The effect of cognitive behavioral stress management on the psychological status and pain stress response of parturients with cesarean section

Purpose: This study aimed to explore the effect of cognitive behavioral stress management on the psychological status and pain stress response of parturients with cesarean section. Method: A total of 100 parturients who received cesarean delivery in Zhejiang Provincial People's Hospital from April 2020 to April 2021 were recruited in this study and randomly divided into control group and study group. The control group received routine nursing care, while the study group received cognitive behavioral stress management for 12 weeks before delivery. The negative emotions, stress levels, hope levels and stress hormone levels in serum of the two groups were measured. Results: Before the intervention (T0), there was no significant difference between the two groups (all p > 0.05). Immediately after entering the operating room (T1) and at the end of the operation (T2), the scores of the Self-rating Anxiety Scale (SAS), the Self-rating Depression Scale (SDS) and Pregnancy Stress Scale (PSS) in study group were significantly lower than those in control group (all p < 0.05). The hope level scale (HHI), the scores of positive attitude to reality and future (T), positive actions taken (P), and maintaining close relationship with others (I) in study group were markedly higher in the study group compared control group (all p < 0.05). The levels of cortisol (Cor), adrenaline (ADR) and adrenocorticotropic hormone (ACTH) in serum were significantly lower in study group than those in control group (all p < 0.05). Conclusion: Cognitive behavioral stress management intervention for parturients with cesarean section before delivery can effectively reduce their negative emotions and stresses, improve their level of hope and relieve their pain-induced stress.

Cesarean section; Cognitive behavioral stress management; Negative emotions; Stresses; Hope level; Pain stress response

[1] Liu X, Huang D, Landon MB, Cheng W, Chen Y. Trends in cesarean delivery rate after cessation of the one-child policy in China. American Journal of Perinatology. 2021; 38: e84–e91.

[2] Olieman RM, Siemonsma F, Bartens MA, Garthus-Niegel S, Scheele F, Honig A. The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review. BMC Pregnancy and Childbirth. 2017; 17: 195.

[3] Beigom Khezri M, Delkhosh Reihany M, Oveisy S, Mohammadi N. Evaluation of the analgesic efficacy of melatonin in patients undergoing cesarean section under spinal anesthesia: a prospective randomized double-blind study. Iranian Journal of Pharmaceutical Research. 2016; 15: 963–971.

[4] Beiranvand S, Noparast M, Eslamizade N, Saeedikia S. The effects of religion and spirituality on postoperative pain, hemodynamic functioning and anxiety after cesarean section. Acta Medica Iranica. 2014; 52 :909–915.

[5] Maheshwari D, Ismail S. Preoperative anxiety in patients selecting either general or regional anesthesia for elective cesarean section. Journal of Anaesthesiology Clinical Pharmacology. 2015; 31: 196.

[6] Nkansah-Amankra S, Luchok KJ, Hussey JR, Watkins K, Liu X. Effects of maternal stress on low birth weight and preterm birth outcomes across neighborhoods of South Carolina, 2000–2003. Maternal and Child Health Journal. 2010; 14: 215–226.

[7] Shi H, O’Reilly VC, Moreau JLM, Bewes TR, Yam MX, Chapman BE, et al. Gestational stress induces the unfolded protein response, resulting in heart defects. Development. 2016; 143: 2561–2572.

[8] Hobel CJ, Goldstein A, Barrett ES. Psychosocial stress and pregnancy outcome. Clinical Obstetrics & Gynecology. 2008; 51: 333–348.

[9] Jones DL, Lopez M, Simons H, Diaz-Gloster M, Tobin JN, Weiss SM. Translation of a comprehensive health behavior intervention for women living with HIV: the SMART/EST women’s program. Translational Behavioral Medicine. 2013; 3: 416–425.

[10] Segal-Isaacson CJ, Tobin JN, Weiss SM, Brondolo E, Vaughn A, Wang C, et al. Improving dietary habits in disadvantaged women with HIV/AIDS: the SMART/EST women’s project. AIDS and Behavior. 2006; 10: 659–670.

[11] Tragea C, Chrousos GP, Alexopoulos EC, Darviri C. A randomized controlled trial of the effects of a stress management programme during pregnancy. Complementary Therapies in Medicine. 2014; 22: 203–211.

[12] Chen C. Revision and validation of a scale to assess pregnancy stress. Journal of Nursing Research. 2015; 23: 25–32.

[13] Mowbray CT, Bybee D, Oyserman D, MacFarlane P. Timing of mental illness onset and motherhood. Journal of Nervous & Mental Disease. 2005; 193: 369–378.

[14] Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstetrics & Gynecology. 2004; 103: 698–709.

[15] Granath J, Ingvarsson S, von Thiele U, Lundberg U. Stress management: a randomized study of cognitive behavioural therapy and yoga. Cognitive Behaviour Therapy. 2006; 35: 3–10.

[16] Li J, Shao D, Xu X, Zhang Y, Jiang Y, Hall J. Cognitive behavior stress management during pregnancy: a randomized controlled trial. Contemporary Nurse. 2019; 55: 543–553.

[17] Dehghanizade Z, Zargar Y, Mehrabizadeh Honarmand M, Kadkhodaie

A, Eydi Baygi M. The effectiveness of cognitive behavior stress management on functional dyspepsia symptoms. Journal of Advances in Medical Education & Professionalism. 2015; 3: 45–49.

[18] Shahrook S, Mori R, Ochirbat T, Gomi H. Strategies of testing for syphilis during pregnancy. Cochrane Database of Systematic Reviews. 2014; CD010385.

[19] Akutsu H, Kaminishi Y, Kurumisawa S, Misawa Y. Bioprosthetic aortic valve replacement 12 years after percutaneous aortic valvuloplasty in a young female adult with hope of pregnancy. Acute Medicine & Surgery. 2016; 3: 364–368.

[20] Ahmed A, Bowen A, Feng CX, Muhajarine N. Trajectories of maternal depressive and anxiety symptoms from pregnancy to five years postpar-tum and their prenatal predictors. BMC Pregnancy and Childbirth. 2019; 19: 26.

[21] Ahmed A, Feng C, Bowen A, Muhajarine N. Latent trajectory groups of perinatal depressive and anxiety symptoms from pregnancy to early postpartum and their antenatal risk factors. Archives of Women’s Mental Health. 2018; 21: 689–698.

[22] Keirns C. Watching the clock: a mother’s hope for a natural birth in a cesarean culture. Health Affairs. 2015; 34: 178–182.

[23] Lavand’homme P. Postoperative cesarean pain: real but is it preventable?Current Opinion in Anaesthesiology. 2018; 31: 262–267.

[24] Kintu A, Abdulla S, Lubikire A, Nabukenya MT, Igaga E, Bulamba F, et al. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC Health Services Research. 2019; 19: 68.

[25] Onyiriuka AN, Utomi TE. Hypocalcemia associated with subcutaneous fat necrosis of the newborn: case report and literature review. Oman Medical Journal. 2017; 32: 518–521.