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Mode of delivery modulates physiological and behavioral responses to neonatal pain

Journal of Perinatology volume 29, pages 44–50 (2009)Cite this article

Abstract

Objective:

To study whether the mode of delivery alters pain expression.

Study Design:

Full-term infants born by vaginal delivery or elective caesarean section were observed following high- and low-intensity pain stimuli, with recording of electrocardiogram, facial expression and vocalization.

Result:

Graded physiological and behavioral responses occurred, with greater responses to higher than lower intensity pain stimuli. Elevation in heart rate following both stimuli increased with time after vaginal delivery. Infants delivered by elective caesarean section showed stronger facial expressions and briefer time in vocalizations response to both interventions.

Conclusion:

Diminished responses following vaginal delivery suggest that physiological events associated with a normal delivery reduce the physiologic and sympathoadrenal activation by nociceptive mechanisms. Pain and stress reactivity appear to be inhibited during fetal life and sensory inputs during vaginal delivery may reverse this inhibition. To minimize neonatal pain, we recommend that postnatal invasive procedures to be performed shortly after vaginal birth.

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Acknowledgements

We thank the midwives at the delivery ward at Karolinska Hospital for their collaboration and help in conducting this research, as well as the parent who allowed us to study their infant. We are also grateful to Björn Palm and Fredrik Rådesand at JORAB, Sweden, for technical support with the BIOPAC and AcqKnowledge software. Thanks to Josef Milerad for participating in designing the protocol and help draft writing of the manuscript. Thanks to Eva Björkner, Karin Nyberg and Agneta Österman for performing part of the vocalization analyses. We thank Pia Baumann, Karin Nyberg and Agneta Österman for participating with data collection at the delivery ward. Thanks also to the midwives Britt Gustavsson, Annika Denbaum, Annika Gustavsson and the speech therapists Maria Södersten, Eva Borell and Elisabet Lundström as listeners of vocalizations to the perceptual estimation. Finally, we thank Björn A Larsson in supervision of Tord Andersson, Camilla Dahlskog and Sara Grönberg for their help with part of the NFCS scoring. Thanks to the statistical support by Birgitta Böhm. Thanks to Ruth E Grunau and Ken D Craig for permission to reproduce the NFCS (Supplementary Figure S1 and Table S2), which were original published in Pain 1987; 28: 395–410. This study was supported by grants from the Freemason Society in Stockholm, The Vårdal Foundation, the Sven Jerring Foundation, FoU Östersunds Hospital, the Swedish Medical Research Council (grant 05234) and Arkansas Children's Hospital Foundation.

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Authors and Affiliations

  1. Department of Woman and Child Health, Neonatal Research Unit Q2:07, Astrid Lindgren Children Hospital, Karolinska Institutet, Stockholm, Sweden

    L L Bergqvist, M Katz-Salamon & H Lagercrantz

  2. Department of Medicine, Östersund Hospital, Östersund, Sweden

    L L Bergqvist

  3. Department of Logopedics and Phonations, Karolinska University Hospital Huddinge, Karolinska Institute, Stockholm, Sweden

    S Hertegård

  4. Department of Pediatrics, College of Medicine, Arkansas Children Hospital Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    K J S Anand

Authors
  1. L L Bergqvist
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  2. M Katz-Salamon
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  3. S Hertegård
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  4. K J S Anand
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  5. H Lagercrantz
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Corresponding author

Correspondence to L L Bergqvist.

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There are no conflicts of interest within these people and the publication.

Supplementary Information accompanies the paper on the Journal of Perinatology website (http://www.nature.com/jp)

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Bergqvist, L., Katz-Salamon, M., Hertegård, S. et al. Mode of delivery modulates physiological and behavioral responses to neonatal pain. J Perinatol 29, 44–50 (2009). https://doi.org/10.1038/jp.2008.129

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