Women with a fear of childbirth antepartum requested pain relief more frequently as compared to women without fear of childbirth antepartum, but this association was not statistically significant. 

Labour pain is extreme pain experienced by women influenced by physiological and psychological processes of birth and extent to which women perceive pain. The experience of labour pain varies among women. The fear and anxiety associated with pregnancy and childbirth lead to increased perception of pain. Due to the higher impact of increased pain perception on both the mother and mother-infant interaction, childbirth fear has gained growing attention.

Pharmacological methods of pain relief have been widely used for treating labour pain. There exist differences in the ways of pain relief and the percentage of women using pain relief. Pharmacological pain relief methods reduce the pain experienced during labour. However, childbirth satisfaction is also influenced by other factors such as involvement of woman in decision making and the attitude of the caregivers during labour.

The relatedness between fear of childbirth antepartum and request for pain relief as well as administering pharmacological pain relief and experienced childbirth postpartum, have rarely been studied in a low-risk population. More knowledge about this topic is required for counselling women for decisions regarding the type of pain relief, use of pharmacological pain relief, and preferred a place of birth 

Rationale behind research:

Previous studies lack in providing robust data for evaluating the pain experiences of women who receive and do not receive analgesia and their childbirth experience or well-being, including fear of childbirth. Therefore, the present study was intended to find the association between fear of childbirth antepartum and request for pharmacological pain relief.

Objective:

The present randomised controlled trial was conducted to evaluate the relatedness between the fear of child antepartum and request of pharmacological pain relief. Also, the association between the used pharmacological methods of pain relief and experienced pain as reported postpartum was also evaluated.  

Study outcomes:

• Patient demographic characteristics were evaluated at baseline.
• Other outcomes included determination of fear of childbirth antepartum & postpartum and comparison of epidural analgesia and remifentanil patient-controlled analgesia (PCA) to relieve labour pain

Time Points: NA

Outcomes:

Baseline: There were no significant differences observed at baseline

Study outcomes:

• Pain relief was frequently requested in women with fear of childbirth antepartum compared to women without fear of childbirth antepartum, but the results were not statistically significant. (Fig 2.)

• Fear of childbirth postpartum was frequently reported in women who received epidural analgesia as compared to women who did not receive epidural analgesia, but the association between remifentanil-PCA and fear of childbirth postpartum was not significant statistically.

The results of the present study reported that the frequency of fear of childbirth antepartum and fear of childbirth postpartum were following the previous literature. Women with a fear of childbirth antepartum were more likely to request pain relief during labour, but the association was not statistical significance. It can be either due to lack of power of study or due to the study population that consisted of low risk labouring women under the care of a primary care midwife. It was also assumed that women receive continuous support of labour during midwife-led care. Previous research has reported that constant support of labour results in less pharmacological pain relief. The present study also suggests that women who received epidural analgesia more often reported fear of childbirth postpartum as compared to women with pharmacological pain relief. Previous studies were unable to distinguish between pain relief methods and only reported about epidural analgesia. No studies have contributed to finding an association between remifentanil-PCA and fear of childbirth. However, the present study suggests that women who received remifentanil-PCA did not report more fear of childbirth postpartum as compared to women who used epidural analgesia with continuous infusion. 

It was also determined that the childbirth experience is more influenced by already existing antepartum fear of childbirth than by complications during labour. Fear of childbirth is also associated with obstetric intervention/complications as well as with caesarean section as a preferred mode of delivery. It makes it essential to distinguish fear of childbirth antepartum. After determination of the above factors, women can choose treatment of their fear of childbirth to preclude both obstetric intervention/complications and fear of childbirth reported postpartum as well as perinatal costs.