Emotional stress in childbirth and its modification by variations in obstetric management. Epidural analgesia and stress in labor

Abstract

Emotional stress before, during and after labor was measured in 20 primigravidae by serial estimation of plasma 11-hydroxycorticosteroids and by stress assessment interviews. The anticipation of epidural analgesia and internal fetal monitoring was a significant source of emotional stress to women awaiting induction of labor, despite explanation and attempted reassurance. During labor epidural analgesia reduced stress by abolishing pain, so eliminating the progressive rise in 11-hydroxycorticosteroids normally seen throughout labor. Epidural analgesia does not, however, block the potential for the adrenocortical response to stress and the physical work, emotional stress and surgical trauma of delivery stimulate a considerable output of 11-hydroxycorticosteroids.