• Sigridur Sia Jonsdottir, Thora Steingrimsdottir, Marga Thome, Guðmundur Kristjan Oskarsson, Linda Bara Lydsdottir, Halldora Olafsdottir, Jon Fridrik Sigurdsson, and Katarina Swahnberg.
• Department of Health and Caring Sciences, Linnaeus University, Stagneliusgatan 14b, 392 34 Kalmar, Sweden; School of Health Sciences, University of Akureyri, Nordurslod 2, 600 Akureyri, Iceland. Electronic address: siaj@unak.is.
• Midwifery. 2019 Feb 1; 69: 1-9.

ObjectiveThe purpose of this study was to investigate possible associations between distress in pregnant women and their use of pain management and medical interventions. Furthermore, we assessed the effects of reported dissatisfaction in relationship with their partner, or weak social support.DesignThis was a prospective cohort study.SettingWomen were invited to participate while attending prenatal care at participating Icelandic health care centres. Birth outcome data were obtained from the hospitals where these women gave birth.ParticipantsWomen in this study participated in a research project where 2523 women were screened three times during pregnancy for anxiety and depression. Women who had positive results at screening were invited to a semi-structured interview during pregnancy as well as every fourth woman who had negative results. Five hundred and sixty-two women participated in the interviews and the final sample was 442 women.MeasurementsDistress was defined as symptoms of anxiety, stress and depression. The Edinburgh Postpartum Depression Scale (EPDS) and the Depression, Anxiety and Stress Scales (DASS) were used for screening purposes. During the interview, the women answered the Dyadic Adjustment Scale (DAS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Adverse Experienced Interview (AEI). The main outcome variables that were obtained from the women's childbirth records were: (1) use of pain management, categorized as: epidural analgesia, non-pharmacological pain management, nitrous oxide, pharmacological medication, or no pain management; (2) medical interventions categorized as: induction, stimulation, and episiotomy; and (3) mode of childbirth. A logistic regression analysis, adjusted for significant covariates, was conducted.FindingsA significant association was found between perinatal distress at 16 weeks gestation and use of epidural as single pain management. Overall, distressed women were 2.6 times more likely than non-distressed women to use epidural as a single pain management. They were also less likely to go through childbirth without use of any pain management method. Women who were dissatisfied in their relationship were significantly more likely to undergo induction of childbirth, an episiotomy and/or a vacuum extraction than those who were satisfied in their relationship, regardless if they were distressed or not. No association was found between social support and the outcome variables.Key ConclusionsWomen with perinatal distress were more likely to use an epidural than non-distressed women. The use of an epidural might help them manage pain and uncertainties related to childbirth. Women who were dissatisfied in their partner relationship may be more likely to undergo induction of childbirth, episiotomy and/or vacuum extraction.Implication For PracticeMidwives need to acknowledge the possible association of distress and use of an epidural during childbirth and screen for distress early in pregnancy. It is important to offer counselling and help during pregnancy for expectant parents who are distressed or dissatisfied in their relationship.Copyright © 2018 Elsevier Ltd. All rights reserved.

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