Do Anxiety and Stress in Early Pregnancy Influence Labour Progression?

Sarfaroj Khan 


February 18, 2021


  • Higher anxiety and pregnancy-specific stress were not directly associated with a longer first stage of labour duration.

  • However, pregnancy-specific stress was associated with epidural use, which in turn was significantly associated with increased risk of augmentation, and longer first stage of labour.

Why this matters

  • Findings suggest that pregnancy-specific stress rather than general anxiety may need to be the focus of any psychological screening in pregnancy.

Study design

  • A study of 1145 pregnant primiparous women (age, ≥18 years) using data from the Wirral Child Health and Development Study.

  • Antenatal anxiety and pregnancy-specific stress were evaluated at 20 weeks’ gestation using State-Trait Anxiety Inventory and Pregnancy Stress Scale score, respectively.

  • Funding: UK Medical Research Council.

Key results

  • Anxiety (high vs low; mean difference [MD], 13.94 minutes; 95% CI, −26.60 to 54.49) and pregnancy-specific stress (high vs low; MD, 12.05 minutes; 95% CI, −19.52 to 43.63) were not directly associated with the duration of first stage of labour.

  • Anxiety (high vs low, 39% vs 31%; P=.042) and pregnancy-specific stress (high vs low, 38% vs 29%; P<.001) were associated with epidural use, which was itself linked to longer labour (MD, 158.79 minutes; 95% CI, 125.89-191.68; P<.001).

  • Anxiety (OR, 1.53; 95% CI, 1.07-2.19) and pregnancy-specific stress (OR, 1.36; 95% CI, 1.02-1.81) were associated with increased risk of augmentation, but these associations were non-significant after accounting for epidural, which was itself associated with augmentation.

  • Pregnancy-specific stress but not general anxiety was particularly linked to both longer labour (b=0.022; P=.015) and augmentation (b=0.137; P=.015) via indirect pathways through epidural.


  • Findings relate only to the first stage of labour and not the total labour duration.


Slade P, Sheen K, Weeks A, Wray S, De Pascalis L, Lunt K, Bedwell C, Thompson B, Hill J, Sharp H. Do stress and anxiety in early pregnancy affect the progress of labor: Evidence from the Wirral Child Health and Development Study. Acta Obstet Gynecol Scand. 2021 Feb 5 [Epub ahead of print]. doi: 10.1111/aogs.14063. PMID: 33543770.  View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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