Effect of prior perinatal loss on the maternal emotional response to labor and delivery of a healthy infant

BACKGROUND: Previous research has shown that women pregnant after perinatal loss experience increased levels of depression, anxiety, stress, and uncertainty compared to women who have not experienced such loss. However, little is known about the emotional response to the actual childbirth experience in this subset of women. METHODS: A prospective analysis was completed with 3000 first time mothers aged 18 to 35 in Pennsylvania. Interviews were conducted between January 2009 and January 2011 during the third trimester and at one month postpartum. The relationship between prior perinatal loss and fear of an adverse neonatal birth outcome during delivery was analyzed. Additionally, self-reported emotional response to labor and delivery was analyzed using four sub-dimensions: emotional adaptation, physical discomfort, fulfillment and negative emotional experience. RESULTS: Approximately 15.9% of the women had a history of perinatal loss. There were no significant differences in the overall emotional response to the birth experience or the four sub-dimensions. However, women with a history of loss were 1.23 times more likely to report moderate to extreme fear that the baby may be hurt or die during delivery compared to women without a history of loss [Odds Ratio (OR)=1.24, 95% Confidence interval (CI) 1.01, 1.52]. This relationship remained after adjustment for race and education (OR=1.24, 95% CI 1.01, 1.53). CONCLUSION: Women with a history of perinatal loss were more likely to have moderate to extreme fear of an adverse neonatal birth outcome compared to women who had not experienced a prior loss.