On the Biopsychosocial Costs of Alienated Labor
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ABSTRACT:
SUBMITTER: Seeman M
PROVIDER: S-EPMC8547591 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo describe labor progression patterns with oxytocin for augmentation in women who achieve vaginal delivery; and to determine how long one should wait with effective uterine contraction before labor arrest can be diagnosed.DesignPopulation-based retrospective cohort study.PopulationThe final sample involved 8,988 women with singleton gestation, term live birth, vertex presentation, no previous cesarean section, vaginal delivery, and neonatal Apgar score at 5 minutes at 7 or higher, and complete information on oxytocin augmentation in 2005-2007.MethodsLinear interpolation was used from the vaginal exam records for each woman to estimate the cervical dilation when oxytocin was started and the highest dose was first reached by parity. We used survival methods to estimate quartiles of the traverse time distributions of cervical dilation.Main outcome measuresDuration of labor under oxytocin augmentation.ResultsWhen oxytocin was just started, it took a long time to observe cervical dilation. The 50th(95th) centiles of the time interval from 4 to 5 cm, 5 to 6 cm, and 6 to 10 cm dilation were 2.9(8.8) hr, 1.7(5.8) hr, and 2.1(6.0) hr in nulliparas; and 3.1(10.1) hr, 1.9(8.0) hr, and 1.7(6.2) hr in multiparas. After effective uterine contractions were achieved under oxytocin, labor progressed much faster. The corresponding values were 0.7(2.4)hr, 0.5(1.5)hr, and 0.5(1.5)hr in nulliparas; and 0.6(1.9)hr, 0.4(1.1)hr, and 0.4(0.9)hr in multiparas. Low- and high-dose oxytocin regimens had similar effects on labor.ConclusionWhen oxytocin is just started for labor augmentation in early first stage, it may take up to 10 hours for the cervix to dilate by 1 cm. Once effective uterine contractions are achieved and the cervix is dilated more than 5 cm, cervical dilation to the next centimeter occurs within 2 hrs in both nulliparas and multiparas in 95% of the cases. High- and low-dose oxytocin had a similar impact on labor progression in augmented labor.
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Project description:BackgroundEmerging adults (aged 18-29) report high levels of musculoskeletal pain; however, it is unknown if body location and intensity patterns are related to different biopsychosocial characteristics. This study identified patterns of self-reported musculoskeletal pain among emerging adults and assessed if there were differences in their lifestyle and psychological characteristics.MethodsData from survey responses from a large public university and a large medical university in the United States were used (n = 1,318). Self-reported pain location and intensity at five body regions were assessed, and latent class analysis identified classes separately for men and women. Mental health, physical activity, and sleep outcomes were compared between the classes.ResultsFour classes were identified for men and women. Three of the classes were consistent between genders - "no pain," (women = 28% of their sample; men = 40% of their sample) "mild multisite pain," (women = 50%; men = 39%) and "moderate-severe multisite pain" (women = 9%; men = 7%). The fourth class for women was "moderate spine pain," (13%) and for men was "mild extremity pain" (13%). For both men and women, the "moderate-severe multisite" pain classes reported the highest levels of depression, anxiety, and stress, poorer sleep, and higher work physical activity than the "no pain" class. The "mild multisite" and "moderate spine" (women only) pain classes fell between the "no pain" and "moderate-severe" pain classes. The characteristics of the "mild upper extremity pain" class for men was similar to the "no pain" class.ConclusionsThe identified classes provide unique information on pain location and intensity in emerging adults. The high prevalence of "mild multisite pain" (n = 593; 45% of the total sample) demonstrates an intervention opportunity during this age range to prevent further increases in musculoskeletal pain later in life. Future work should assess the longitudinal outcomes of these pain classes, the impact of interventions for this age group, and the balance between leisure and occupational physical activity when addressing musculoskeletal health.
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