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Induction of labor, and physiological and psychological stress responses as expressed by salivary cortisol: a prospective study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To describe patterns of physiological and psychological stress during induced labor and their correlation to obstetrical and neonatal outcomes.

Methods

This prospective, observational study included 167 women, with low-risk, singleton pregnancies, who delivered at term, at a tertiary academic center from 2015 through 2018. Among them, 72 (43%) underwent induction and 95 (57%) had spontaneous labor onset. Physiological stress was evaluated by salivary cortisol measurements and emotional stress by questionnaires (visual analogue stress scale 0–10) during latent phase, active phase and full dilation stages of labor, as well as 2 min and 2 h postpartum. Cord blood cortisol and pH were obtained. Stress patterns were compared between parturients who did or did not undergo induction. Modes of delivery, labor and delivery complications, and early neonatal outcomes were compared. Mothers completed the Hospital Anxiety and Depression Scale.

Results

Induced women had lower cortisol concentrations during the latent phase compared to spontaneous onset of labor (p = 0.003), with no differences during active (p = 0.237), full dilation (0.668), 2 min and 2 h after delivery (p = 0.666). Stress scale and Hospital Anxiety and Depression Scale scores were similar between groups. Cord cortisol (p = 0.294), 1-min Apgar score ≤ 7 (p = 0.502) and 5-min Apgar score ≤ 7 (p = 0.37) were similar. All had cord pH > 7.

Conclusions

Induction does not increase stress during labor. Moreover, it might have a positive effect on reducing cortisol during the latent phase. These findings might reassure women who are concerned about induction of labor.

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Data availability

Data will be made available upon reasonable request to the corresponding author.

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Acknowledgements

The authors express their appreciation to Faye Schreiber, MS for English language contributions and editing.

Funding

The study was funded by the research fund of the Israel Insurance Association.

Author information

Author notes

  1. Nasreen Haj-Yahia and Aula Asali have contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba, 4428164, Israel

    Nasreen Haj-Yahia, Aula Asali, Gal Cohen, Eran Neumark, Michal Matzkin Eisenberg, Ami Fishman, Tal Biron-Shental & Netanella Miller

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Nasreen Haj-Yahia, Aula Asali, Gal Cohen, Eran Neumark, Ami Fishman, Tal Biron-Shental & Netanella Miller

Authors
  1. Nasreen Haj-Yahia
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  2. Aula Asali
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  3. Gal Cohen
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  4. Eran Neumark
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  5. Michal Matzkin Eisenberg
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  7. Tal Biron-Shental
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  8. Netanella Miller
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Contributions

NH: recruitment of parturients, data collection, and drafted the initial manuscript. AA: recruitment of parturients, data collection, and drafted the initial manuscript. GC: recruitment of parturients, and carried out the data collection. EN: analyzed cortisol samples in the laboratory. MME: analyzed cortisol samples in the laboratory. AF: drafted the initial manuscript. TB-S: carried out the initial analyses and drafted the initial manuscript. NM: recruitment of parturients, carried out the initial analyses, conceptualized and designed the study, and drafted the initial manuscript.

Corresponding author

Correspondence to Aula Asali.

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Conflict of interest

All authors report no conflict of interest.

Ethical approval

The study was approved by the Institutional Ethics Committee on 06/09/2016, number: 173-16.

Informed consent

All participants provided written informed consent.

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Haj-Yahia, N., Asali, A., Cohen, G. et al. Induction of labor, and physiological and psychological stress responses as expressed by salivary cortisol: a prospective study. Arch Gynecol Obstet 302, 93–99 (2020). https://doi.org/10.1007/s00404-020-05577-4

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  • DOI: https://doi.org/10.1007/s00404-020-05577-4

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