Generic placeholder image

Current Women`s Health Reviews


ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Research Article

The Effectiveness of an Integrated Symptom-related Fatigue Management Program (ISFMP) on Pain, Anxiety, Fatigue Score and Lactate Levels in Low-risk Pregnant Women During Childbirth

Author(s): Kunnikar Chaisitsa-Nguan*, Puangpaka Kongvattananon and Dawn Hawthorne

Volume 20, Issue 1, 2024

Published on: 01 March, 2023

Article ID: e030223213429 Pages: 13

DOI: 10.2174/1573404819666230203144039

Price: $65


Background: Fatigue accumulates throughout the labor period and often occurs in conjunction with pain and anxiety during childbirth, resulting in negative effects on laboring women.

Objective: The purpose of this study is to investigate the effectiveness of an integrated symptomrelated fatigue management program (ISFMP) on pain, anxiety, fatigue score and lactate levels in a low-risk pregnant woman during childbirth.

Methods: This quasi-experimental study was conducted from August of 2021 to March of 2022 at Prachuap Khiri Khan Hospital. Sixty-five low-risk pregnant women with 32–41+6 weeks gestation were selected by the stratified random-sampling and matching techniques. They were then randomly assigned to either comparison or intervention groups. Data were collected using a demographic questionnaire and a visual analogue scale for pain, anxiety and fatigue. Lactate Pro 2 was used to evaluate lactate levels. Data were analyzed through statistical software (SPSS-26) using independent t-test, chisquare, repeated measure ANOVA and repeated measure multivariate analysis of variance (MANOVA). The significance level was set at p <.05.

Results: The participants in the comparison and experimental groups had varying pain, anxiety, fatigue scores and lactate levels throughout their progression of labor. Pain, anxiety and fatigue in the experimental group were significantly lower than in the comparison group (p < .001). There were no statistically significant differences in lactate levels between the two groups.

Conclusion: The ISFMP was shown to be effective in lowering the symptoms of pain, anxiety and fatigue in women in labor. Midwives should apply the ISFMP in their clinical practice when caring for low-risk pregnant women.

Keywords: Parturition, pregnant women, pain, anxiety, fatigue, lactates.

Graphical Abstract
Chien, L.Y.; Ko, Y.L. Fatigue during pregnancy predicts caesarean deliveries. J. Adv. Nurs., 2004, 45(5), 487-494.
[] [PMID: 15009351]
Cheng, C.Y.; Chou, Y.H.; Wang, P.; Tsai, J.M.; Liou, S.R. Survey of trend and factors in perinatal maternal fatigue. Nurs. Health Sci., 2015, 17(1), 64-70.
[] [PMID: 24835296]
Behrenz, K.; Monga, M. Fatigue in pregnancy: A comparative study. Am. J. Perinatol., 1999, 16(4), 185-188.
[] [PMID: 10458531]
Pugh, L.C.; Milligan, R.A. Patterns of fatigue during childbearing. Appl. Nurs. Res., 1995, 8(3), 140-143.
[] [PMID: 7668856]
Zib, M.; Lim, L.; Walters, W.A. Symptoms during normal pregnancy: A prospective controlled study. Aust. N. Z. J. Obstet. Gynaecol., 1999, 39(4), 401-410.
[] [PMID: 10687753]
Eidelman, D. Fatigue: Towards an analysis and a unified definition. Med. Hypotheses, 1980, 6(5), 517-526.
[] [PMID: 7412641]
Labor, S.; Maguire, S. The pain of labour. Rev. Pain, 2008, 2(2), 15-19.
[] [PMID: 26526404]
Lowe, N.K.; Corwin, E.J. Proposed biological linkages between obesity, stress, and inefficient uterine contractility during labor in humans. Med. Hypotheses, 2011, 76(5), 755-760.
[] [PMID: 21382668]
Pugh, L.C.; Milligan, R. A framework for the study of childbearing fatigue. ANS. Adv. Nurs. Sci., 1993, 15(4), 60-70.
[] [PMID: 8512305]
Poole, C.J. Fatigue during the first trimester of pregnancy. J. Obstet. Gynecol. Neonatal Nurs., 1986, 15(5), 375-379.
[] [PMID: 3639925]
Mayberry, L.J.; Gennaro, S.; Strange, L.; Williams, M.; De, A. Maternal fatigue: implications of second stage labor nursing care. J. Obstet. Gynecol. Neonatal Nurs., 1999, 28(2), 175-181.
[] [PMID: 10102545]
Tzeng, Y.L.; Chao, Y.M.Y.; Kuo, S.Y.; Teng, Y.K. Childbirth-related fatigue trajectories during labour. J. Adv. Nurs., 2008, 63(3), 240-249.
[] [PMID: 18702771]
Peaceman, A.M.; Socol, M.L. Active management of labor. Am. J. Obstet. Gynecol., 1996, 175(2), 363-368.
[] [PMID: 8765254]
Schneider, H.; Prögler, M.; Ziegler, W.H.; Huch, R. Biochemical changes in the mother and the fetus during labor and its significance for the management of the second stage. Int. J. Gynaecol. Obstet., 1990, 31(2), 117-126.
[] [PMID: 1968856]
Corwin, E.J.; Brownstead, J.; Barton, N.; Heckard, S.; Morin, K. The impact of fatigue on the development of postpartum depression. J. Obstet. Gynecol. Neonatal Nurs., 2005, 34(5), 577-586.
[] [PMID: 16227513]
Nordström, L.; Achanna, S.; Naka, K.; Arulkumaran, S. Fetal and maternal lactate increase during active second stage of labour. BJOG, 2001, 108(3), 263-268.
[] [PMID: 11281466]
Weil, M.H.; Afifi, A.A. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation, 1970, 41(6), 989-1001.
[] [PMID: 5482913]
Medicine Io. Pray, L., Ed.; Council NR. An Update on Research Issues in the Assessment of Birth Settings: Workshop Summary; The National Academies Press: Washington, DC, , 2013; p. p. 202.
Cohen, J. Statistical power analysis for the behavioral sciences, 2nd ed.; Lawrence Eribaum associates: New York, 1988.
Wannapa, S.; Phumdoung, S.; Thitimapong, B. The effects of natural pushing together with a priliminary controlled breathing of yoka on duration of the second stage of labor and postpartum fatigue in primiparous women. PNUJR, 2018, 10(1), 1-12.
Couper, M.P.; Tourangeau, R.; Conrad, F.G.; Singer, E. Evaluating the effectiveness of visual analog scales. Soc. Sci. Comput. Rev., 2006, 24(2), 227-245.
Aun, C.; Lam, Y.M.; Collett, B. Evaluation of the use of visual analogue scale in chinese patients. Pain, 1986, 25(2), 215-221.
[] [PMID: 3725409]
Revill, S.I.; Robinson, J.O.; Rosen, M.; Hogg, M.I.J. The reliability of a linear analogue for evaluating pain. Anaesthesia, 1976, 31(9), 1191-1198.
[] [PMID: 1015603]
Facco, E.; Zanette, G.; Favero, L.; Bacci, C.; Sivolella, S.; Cavallin, F.; Manani, G. Toward the validation of visual analogue scale for anxiety. Anesth. Prog., 2011, 58(1), 8-13.
[] [PMID: 21410359]
Mock, V.; Atkinson, A.; Barsevick, A.; Cella, D.; Cimprich, B.; Cleeland, C.; Donnelly, J.; Eisenberger, M.A.; Escalante, C.; Hinds, P.; Jacobsen, P.B.; Kaldor, P.; Knight, S.J.; Peterman, A.; Piper, B.F.; Rugo, H.; Sabbatini, P.; Stahl, C. NCCN practice guidelines for cancer-related fatigue. Oncology (Williston Park), 2000, 14(11A), 151-161.
[PMID: 11195408]
Bauer, M.E.; Balistreri, M.; MacEachern, M.; Cassidy, R.; Schoenfeld, R.; Sankar, K.; Clauw, D.J.; Langen, E. Normal range for maternal lactic acid during pregnancy and labor: A systematic review and meta-analysis of observational studies. Am. J. Perinatol., 2019, 36(9), 898-906.
[] [PMID: 30396223]
Burns, N.; Grove, S.K. The practice of nursing research conduct,critique, and utilization, 2nd ed; WB Saunders Company: Philadelphia, 1993.
Turner, R.C.; Carlson, L. Indexes of item-objective congruence for multidimensional items. Int. J. Test., 2003, 3(2), 163-171.
Bijur, P.E.; Silver, W.; Gallagher, E.J. Reliability of the visual analog scale for measurement of acute pain. Acad. Emerg. Med., 2001, 8(12), 1153-1157.
[] [PMID: 11733293]
Berchtold, A. Test-retest: Agreement or reliability? Methodol. Innov., 2016, 9, 1-7.
Laerd Statistics. Pearson’s product moment correlation., 2020. Available from:
Dodd, M.J.; Miaskowski, C.; Lee, K.A. Occurrence of symptom clusters. J. Natl. Cancer Inst. Monogr., 2004, 2004(32), 76-78.
[] [PMID: 15263044]
Watson, M.J. New dimensions of human caring theory. Nurs. Sci. Q., 1988, 1(4), 175-181.
[] [PMID: 3205483]
Humphreys, J.; Janson, S.; Donesky, D.A.; Dracup, K.; Lee, K.A.; Puntillo, K. Theory of Symptom Management. In: Middle range theory for nursing, 3rd ed.; Smith, M.J.L.; Patricia, R., Eds.; Springer Publishing Co: New York, 2014, pp. 141-165.
Payant, L.; Davies, B.; Graham, I.D.; Peterson, W.E.; Clinch, J. Nurses’ intentions to provide continuous labor support to women. J. Obstet. Gynecol. Neonatal Nurs., 2008, 37(4), 405-414.
[] [PMID: 18754978]
Esmaelzadeh Saeieh, S.; Rahimzadeh, M.; Yazdkhasti, M.; Torkashvand, S. Perceived social support and maternal competence in primipara women during pregnancy and after childbirth. Int. J. Community Based Nurs. Midwifery, 2017, 5(4), 408-416.
[PMID: 29043286]
World Health Organization. 2002. WHO antenatal care randomized trial: manual for the implementation of the new model., Available from: (Accessed on: 12th May, 2022).
Pooltananan, P.; Luengratsameerung, S. Effect of unfulfilled standard antenatal care on pregnancy outcomes. Thai J. Obst. Gynaecol., 2019, 27(2), 71-78.
Cook, K.; Loomis, C. The impact of choice and control on women’s childbirth experiences. J. Perinat. Educ., 2012, 21(3), 158-168.
[] [PMID: 23730127]
Klomp, T.; Manniën, J.; de Jonge, A.; Hutton, E.K.; Lagro-Janssen, A.L.M. What do midwives need to know about approaches of women towards labour pain management? A qualitative interview study into expectations of management of labour pain for pregnant women receiving midwife-led care in the Netherlands. Midwifery, 2014, 30(4), 432-438.
[] [PMID: 23790961]
Firouzbakht, M.; Nikpour, M.; Khefri, S.; Jamali, B.; Kazeminavaee, F.; Didehdar, M. The effectiveness of prenatal intervention on pain and anxiety during the process of childbirth-northern Iran: Clinical trial study. Ann. Med. Health Sci. Res., 2015, 5(5), 348-352.
Howharn, C. Effects of childbirth preparation classes on selfefficacy in coping with labor pain in Thai primiparas., PhD dissertation. University of Texas at Austin Library, Austin, 2008.
Lawrence, A.; Lewis, L.; Hofmeyr, G.J.; Dowswell, T.; Styles, C. Maternal positions and mobility during first stage labour. Cochrane Database Syst. Rev., 2009, 15(2), CD003934.
De Jonge, A.; Lagro-Janssen, A.L.M. Birthing positions. A qualitative study into the views of women about various birthing positions. J. Psychosom. Obstet. Gynaecol., 2004, 25(1), 47-55.
[] [PMID: 15376404]
Gupta, J.K.; Sood, A.; Hofmeyr, G.J.; Vogel, J.P. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Libr., 2017, 2017(5), CD002006.
[] [PMID: 28539008]
Storton, S. Step 4: Provides the birthing woman with freedom of movement to walk, move, assume positions of her choice: The coalition for improving maternity services. J. Perinat. Educ., 2007, 16(Suppl. 1), 25-27.
[] [PMID: 18523670]
Barasinski, C.; Vendittelli, F. Effect of the type of maternal pushing during the second stage of labour on obstetric and neonatal outcome: a multicentre randomised trial-the EOLE study protocol. BMJ Open, 2016, 6(12), e012290.
[] [PMID: 27998899]
Yildirim, G.; Beji, N.K. Effects of pushing techniques in birth on mother and fetus: A randomized study. Birth, 2008, 35(1), 25-30.
[] [PMID: 18307484]
Anwar, S.; Jan, R.; Qureshi, R.N.; Rattani, S. Perinatal women’s perceptions about midwifery led model of care in secondary care hospitals in Karachi, Pakistan. Midwifery, 2014, 30(3), e79-e90.
[] [PMID: 24290946]
Klomp, T.; de Jonge, A.; Hutton, E.K.; Hers, S.; Lagro-Janssen, A.L. Perceptions of labour pain management of Dutch Primary Care Midwives: A focus group study. BMC Pregnancy and Childbirth, 2016, 16(1), 1-9.
Lally, J.E.; Thomson, R.G.; MacPhail, S.; Exley, C. Pain relief in labour: A qualitative study to determine how to support women to make decisions about pain relief in labour. BMC Pregnancy Childbirth, 2014, 14(1), 1-10.
Ekrami, F.; Mohammad, A.C.S.; Babapour, K.J.; Mirghafourvand, M. The effect of counselling on depression and anxiety of women with unplanned pregnancy: A randomized controlled trial. Community Ment. Health J., 2019, 55(6), 1047-1056.
[] [PMID: 31183585]
Kuruvilla, S. Effect of Lamaze method on pain perception, anxiety, fatigue and labour outcome among primi mothers during labour process. J. Biomed. Sci., 2019, 24, 9.
Bakker, J.; Schieveld, S.J.; Brinkert, W. Serum lactate level as a indicator of tissue hypoxia in severely ill patients. Ned. Tijdschr. Geneeskd., 2000, 144(16), 737-741.
Hanley, J.A.; Weeks, A.; Wray, S. Physiological increases in lactate inhibit intracellular calcium transients, acidify myocytes and decrease force in term pregnant rat myometrium. J. Physiol., 2015, 593(20), 4603-4614.
[] [PMID: 26223765]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy