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I am looking for any studies (ideally peer reviewed journals, but anything is helpful) that links maternal anxiety levels to birth outcomes - in short, studies that show that when a mama is anxious, her birth outcomes will not be as good (i.e. increased risk of complications, etc), and/or when a mama is less anxious this leads to improved outcomes. I know this is common sense to many midwives and probably (one would think) to many doctors, but I am seeking studies that document this. Thanks for any thoughts. Sincerely, Elizabeth
 

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<a href="http://www.ncbi.nlm.nih.gov/pubmed/12685335" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/12685335</a><br>
J Psychosom Obstet Gynaecol. 2003 Mar;24(1):1-14.<br>
Obstetric complications and anxiety during pregnancy: is there a relationship?<br>
Johnson RC, Slade P.<br>
This review examines the contribution of recent research into the effects of anxiety during pregnancy. The focus of interest is upon the process of labor and delivery rather than its timing or the size of the baby. Therefore studies directed at areas of prematurity or low birthweight are specifically excluded as these have already been well evaluated in the literature. It is known that one proximal cause of obstetric complications is increased hormone levels in the uterus. It seems likely therefore that anxiety, a form of arousal, known to influence hormone levels, may be implicated as a distal determinant of obstetric complications. Attempts to evaluate this hypothesis have been hampered by methodological issues such as: poor definition and measurement of obstetric outcomes, in particular utilizing composite measures of diverse components; inappropriate measurements or over broad conceptualizations of anxiety; failure to account for confounding variables and inadequate sample sizes. On balance the evidence reviewed suggests that a general association between anxiety and obstetric complications per se does not exist, but specific types of anxiety, such as psychosocial stress, family functioning, or fear of childbirth may have associations with specific complications, such as prolonged labor or Cesarean section. Recent studies considering the effect of fear of childbirth, for example, on specific obstetric outcomes, such as type of delivery, have produced more clear-cut relationships. Recommendations for future research into the relationships between specific combinations of types of anxiety and individual obstetric complications are discussed.<br><br><br><a href="http://www.ncbi.nlm.nih.gov/pubmed/19187514" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/19187514</a><br>
Trop Med Int Health. 2009 Feb;14(2):156-66. Epub 2009 Jan 31.<br>
Impact of antenatal common mental disorders upon perinatal outcomes in Ethiopia: the P-MaMiE population-based cohort study.<br>
Hanlon C, Medhin G, Alem A, Tesfaye F, Lakew Z, Worku B, Dewey M, Araya M, Abdulahi A, Hughes M, Tomlinson M, Patel V, Prince M.<br><br>
OBJECTIVES: To examine the impact of antenatal psychosocial stressors, including maternal common mental disorders (CMD), upon low birth weight, stillbirth and neonatal mortality, and other perinatal outcomes in rural Ethiopia. METHODS: A population-based sample of 1065 pregnant women was assessed for symptoms of antenatal CMD (Self-Reporting Questionnaire-20: SRQ-20), stressful life events during pregnancy (List of Threatening Experiences: LTE) and worry about the forthcoming delivery. In a sub-sample of 654 women from six rural sub-districts, neonatal birth weight was measured on 521 (79.7%) singleton babies within 48 h of delivery. Information about other perinatal outcomes was obtained shortly after birth from the mother's verbal report and via the Demographic Surveillance System. RESULTS: After adjusting for potential confounders, none of the psychosocial stressors were associated with lower mean birth weight, stillbirth or neonatal mortality. Increasing levels of antenatal CMD symptoms were associated both with prolonged labour (>24 h) (SRQ 1-5: RR 1.4; 95% CI 1.0-1.9, SRQ >or= 6: RR 1.6; 95% CI 1.0-2.6) and delaying initiation of breast-feeding more than eight hours (SRQ 1-5: RR 1.4; 95% CI 0.8 to 2.4, SRQ >or= 6: RR 2.8; 95% CI 1.3-6.1). Worry about delivery was also associated with labour longer than 24 h (RR 1.5; 95% CI 1.0-2.1). CONCLUSIONS: This study provides preliminary evidence of important public health consequences of poor maternal mental health in low-income countries but does not replicate the strong association with low birth weight found in South Asia.<br><br><a href="http://www.ncbi.nlm.nih.gov/pubmed/16714913" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/16714913</a><br>
J Perinat Neonatal Nurs. 2006 Apr-Jun;20(2):138-46.<br>
Does relaxation education in anxious primigravid Iranian women influence adverse pregnancy outcomes?: a randomized controlled trial.<br><br>
Bastani F, Hidarnia A, Montgomery KS, Aguilar-Vafaei ME, Kazemnejad A.<br><br>
Maternal anxiety and stress are found to be predictors of adverse pregnancy outcomes, including low birth weight and prematurity. OBJECTIVE: The aim of the study was to determine whether relaxation education in anxious pregnant Iranian women in their first pregnancy affects selected pregnancy outcomes, including birth weight, preterm birth, and surgical delivery rate. SUBJECTS: A total of 110 obstetrically and medically low-risk primigravid women in Iran with a high anxiety level demonstrated by Spielberger's State-Trait Anxiety Inventory were randomly assigned into experimental and control groups. METHOD: In this randomized controlled trial, the experimental group received routine prenatal care along with 7-week applied relaxation training sessions, while the control group received only routine prenatal care. Anxiety and perceived stress were measured by pre-educational and post-educational intervention. Data related to pregnancy outcomes include birth weight, gestational age at birth, and type of delivery. RESULTS: Significant reductions in low birth weight, cesarean section, and/or instrumental extraction were found in the experimental group compared with the control group. No significant differences were found in the rate of preterm birth. CONCLUSION: The findings suggest beneficial effects of nurse-led relaxation education sessions during the prenatal period. This intervention could serve as a resource for improving pregnancy outcomes in women with high anxiety.<br><br><br><a href="http://www.ncbi.nlm.nih.gov/pubmed/15385704" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/15385704</a><br>
Psychosom Med. 2004 Sep-Oct;66(5):762-9.<br>
Maternal prenatal anxiety and corticotropin-releasing hormone associated with timing of delivery.<br><br>
Mancuso RA, Schetter CD, Rini CM, Roesch SC, Hobel CJ.<br><br>
OBJECTIVE: The high rate of preterm births is an imposing public health issue in the United States. Past research has suggested that prenatal stress, anxiety, and elevated levels of maternal plasma corticotropin-releasing hormone (CRH) are associated with preterm delivery in humans and animals. Studies to date have not examined all three variables together; that is the objective of this paper. METHODS: Data from 282 pregnant women were analyzed to investigate the effect of maternal prenatal anxiety and CRH on the length of gestation. It was hypothesized that at both 18 to 20 weeks (Time 1) and 28 to 30 weeks gestation (Time 2), CRH and maternal prenatal anxiety would be negatively associated with gestational age at delivery. CRH was also expected to mediate the relationship between maternal prenatal anxiety and gestational age at delivery. RESULTS: Findings supported the mediation hypothesis at Time 2, indicating that women with high CRH levels and high maternal prenatal anxiety at 28 to 30 weeks gestation delivered earlier than women with lower CRH levels and maternal prenatal anxiety. Women who delivered preterm had significantly higher rates of CRH at both 18 to 20 weeks gestation and 28 to 30 weeks gestation (p <.001) compared with women who delivered term. CONCLUSIONS: These findings are the first to link both psychosocial and neuroendocrine factors to birth outcomes in a prospective design.
 

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For any one who is interested, these studies all point to a link between anxiety during pregnancy and suboptimal birth outcomes.<br><br>
•Dunkel-Schetter, C. “Maternal stress and preterm delivery,” Prenatal and Neonatal Medicine, 1998, 3: 39-42.<br>
•Johnson, RC and Slade P. "Obstetric complications and anxiety during pregnancy: is there a relationship?," Journal of Psychosomatic Obstetrics and Gynecology, 2003 Mar;24(1):1-14.<br>
•Lobel, M. “Conceptualizations, measurement, and effects of prenatal maternal stress on birth outcomes,” Journal of Behavioral Medicine,1994, 17, 225-272.<br>
•Rini, CK. “Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy,” Health Psychology, 1999, 18(4): 333-345.<br>
•Wadhwa PD, Dunkel-Schetter C, Chicz-DeMet A, Porto M, Sandman CA. “Prenatal psychosocial factors and the neuroendocrine axis in human pregnancy,” Journal of Psychosomatic Obstetrics and Gynecology 1996;58:432–46.<br>
•Mancuso RA, Schetter CD, Rini CM, Roesch SC, Hobel CJ. “Maternal prenatal anxiety and corticotropin-releasing hormone associated with timing of delivery,” Psychosomatic Medicine, 66, 762-769<br><br>
They all deal with anxiety during pregnancy (rather than just the labor and birth). Thus, if any one ever finds studies that show anxiety during labor and birth and how this relates to increased interventions during the labor and birth, I'd love to know about them. It is, of course, my sense that a nervous and anxious mom is going to have a harder time in labor and birth than a non-anxious one, and that anxiety likely leads to more interventions and thus a higher chance of complications, but it sure would be nice to find peer reviewed studies on this. Thanks, Elizabeth
 

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One thing you could do in a search is to start with more basic, general info:<br><br>
look into the impact of stress/anxiety/catecholamines on general physiological functioning for all people. It has been well proven and documented over the last 40 or more years that both body and mind are negatively impacted by stress/fear. This kind of info would not be specific to birth, but can definitely show that health, and all systems functioning, is better when we are reasonably relaxed and worse when under stress--this is easily extrapolated logically to include labor/birth/pp time.<br><br>
Also, look into Michel Odent's writings on the effect of adrenaline on birth/the laboring woman. I do not have links, sorry--but much of his writing can be found on the Primal Health website.<br><br>
For myself, my experiences with birth as mama and mw both, have proven to me without a doubt that fear/anxiety/stress makes a definite negative contribution to motherbaby health and functioning during pregnancy, birth, breastfeeding and the postpartum time.<br><br>
Good luck finding what you need!
 
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