Are women‘s attitudes towards pregnancy, childbirth and motherhood associated with length of labour?

Authors: L. Takács 1;  J. Mlíková Seidlerová 2;  P. Čepický 3
Authors‘ workplace: Katedra psychologie FF UK, Praha, vedoucí katedry doc. PhDr. I. Gillernová, CSc. 1;  II. interní klinika LF UK, Plzeň, přednosta prof. MUDr. J. Filipovský, CSc. 2;  Gynekologicko-porodnická klinika 3. LF UK a FN KV, Praha, přednosta prof. MUDr. L. Rob, CSc. 3
Published in: Ceska Gynekol 2017; 82(6): 462-472


To examine the association between length of labour and women‘s attitudes towards pregnancy, childbirth and motherhood, while controlling for biomedical and maternal psychosocial characteristics.

Original study.

Department of Psychology, Faculty of Arts and Philosophy, Charles University, Prague.

The sample consisted of 362 women who gave birth in one of the five maternity hospitals in Vysočina region (Havlíčkův Brod, Jihlava, Pelhřimov, Třebíč, Nové Město na Moravě) between October 2013 and September 2014. The data were collected at two points in time. In the third trimester of pregnancy, women‘s attitudes towards pregnancy, childbirth and motherhood and other psychosocial characteristics were surveyed using the range of validated tools. Within one week of delivery, women were asked about social support they received during labour. Data concerning the course of labour were extracted from medical records. The dependent variable was the active phase of the first stage of labour (time from 3 cm to full dilatation). The differences among women with prolonged/rapid labour (duration above 90th percentile/less than 10th percentile) with respect to their attitudes towards pregnancy, childbirth and motherhood and other characteristics were assessed using the Student‘s t test and the χ2 test. Factors associated with length of labour were analysed using logistic regression. The results were adjusted for maternal age, marital status and newborn weight.

In labours without oxytocin administration, the median of the duration of active phase of the first stage was 180 minutes for primiparas and 144 minutes for multiparas. Women with prolonged labour reported more frequently low maternal self-esteem compared to women with normal labour duration (34.0% vs. 19.1%; p = 0,021), but maternal self-esteem was not a significant predictor of prolonged labour in regression analysis. No other differences were found with respect to psychosocial and personality characteristics in women with prolonged and normal labour. Women with rapid labour did not differ from women with normal labour as for their attitudes towards pregnancy, labour and motherhood. Nevertheless, they reported clinically relevant scores for trait anxiety more frequently, a difference that approached statistical significance (52.6% vs. 38.3%; p = 0,090). Multiple regression analysis showed a trend towards trait anxiety being associated with rapid labour (p = 0,098). No significant predictor of labour duration was identified except newborn weight which predicted both prolonged and rapid labour.

Our data indicate that the association between length of labour and women‘s attitudes towards pregnancy, childbirth and motherhood is rather weak and clinically less relevant. Our results portray the newborn weight as a key factor affecting labour duration.

length of labour, psychosocial aspects, pregnancy, motherhood, cohort studies


1. Adams, SS., Eberhard-Gran, M., Eskild, A. Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG, 2012, 119, p. 1238–1246.

2. Bartáková, V., Ťápalová, V., Wágnerová, K., et al. Pregnancy outcomes in women with gestational diabetes: specific subgroups might require increased attention. Ces Gynek, 2017, 82, p. 16.

3. Bayrampour, H., Salmon, C., Vinturache, A., et al. Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions. J Obstet Gynaecol Res, 2015, 41, p. 1040–1048.

4. Binder, T. Porodnictví. Praha: Karolinum, 2011.

5. Bugg, GJ., Stanley, E., Baker, PN., et al. Outcomes of labours augmented with oxytocin. Eur J Obstet Gynecol Reprod Biol, 2006, 124, p. 37–41.

6. Cohen, S., Kamarck, T., Mermelstein. R. A global measure of perceived stress. J Health Soc Behav, 1983, 24, p. 385–396.

7. Cramond, WA. Psychological aspects of uterine dysfunction. Lancet, 1954, 267, p. 1241–1245.

8. Čepický, P. Porod. Moderní gynekologie a porodnictví, 1999, 8, p. 232–236.

9. Čepický, P., Dudová, S., Mandys, F., et al. Minnesota Multiphasic Personality Inventory (MMPI) in third trimester of physiological pregnancy. Int J Prenat Perinat Psychol Med, 1993, 5, p. 311–316.

10. Decca, L., Daldoss, C., Fratelli, N., et al. Labor course and delivery in epidural analgesia: a case-control study. J Matern Fetal Neonatal Med, 2004, 16, p. 115–118.

11. Doležal, A. Samovolný porod a jeho vedení. In: Porodnictví. Praha: Galén; 2004, s. 120.

12. Enkin, M., Keirse, MJNC., Renfrew M., Nielson, M. Efektivní péče v perinatologii. Praha: Grada, 1998.

13. Farrow, C., Blissett, J. The development of maternal self-esteem. Infant Ment Health J, 2007, 28, p. 517–535.

14. Ferreira, CR., Orsini, MC., Vieira, CR., et al. Prevalence of anxiety symptoms and depression in the third gestational trimester. Arch Gynecol Obstet, 2015, 291, p. 999–1003.

15. Fraser, WD., Cayer, M., Soeder, BM., et al. Risk factors for difficult delivery in nulliparas with epidural analgesia in second stage of labor. Obstet Gynecol, 2002, 99, p. 409–418.

16. Grant, KA., McMahon, C., Austin, MP. Maternal anxiety during the transition to parenthood: a prospective study. J Affect Disord, 2008, 108, p. 101–111.

17. Haines, H., Pallant, JF., Karlstrom, A., et al. Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample. Midwifery, 2011, 27, p. 560–567.

18. Hájek, Z., Pařízek, A., Fait, T., Pašková, A. Vedení patologického porodu. Moderní gynekologie a porodnictví, 2004, 13, 4, suppl. C, p. 827.

19. Incerti, M., Locatelli, A., Ghidini, A., et al. Prediction of duration of active labor in nulliparous women at term. Am J Perinatol, 2008, 25, p. 85–89.

20. Istvan, J. Stress, anxiety, and birth outcomes: a critical review of the evidence. Psychol Bull, 1986, 100, p. 331–348.

21. Kapp, FT., Hornstein, S., Graham, VT. Some psychologic factors in prolonged labor due to inefficient uterine action. Compr Psychiatry, 1963, 4, p. 9–18.

22. Kashanian, M., Javadi, F., Haghighi, MM. Effect of continuous support during labor on duration of labor and rate of cesarean delivery. Int J Gynaecol Obstet, 2010, 109, p. 198–200.

23. Kennedy, C. Inco-ordinate uterine action. Edinb Med J, 1949, 56, p. 445–460.

24. Korečko, V., Landsmanová, J., Mocková, A., Kutová, T. Results of perinatal care of pregnant women with diabetes in Western Bohemia. Ces Gynek, 2014, 79, p. 43–47.

25. Kotásek, A. Porodnictví. Praha: Avicenum, 1972.

26. Littleton, HL., Breitkopf, CR., Berenson, AB. Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: a meta-analysis. Am J Obstet Gynecol, 2007, 196, p. 424–432.

27. Lowe, NK. A review of factors associated with dystocia and cesarean section in nulliparous women. J Midwifery Womens Health, 2007, 52, p. 216–228.

28. Magann, EF., Lutgendorf, MA., Keiser, SD., et al. Risk factors for a prolonged third stage of labor and postpartum hemorrhage. South Med J, 2013, 106, p. 131–135.

29. Michalec, I., Navrátilová, M., Tomanová, M., et al. Vaginální porod s použitím vakuumextraktoru není spojen se signifikantně vyšším výskytem avulzního poranění levátorů. Čes Gynek, 2015, 80, p. 37–41.

30. Morhason-Bello, IO., Adedokun, BO., Ojengbede, OA., et al. Assessment of the effect of psychosocial support during childbirth in Ibadan, south-west Nigeria: a randomised controlled trial. Aust N Z J Obstet Gynaecol, 2009, 49, p. 145–150.

31. Newham, JJ., Westwood, M., Aplin, JD., et al. State-trait anxiety inventory (STAI) scores during pregnancy following intervention with complementary therapies. J Affect Disord, 2012, 142, p. 22–30.

32. Nystedt, A., Hildingsson, I. Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment. BMC Pregnancy Childbirth, 2014, 14, p. 233.

33. Nystedt, A., Hogberg, U., Dejin-Karlsson, E., et al. Low psychosocial resources during early pregnancy are not associated with prolonged labour. Eur J Obstet Gynecol Reprod Biol, 2006, 125, p. 29–33.

34. Pearlin, LI., Schooler, C. The structure of coping. J Health Soc Behav, 1978, 19, p. 2–21.

35. Procházka, M., Pilka R. Porodnictví pro studenty lékařství a porodní asistence. Olomouc: AED, 2016.

36. Reck, C., Zimmer, K., Dubber, S., et al. The influence of general anxiety and childbirth-specific anxiety on birth outcome. Arch Womens Ment Health, 2013, 16, p. 363–369.

37. Scott, EM., Thomson, AM. A psychological investigation of primigravidae. IV. Psychological factors and the clinical phenomena of labour. J Obstet Gynaecol Br Emp, 1956, 63, p. 502–508.

38. Sheiner, E., Levy, A., Feinstein, U., et al. Risk factors and outcome of failure to progress during the first stage of labor: a population-based study. Acta Obstet Gynecol Scand, 2002, 81, p. 222–226.

39. Sheiner, E., Levy, A., Mazor, M. Precipitate labor: higher rates of maternal complications. Eur J Obstet Gynecol Reprod Biol, 2004, 116, p. 43–47.

40. Sluijs, AM., Cleiren, MP., Scherjon, SA., et al. No relationship between fear of childbirth and pregnancy-/delivery-outcome in a low-risk Dutch pregnancy cohort delivering at home or in hospital. J Psychosom Obstet Gynaecol, 2012, 33, p. 99–105.

41. Spielberger, C. Manual for the State-Trait Anxiety Inventory. rev. ed. Palo Alto: Consulting Psychologists Press, 1983.

42. Suzuki, S. Clinical significance of precipitous labor. J Clin Med Res, 2015, 7, p. 150–153.

43. Wijma, K., Wijma, B., Zar, M. Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth. J Psychosom Obstet Gynaecol, 1998, 19, p. 84–97.

44. Zhang, J., Troendle, JF., Yancey, MK. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol, 2002, 187, p. 824–828.

45. Zimet, GD., Dahlem, NW., Zimet, SG., et al. The Multidimensional Scale of Perceived Social Support. J Pers Assessment, 1988, 52, p. 30–41.

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