Predictors of severe labor pain: prospective observational study.

Introduction: Pain during childbirth is a complex and subjective experience that every mother experiences differently [1]. The degree of a woman's suffering in childbirth depends on the intensity of labor pain and many indirect factors [2]. Complex interrelated effects on labor pain are limited by the little number of studies available. That is why it is necessary to determine the probable factors that may affect the intensity of pain. In accordance with this, determining predictors of the intensity of pain during vaginal delivery remains an important issue for the maternity health policy. Aim: Investigate predictors of severe labor pain. Method: A prospective observational study was conducted in the period from December 2020 to May 2021 at the Kyiv City Maternity Hospital №5 (Kyiv, Ukraine). Logistic regression was used to measure the influence of risk factors on the probability of severe labor pain. Results: : The examined predictors were derived from mothers` self-report of overall childbirth. 366 women took part in research, 282 of them rated their pain by ≤ 60 mm visual analog scale (VAS), while 84 patients reported their pain by ≥70 mm VAS. The study identified predictors that reduce the risk of severe labor pain, such as a woman's prenatal health (namely, a healthy prenatal woman) (OR 0.0967 [95% CI 0,0344 - 0,2719], p=0,0001), attendance of maternal school (OR 0.0978 [95% CI 0.0541 - 0.1767], p<0,0001), doula`s help (OR 0,1266 [95% CІ 0,0711 - 0,2255], p<0,0001) and feeling of control over pain in labor (OR 0,0176 [95% CІ 0,0086 - 0,0359], p<0,0001). In addition, predictors such as first delivery (OR 1.67 [95% CI 1.0240 - 2.7387], p=0,04) and prenatal anxiety (OR 9.1277 [95% CI 5.2973 - 15.7276], p<0,0001) in contrast to the factors listed above, increase the risk of severe labor pain. Conclusion: Significant predictors of severe labor pain were identified through this study. The findings are useful in the maternal care system by focusing on early prevention of treatment labor pain. ClinicalTrials.gov: Retrospectively registered on February 23, 2022, NCT05226208