The relationship of maternal prenatal development to progress in labor and fetal-newborn health.

A study of 32 normal married primigravidas was conducted to determine the relationships among maternal psychological and physiological variables, subsequent progress in labor, and the health status of the fetus and neonate. At the onset of phase 2 of labor (3 cm of cervical dilatation), self-reported anxiety and endogenous plasma epinephrine were significantly correlated. With the deletion of subjects to control for the effect of medications, higher epinephrine levels were significantly associated with lower uterine contractile activity at the onset of phase 2 and with longer labor in phase 2 (3-10 cm of cervical dilatation). Psychological variables measured in pregnancy correlated significantly with the variables measured at the onset of phase 2 labor. Conflict concerning the acceptance of pregnancy showed the most significant relationships to the phase 2 labor variables, with correlations of 0.39 for anxiety, 0.59 for plasma epinephrine, -0.70 and -0.52 for the two adjacent Montevideo units, and 0.58 for duration of labor in phase 2. Conflict regarding the acceptance of pregnancy also correlated significantly with the newborns' 5 minute Apgar scores. Anxiety in labor and plasma epinephrine were significantly correlated with the fetal heart rate pattern during phase 2 of active labor. The fetal heart rate pattern was significantly correlated with newborns' Apgar scores at 1 and 5 minutes. The results of this study support the following hypotheses: conflicts in pregnancy are predictive of maternal anxiety and stress-related biochemical factors, and these variables are related to prolonged labor and to fetal-newborn depression.