Does cognitive flexibility affect the course of labor? A prospective study

Abstract

Objective: To evaluate cognitive flexibility and labor and delivery outcomes.

Methods: A prospective study was conducted of nulliparas with singleton term pregnancy, admitted for labor to a tertiary referral center from 1 January to 31 July, 2017. After epidural anesthesia, parturients completed the validated Psychological Flexibility Questionnaire (20 questions that evaluate a person's level of cognitive flexibility) before delivery. They were asked to grade (from 1 to 10) their hope for vaginal delivery (Hope score). Within 2 hours after delivery, they graded (1-10) the similarity between their delivery and their expectations (Expectation score). Outcomes of the flexible versus less flexible group were compared.

Results: Among the flexible (n=120) versus less flexible (n=40) group, vaginal delivery was more common (74.2% vs 20.8%) than vacuum extraction (20.8% vs 35%) or cesarean delivery (5% vs 12.5%) (P=0.031). High Expectation score and delivery without grade III-IV perineal tear (P=0.032) were correlated. Groups were similar regarding Expectation (P=0.163) and Hope scores (P=0.591). The mode of delivery of parturients was not correlated with their mothers' (P=0.836) or sisters' (P=0.758).

Conclusion: High cognitive flexibility increases the likelihood of vaginal delivery. These findings support the mind-body correlation. Maternal cognitive perceptions can influence labor and delivery and should be considered when counseling patients during labor.

Keywords: Cesarean delivery; Cognitive flexibility; Labor and delivery outcomes; Parturient; Psychological Flexibility Questionnaire; Vaginal delivery.