Anxiety and epinephrine in multiparous women in labor: relationship to duration of labor and fetal heart rate pattern.

The duration of labor in multigravid subjects in phase 1 labor at term (from 3 to 6 cm of cervical dilatation; mean duration = 2.7 hours) was significantly related to measures of plasma epinephrine and norepinephrine obtained at the onset of the phase (n = 50). Epinephrine was significantly related to observer ratings of subject stress and the scores from the three dimensions of our self-report Labor Anxiety Inventory. The fetal heart rate pattern in phase 2 labor (7 to 10 cm of cervical dilatation; mean duration = 1.2 hours) was significantly related to phase 1 measures of epinephrine, observed stress, and two of the anxiety dimensions (n = 44 to 47). The results provide support for the hypotheses that, under normal clinical conditions, several types of patient anxiety are related to catecholamine levels and that anxiety and epinephrine are related to duration of labor and fetal well-being. The results suggest that medical/nursing evaluation and management of patient anxiety should include a self-report measure of three dimensions of anxiety (coping, safety, and pain), which are relatively independent of observed physical stress and which may relate to maternal labor progress as well as fetal heart rate pattern.