrophising scores of ≥20 and ≥30 were considered. There were 28.1% of women who indicated PCS scores ≥20 and 7.6% who were in the group with PCS scores ≥30. There was no significant association between pain catastrophising and the timing of hospital admission. The percentage of women reporting FOC (WDEQ-A score ≥85) was 10.6%. FOC (WDEQ-A score ≥85) was highly associated with PCS scores (p<.001) at both the lower (≥20) and higher (≥30) thresholds. Other significant associations were found between pain catastrophising and the variables of ethnicity, age, antenatal pain, and postnatal mental health issues. Discussion: Although there was no significant association found between pain catastrophising and the timing of hospital admission, there was a tendency identified for women who pain catastrophise to present to hospital for admission during the latent phase of labour. Since FOC is known to be associated with latent phase admission, the highly significant association between PCS and WDEQ-A scores has implications for the identification of these women. The findings suggest that the PCS can be used as a screening tool to identify those women who have exaggerated, negative cognitions around pain and who may also go on to develop clinically relevant FOC. Further studies are needed to confirm the acceptability of the PCS as a screening tool with women, and to confirm the tendency that women who pain catastrophise are more likely to present to hospital for admission during the latent phase of labour. Impact: To date no studies have sought to measure the prevalence of pain catastrophising in a population of nulliparous women who are experiencing a healthy pregnancy at low obstetric risk. This is also the first study to explore the impact of pain catastrophising on nulliparous women’s decision-making regarding when to seek hospital admission in labour. This thesis makes an original contribution to knowledge by addressing these gaps in knowledge and brings together pain catastrophising and the latent phase of labour, two areas that have not been studied together before. It paves the way with evidence to facilitate further work for early identification of vulnerable women and the development of a targeted support intervention.