Childbirth-related fatigue trajectories: predictor and birth outcome
Date Issued
2008
Date
2008
Author(s)
Tzeng, Ya-Ling
Abstract
Fatigue is not only a distressful symptom that is prevalent in childbirth; it also may interfere with a woman''s ability to adjust to labor pain, to bear down in the second labor stage, hinder maternal recovery, and impair the assumption of the maternal role after birth. Fatigue is apt to cause physical and mental discomfort during labor, and increases the chances of medical intervention such as instrumental delivery and cesarean section. Despite these importance potential influences of labor to childbirth, little information exists on the actual effects of labor to the birth process. Empirical scientific knowledge related to childbirth fatigue is insufficient, especially concerning the lack of clinical research on maternal fatigue over time during labor. This lack of knowledge hinders the effectiveness in managing childbirth-related fatigue and in promoting the quality of intrapartum nursing care.herefore, the purpose of the present research was to describe the childbirth-related fatigue trajectory throughout the labor process, identify the pattern of distinct fatigue trajectory, and determine the predictors of trajectory class membership and also on the influence of distinct fatigue patterns toward maternal performance and childbirth outcome. Under a natural setting, a prospective, longitudinal design and plurality methods (which included field observation, questionnaire, physiological and physical measurement) were taken to systematically collect both subjective and objective data. Obstetric low-risk women (n=209) were followed throughout their labor and delivery experiences. Longitudinal analyses on the repeated measures of fatigue were conducted using trajectory models (growth curve modeling). Predictors of trajectory class membership were identified in binary logistic regression. Chi-square and Student''s t-test were used to examine the influence of distinct childbirth-related fatigue patterns toward maternal performance and childbirth outcome.he results showed when the women entered the labor process, they suffered from different level of fatigue, with most experiencing a high level of fatigue. The level of fatigue intensified with the progress of childbirth, reaching a peak that coincided with full dilation of the uterus. Fatigue increased in the active phase of labor and was somewhat reduced after birth. Considerable between-subject heterogeneity in individual trajectories over time were evident. Two trajectories of childbirth-related fatigue were identified: low intensity class (30.8%) and high intensity class (69.2%). The fatigue level of both classes intensified following the labor progress. Fatigue also increased most quickly during the active phase of labor, and remained high following delivery. arity (OR: 4.86,p< 0.003), maternal blood lactate concentration at admission (OR: 4.57,p< 0.004), and anxiety(OR: 26.59,p< 0.0001) independently predicted the distinct trajectory pattern. Primiparas in the high fatigue intensity class experienced significantly more anxiety and higher lactate concentration at admission than the low intensity class. Regarding the influence of distinct fatigue pattern, the influences of the length of labor, the mode of delivery, in using analgesia, adopting fungus pressure or instrumental delivery were insignificant. Only the effective adaptation of labor pain at active stage displayed statistical significance (P=0.02), with the women in low intensity fatigue pattern more effectively adapting to their labor pain during the active stage than women in the high intensity fatigue class. There is also no statistical significance in the lactate acid and Apgar scores of newborns between the two fatigue trajectories.hese findings suggest that there are critical points at which caregiver actions may have an effect on childbirth-related fatigue. The caregiver should endeavor to prevent a high level of fatigue once a woman enters the labor phase. Women who present with high fatigue at the onset of labor should be targeted for early intervention, especially in the period where fatigue increases rapidly. In this study, women with high levels of anxiety had a high risk of belonging to the high-fatigue intensity group. Accordingly, childbirth-related fatigue might be lessened if a woman’s anxiety could be alleviated. In general, this empirical research not only contributes to determining the critical time for dealing with childbirth-related fatigue, but also may contribute to a theoretical foundation that can be explored in further study, with the eventual goal of improving intrapartum care.
Subjects
childbirth
fatigue
clinical field study
observation
measurement
symptom experience
trajectory
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