Journal of Psychosomatic Obstetrics & Gynecology

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Anxiety sensitivity and anxiety as correlates of

expected, experienced and recalled labor pain

Doris Curzik & Natasa Jokic-Begic

To cite this article: Doris Curzik & Natasa Jokic-Begic (2011) Anxiety sensitivity and anxiety as
correlates of expected, experienced and recalled labor pain, Journal of Psychosomatic Obstetrics &
Gynecology, 32:4, 198-203, DOI: 10.3109/0167482X.2011.626093

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Journal of Psychosomatic Obstetrics & Gynecology, 2011; 32(4): 198–203
Copyright © 2011 Informa UK, Ltd.
ISSN 0167-482X print/ISSN 1743-8942 online
DOI: 10.3109/0167482X.2011.626093
ORIGINAL ARTICLE
Anxiety sensitivity and anxiety as correlates of expected, experienced
and recalled labor pain
Doris Curzik1 & Natasa Jokic-Begic2
1
Department of Psychiatry, University Hospital Center Zagreb, Croatia and 2Department of Psychology, Faculty of Humanities
and Social Sciences, University of Zagreb, Croatia
There has been a good deal of research on the role of
anxiety sensitivity in pain perception, but only recently have
investigators begun to assess its role in labor pain. The aim of
this study was to investigate the nature of this relationship as
well as the relationship of state and trait anxiety with labor
pain. Assessments of maximum and average labor pain were
completed in three different time periods (before, during and
immediately after labor, and 1 month postpartum). Anxiety
and anxiety sensitivity measures were completed during the
late stage of pregnancy. A total of 46 primiparous healthy
pregnant women, carrying a single child, participated in the
study. State anxiety correlated significantly with maximum
(r = 0.352, p < 0.01) and average (r = 0.325, p < 0.05) labor pain
expectancies, whereas trait anxiety correlated significantly
with maximum labor pain expectancies (r = 0.306, p < 0.05).
During labor, only the physical concerns dimension of anxiety
sensitivity shared a significant relationship with sensory pain
(r = 0.292, p < 0.05). In conclusion, anxiety shares a significant
relationship with labor pain expectancies only, whereas the
physical concerns dimension of anxiety sensitivity correlates
significantly with sensory pain during labor. These data clarify
the role of anxiety and anxiety sensitivity in the experience of
labor pain. Clinical implications are discussed.
Keywords:  anxiety, anxiety sensitivity, childbirth, pain
Introduction
Trait anxiety, defined as a stable tendency to respond with
state anxiety in the anticipation of threatening situations, is
commonly proposed as one of the main psychological factors
contributing to higher labor pain intensity [1,2]. Yet, studies
have thus far failed to obtain consistent data to support this
hypothesis [3,4]. Moreover, Lang et al [4]. suggest that labor
pain may not be influenced by trait anxiety, but rather by the
woman’s fear that those experiences of pain are threatening
Correspondence: Dr. Natasa Jokic-Begic PhD., Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, I. Lucica
3, Zagreb, 1000 Croatia. E-mail: njbegic@ffzg.hr
198
and harmful. In other words, anxiety sensitivity, defined as a
tendency to fear anxiety-related symptoms due to the belief
that there will be some negative outcome as a result of hav-
ing those symptoms, may be a factor significantly related to
labor pain. In this single research study [4] that investigated
the role of anxiety sensitivity in labor pain, the authors found
that anxiety sensitivity shared a significant relationship with
maximum sensory and affective labor pain, but that state
and trait anxiety (measured by the state-trait anxiety inven-
tory (STAI)) did not correlate significantly with labor pain.
Anxiety sensitivity predicted both maximum pain during
labor and sensory aspects of pain above and beyond demo-
graphic and social factors as well as other theoretically impor-
tant psychological factors (e.g. depression and state anxiety).
Similar results were obtained by Spice et al. [5], who found
that anxiety sensitivity significantly predicted elevated fear of
childbirth even after controlling for parity and trait anxiety.
Currently, Norton and Asmundson’s amended fear-avoid-
ance model [6] provides the best explanation for why anxiety
sensitivity seems to contribute to higher labor pain intensi-
ties. They argue that symptoms of physiological arousal (e.g.
increased heart rate, increased blood flow to voluntary mus-
cles) may produce bodily sensations such as muscular tension
that elicit misinterpretations of the nature and meaning of the
sensations. These misinterpretations are seen as the product of
individual differences in the propensity to respond with fear
to sensations that are anxiety provoking (e.g. anxiety sensitiv-
ity and/or negative affect). Those with high anxiety sensitivity
will catastrophically misinterpret the physiological sensations
of anxiety, provoked by the anticipation of, or exposure to,
a pain-provoking situation, as evidence of impending harm
and/or pain [7]. In turn, these catastrophically misinterpreted
bodily sensations can lead to the avoidance of associated situ-
ations. Indeed, research has demonstrated that women who
are prone to pain anticipated and experienced more intense
labor pain and had poorer postpartum physical recovery [8].

According to Reiss  [9], anxiety sensitivity facilitates a fear
response during specific anxiety-evoking situations as it may
exacerbate concerns about physiological responses leading to
increased fear and avoidance of pain-related activities as well
as further increasing physiological reactivity (i.e. a vicious
cycle of fear and anxiety leading to more physiological reac-
tivity). Indeed, healthy persons with high anxiety sensitivity
demonstrated greater interpretive bias and more negative pain
experiences relative to persons with low anxiety sensitivity, and
interpretive biases were related to worse affective pain experi-
ences [10]. In the context of labor, women with high levels of
anxiety sensitivity would be more likely to be hypervigilant
for both pain and other bodily sensations and to catastrophi-
cally misinterpret them as more threatening and dangerous.
Consequently, this may lead to avoidance behaviors such as not
taking part in childbirth classes and/or asking more frequently
for C-section in order to avoid anxiety and pain.
Pain anticipation and pain avoidance seem to be important
factors when considering the role of trait and state anxiety and
anxiety sensitivity in labor pain. Therefore, establishing the
role of trait and state anxiety and anxiety sensitivity in correla-
tion to expected, experienced and recalled labor pain should
also provide a better insight in understanding the role of psy-
chological factors in labor pain.
Previous studies have to some extent explored the role of
anxiety (i.e. trait anxiety, dental anxiety) in expected, expe-
rienced and recalled pain (i.e. dental pain, chronic low back
pain). It seems that trait anxiety, defined as a tendency to
respond with fear in situations perceived as harmful, is related
to pain expectancies rather to experienced pain [11–15]. On
the other hand, Terry et al. [16] found that preoperative state
and trait anxiety correlated significantly with actual, but not
with expected and recalled postoperative pain.
To our knowledge, there is not yet any research that has
investigated the role of trait and state anxiety and anxiety
sensitivity in labor pain expectancies, nor in recalled labor
pain. Thus, the aim of this study was to investigate the role of
trait and state anxiety and anxiety sensitivity as correlates of
expected, experienced and recalled labor pain.
In their research, Lang et al. [4] emphasized that one of the
limitations of their study was that labor pain was not mea-
sured immediately after labor, which could have lead to dis-
tortions in labor pain assessments. This research presents an
attempt to eliminate this methodological limitation by taking
labor pain assessments during and immediately after labor. In
research conducted by Spice et al. [5] the role of trait anxiety
and anxiety sensitivity in fear of childbirth, rather than fear of
pain, was explored.
We generally hypothesized that trait and state anxiety would
be related to labor pain expectancies and that anxiety sensitiv-
ity would be significantly correlated with actual labor pain.
Methods
This study was approved by the Zagreb Faculty of Humanities
and Social Sciences’ Institutional Review Board. All women
provided informed consent. The research was performed at
Osijek Clinical Hospital Centre.
Copyright © 2011 Informa UK Ltd.
Anxiety sensitivity and labor pain  199
Participants
To participate, women had to be healthy primiparas, who
were not experiencing any acute pain and had no chronic
pain problems (i.e. chronic back pain) at the first stage of the
study. All women were between 37 and 40 weeks of pregnancy,
and carrying a single child. Of 60 women who enrolled in the
study, 46 completed all three stages of the study and thus were
included in this analysis. None of these women received epi-
dural analgesia in any stage of their labor. However, as a part of
the regular procedure, all of the women who enrolled this study
received 50 mg of spasmoanalgetic meperidine during labor.
In the second stage of the study, 11 women were excluded from
the study because of cesarean delivery and/or complications
during labor. The indications for cesarean section (or labor
related complications) included different severe medical con-
ditions such as placenta previa, dispoportio cefalopelvina and
asfixio fetus imminens, but none was performed for reasons
such as unbearable labor pain. These women were excluded
from the study because they did not reach the pushing stage of
the labor and therefore maximum labor pain assessments (that
constituted the first part of the study’s second stage) could not
be taken. The average labor pain assessments immediately
after labor could also not be taken in this group because of the
qualitatively different nature of labor and pain experienced.
Three women did not show up at the control examination 1
month postpartum and were also excluded from the study.
Procedure
Women were recruited during late prenatal examinations.
They were briefly informed about the research by their gyne-
cologist at the end of their examination and were directed to
a room where they were more completely informed about the
research procedure by one of the investigators. Once informed
consent had been given, women completed the Spielberger’s
state-trait anxiety inventory, The anxiety sensitivity index (ASI)
and provided estimates of expected average and maximum
labor pain intensities on a scale from 1 to 10 (1 = no pain,
10 = unbearable pain). Demographic information about age,
education, household income, marital status, and marriage/
relationship satisfaction (on a scale from 1 to 10, with a higher
number indicating higher level of satisfaction) was also pro-
vided. That completed the first stage of the study. The second
stage of the study consisted of two parts. In the first part − after
the first stage of labor− before pushing (later in text referred as
during labor) participants assessed maximum labor pain and
completed the short-form McGill pain questionnaire. In the sec-
ond part (immediately after the baby was born), assessments of
average labor pain were taken. Assessments of actual maximum
labor pain were taken on a scale from 1 to 10 and each of the 15
words from the short-form McGill pain questionnaire (MPQ-SF)
Swere read aloud by the investigator, and were assessed on a scale
from 0 to 3 (0 = none, 1 = mild, 2 = moderate, 3 = severe). Average
labor pain was assessed on a scale from 1 to 10. Finally, in the
third stage of the study, recalled labor pain was assessed 1 month
postpartum after the first postnatal examination by completing
the short form McGill pain questionnaire as a measure of recalled
maximum labor pain intensity, and providing estimates of maxi-
mum and average labor pain intensity on scales from 1 to 10.
200  D. Curzik & N. Jokic-Begic
Assessment measures SD = 10.0) showed normal distribution and Cronbach’s α was
In this research, the following measures of psychopathology 0.90. Research supports a hierarchical factor structure of the
were used: the STAI, the ASI and the MPQ-SF. ASI consisting of three lower-order factors measuring physi-
cal concerns, mental incapacitation (psychological) concerns,
The state-trait anxiety inventory (STAI) and social concerns [19].
The STAI [17] is a widely used measure of general anxiety. It
has demonstrated good reliability, with a median test-retest The short-form McGill pain questionnaire (MPQ-SF)
reliability coefficient for the trait version of 0.76. The reliabil- Finally, The MPQ-SF [20] was used in the present research,
ity coefficients for the state version is lower (0.33), which is which is the most commonly used measure of labor pain and
understandable because it is designed to reflect fluctuations provides information about both sensory and affective aspects
in anxiety  [17]. The results in our sample (N = 60; STAI-S: of pain [21]. Sensory aspects of pain refer to temporal, spa-
M = 41.62, SD = 8.9; STAI-T: M = 37.77, SD = 8.4) showed nor- tial, pressure and thermal properties of pain whereas affective
mal distributions and Cronbach’s α coefficients were 0.46 for aspects of pain refer to tension, fear and autonomic properties
the state version, and 0.67 for the trait version. of the pain [20]. To prevent the results (labor pain assessments)
from being distorted by the possibility that women (healthy
The anxiety sensitivity index (ASI) primiparas) might become more alert to different types of pain
The second measure was the ASI [18], a 16-item self-report during labor  [22–25] the short-form McGill Questionnaire
measure of anxiety sensitivity. It has excellent psychomet- was not used to assess labor pain expectancies.
ric properties in both clinical and non-clinical samples.
A Cronbach’s α between 0.84–0.90 suggests good internal Statistical analyses
reliability  [18]. The results in our sample (N = 60; M = 18.0, The Statistical Package for the Social Sciences, version 12.0
(SPSS Inc., Chicago, IL, USA) was used for data analyses. The
Table I.  Demographic features of the study sample. level of statistical significance was set at p < 0.05.
M (SD) Range N
Age 26.18 (4.952) 17–40 60
Results
Marriage satisfaction 9.46 (0.816) 7–10 59
frequency % N Demographic features
Education 60 Demographic features of the study sample are presented
  Primary school 6 10.0 in Table  I. Women with and without complete data from
  High school 40 66.7 all three stages of the research did not differ in age, marital
  Some college 4 6.7 status, income, education, state and trait anxiety and anxiety
  College graduate 10 16.7 sensitivity. The excluded women and women with complete
Household income (monthly) 60 data from all three stages of the research did not differ in age,
  <$1000 20 33.3 marital status, income, education, state and trait anxiety and
  $1000–$1500 24 40.0 anxiety sensitivity.
  $1501–$3000 14 23.3
  >$3000 2 3.3 The relationship between labor pain assessments,
Marital status 60 anxiety and anxiety sensitivity
  Single 1 1.7 To establish the relationship between labor pain assessments,
  Married 54 90.0 anxiety and anxiety sensitivity in three different time periods,
  Living with partner 5 8.3 Pearson’s correlation coefficients were computed. As pre-
M, mean; N, total sample number; SD, standard deviation. sented in Table II, anxiety as state correlated significantly with

Table II.  Pearson’s correlation coefficients between anxiety, anxiety sensitivity, anxiety sensitivity physical concerns and labor pain assessments in three
­different time periods.
Expected Expected Experienced Experienced MPQ-SF MPQ-SF Recalled Recalled MPQ-SF
maximum average maximum average experienced experienced maximum average recalled
labor labor labor labor maximum max.sensory labor labor max.labor
pain pain pain pain labor pain labor pain pain pain pain
State anxiety 0.352b 0.325a 0.254 0.109 0.089 0.042 0.193 0.036 0.240
Trait anxiety 0.306a 0.244 0.146 0.164 0.047 0.035 0.055 0.079 0.000
Anxiety sensitivity 0.151 0.118 0.032 0.144 0.197 0.245 0.061 0.141 0.010
Anxiety sensitivity− 0.128 0.137 0.133 0.177 0.268 0.335a 0.151 0.211 0.022
physical concerns
Anxiety sensitivity− 0.121 0.028 0.017 0.160 0.122 0.154 −0.039 0.041 −0.026
psychological concerns
Anxiety sensitivity− 0.162 0.170 −0.292a 0.155 −0.043 −0.069 −0.050 0.010 0.052
social concerns
N1 = 60, N2 = 49, N3 = 46.
ap < 0.05, bp < 0.01.

Journal of Psychosomatic Obstetrics & Gynecology

 Anxiety sensitivity and labor pain  201

Table III.  Descriptive statistics for maximum and average labor pain assessments in women divided into four groups according to high/low levels of trait
anxiety and anxiety sensitivity.
↓ASI ↓STAI ↑ASI ↑STAI ↓ASI ↑STAI ↑ASI ↓STAI
(N = 15) (N = 16) (N = 11) (N = 4)
Expected average labor pain M 5.85 5.95 6.54 4.60
SD 2.477 1.774 1.941 1.140
Expected maximum labor pain M 7.25 8.14 8.31 6.40
SD 2.359 1.621 1.702 1.342
Experienced average labor pain M 6.19 6.56 6.67 6.80
SD 3.016 2.308 2.309 2.168
Experienced maximum labor pain M 8.81 8.88 9.18 8.60
SD 1.601 0.885 1.240 1.949
MPQ-SF − experienced max. labor pain M 24.75 24.63 22.92 26.00
SD 8.933 8.702 7.798 8.246
Recalled average labor pain M 7.00 6.75 7.64 8.75
SD 2.420 2.049 1.567 0.957
Recalled maximum labor pain M 8.27 8.38 9.08 9.75
SD 1.870 1.310 0.751 0.500
MPQ-SF − recalled max. labor pain M 18.40 17.25 20.18 16.75
SD 8.576 9.567 7.250 7.042
M, mean; MPQ-SF, short-form McGill pain questionairre; ASI, anxiety sensitivity index; STAI, state/trait anxiety inventory (trait anxiety scores); N, number of women; SD,
standard deviation; ↑ASI, anxiety sensitivity index median score above 18; ↓ASI, anxiety sensitivity index median score under 18; ↑STAI, trait anxiety median score above 36;
↓STAI, trait anxiety median score under 36.

maximum (r = 0.352, p < 0.01) and average (r = 0.325, p < 0.05)

labor pain expectancies, whereas anxiety as trait correlated
significantly with maximum labor pain expectancies (r = 0.306,
p < 0.05). Anxiety shared no significant relationship with per-
ceived nor with recalled labor pain. Anxiety sensitivity shared
a significant relationship with labor pain assessments when
these measures were divided into three dimensions (physical,
psychological and social concerns) (Table II). Namely, the
physical concerns dimension of anxiety sensitivity shared a
significant relationship with experienced maximum sensory
labor pain (assessments completed during labor – before the
pushing stage) (r = 0.292, p < 0.05).

Examining differences among women grouped

according to high/low levels of trait anxiety and
anxiety sensitivity
In addition, we explored differences in expected, experienced and
recalled labor pain between woman of varying anxiety sensitivity
and trait anxiety levels. An interesting trend was observed when
women were divided into four groups according to high and
low levels of trait anxiety and anxiety sensitivity using a median-
split method, a method used in previous research [26,27]. Scores
above a median of 36 on the STAI indicated high trait anxiety,
and those below the median indicated low trait anxiety. Scores
above a median of 18 on the ASI indicated high anxiety sen-
sitivity, whereas those below the median indicated low anxiety
sensitivity. These numbers are comparable with those from pre-
vious research conducted by Staničić and Jokić-Begić [27] with
a sample of Croatian women, where the median score for trait
anxiety was 36 and the ASI median score was 17. Descriptive
statistics for maximum and average labor pain assessments in
these four groups are presented in Table III. To establish whether
the four groups of women differed significantly in assessments
of expected, experienced or recalled labor pain, analysis of vari-
ance was performed. The four groups of women did not differ
Figure 1.  Maximum labour pain assessments in three different time
periods in women divided into four groups according to high/low lev-
els of anxiety and anxiety sensitivity.
significantly in assessments of expected, experienced or recalled
labor pain. Women high in anxiety sensitivity, but low in anxiety
1 month postpartum demonstrated a trend (although not statis-
tically significant) to provide higher estimates of both maximum
and average labor pain postpartum than those completed dur-
ing labor. In the other three groups, a trend (although not sta-
tistically significant) towards a reduction in recalled maximum
and average labor pain 1 month postpartum was observed. To
provide a better view of the observed trends, maximum labor
pain assessments are presented as a graph (Figure 1).
Discussion
High perceived and recalled labor pain correlates with nega-
tive labor experiences that can influence the occurrence of

Copyright © 2011 Informa UK Ltd.

202  D. Curzik & N. Jokic-Begic
postpartum psychological problems [28]. In order to prevent
the occurrence of such problems, it is important to establish
personality traits that correlate with high perceived labor
pain intensities. Previous research showed higher pain inten-
sity in primiparous women in comparison with multiparous
women  [29]. In order to exclude the influence of former
labor pain experiences on labor pain assessments, especially
on labor pain expectancies, only primiparous women were
included in this research.
In our research, state anxiety correlated significantly with
expectancies of maximum and average labor pain. These results
were expected because these measures were completed only a
few weeks before labor and thus reflected the woman’s state
before her first birth. In other words, because labor presented a
new experience to our participants, expectancies of maximum
and average labor pain escalated as levels of incertitude, anxiety
and fear grew. Trait anxiety correlated significantly only with
maximum labor pain expectancies. Trait anxiety is character-
ized by a tendency to experience fear, uneasiness or worry in
situations that are perceived as threatening, for example, when
experiencing the highest intensities of labor pain. Thus, women
higher in trait anxiety focused more on maximum labor pain
intensities. The findings of this study are consistent with those
of Zakka et al. [29] in that higher pain intensity before vaginal
delivery was associated with higher anxiety levels. Similarly,
Schnur et al. [15] found that anxiety was significantly corre-
lated with postoperative pain expectancies in women sched-
uled to undergo an excisional breast biopsy or lumpectomy.
State and trait anxiety did not correlate significantly with
pain assessments during labor or those made 1 month postpar-
tum. However, the physical concerns dimension of anxiety sen-
sitivity correlated significantly with sensory pain during labor.
These findings support Lang et al.’s [4] hypothesis that sensory
labor pain may not be influenced by diffuse anxiety, as it has for
a long time been considered, but rather by the mother’s belief
that these experiences are threatening and potentially harmful.
Recent research conducted by Spice et al. [5] also found that
physical concerns are distinct from trait anxiety in predicting
fear of childbirth. Similar to other fears, the results of the pres-
ent research support the possibility that anxiety sensitivity may
be a risk factor for elevated fear of childbirth.
The results of our research are consistent with Norton and
Asmundson’s amended fear-avoidance model of pain [6]. In
their model, they emphasize the manner in which cognitive
components of pain-related fear impact physiological pain
symptoms. They argue that physiological arousal can produce
pain, leading to bodily sensations such as muscle tension, fol-
lowed by the misinterpretation of the origin of these bodily
sensations. In our research, a pregnant woman with high lev-
els of anxiety sensitivity was more likely to be fearful of intero-
ceptive sensations during labor such as pain and other bodily
sensations and to interpret them as more threatening and
dangerous. The interaction between interoceptive sensitivity,
misinterpretation and physiological reactivity among women
high in anxiety sensitivity might have lead to increased rates
of sensory pain.
Interoceptive sensitivity, defined as sensitivity in detecting
signals arising from the inner organs, has been suggested to
play a pivotal role in the pathogenesis of anxiety and anxiety
disorders [30]. Arguably, it is possible that the correlation of
sensory pain assessments and the physical concerns dimen-
sion of anxiety sensitivity in the present research is a result of
the interaction between interoceptive sensitivity and selective
attention to bodily sensations. Furthermore, interoceptive
sensitivity might have also been a factor contributing to the
observed trend of higher recalled labor pain in women high
in anxiety sensitivity and low in anxiety. We hypothesized that
low levels of anxiety in this group of women had lead to low
labor pain expectancies. During labor, actual labor pain might
have come as a surprise to these women and, due to a low
anxiety level, they would not have attributed it to a state of
great anxiety. Finally, because of a greater tendency to inter-
pret bodily sensations and pain as threatening and danger-
ous, women in this group provided higher recalled labor pain
intensities than those reported during and immediately after
labor. In other words, a form of interoceptive conditioning
may have occurred in this group of women. It is consistent
with the model of acute pain recall proposed by Gedney &
Logan [31]. They postulated that over time negative emotions
mediate pain memory processing such that increasingly the
aversiveness of the experience and not the pain intensity per
se, will be remembered. Of course, this hypothesis is a matter
for future research to investigate.
There are several limitations to the present research.
First, the investigator’s presence could have been a distracter
to pain perception, although pain assessments during
labor were taken after the last part of active labor. Second,
our sample was relatively small. A larger sample in future
research would provide a more equal distribution of partici-
pants in groups according to different levels of anxiety and
anxiety sensitivity. This would allow further examination of
the trends in recalled labor pain observed in this research.
Finally, for better insight into expected and perceived labor
pain, we recommend that future research use a fear of pain
questionnaire as well as a more adequate measure of affec-
tive labor pain than the currently used short-form McGill
pain questionnaire.
Conclusion
The findings from this research emphasize the role of anxiety
sensitivity in the perception of labor pain. In other words, these
findings imply that, during labor, there is no reason to expect
greater labor pain intensity in women high in anxiety, but it can
be expected in women high in anxiety sensitivity. Rather than
directing attention solely to anxiety as a psychological con-
tributor to labor pain and complications during birth, child-
birth classes should also address the role of anxiety sensitivity
in labor pain perception. This is consistent with the findings
of Arntz & Claassens  [32], who experimentally proved that
the meaning people attach to a stimulus influences its expe-
rienced painfulness. The clinical implication of such findings
is that the correction of dysfunctional interpretations of pain
might help to reduce the burden of the experience of pain.
Different cognitive-behavioral techniques, including inducing
fear related bodily sensations (in order to achieve habituation
Journal of Psychosomatic Obstetrics & Gynecology

to a fear-eliciting stimulus) and education of highly anxiety
sensitive pregnant women about how they differently process
information on pain and other bodily sensations should help
minimize the role of psychological factors in increased labor
pain perception. The use of different cognitive pain coping
strategies significantly extends the duration of pain toler-
ance [33]. Research studies also suggest that regular massage
with relaxation techniques from late pregnancy to birth can
result in lower labor pain perception  [34]. Combined, such
interventions might have an impact on woman’s overall birth
experience and can help prevent the occurrence of postpar-
tum psychological problems.
Declaration of interest: This study was performed as part
of the larger project “Anxiety and Depression in Life-long
Perspective”, funded by the Ministry of Education, Science
and Sport of the Republic of Croatia.
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Current knowledge on this subject

• We reviewed the available literature and observed that only a single study investigated the role of anxiety sensitivity in labor
pain. The study suggested that anxiety sensitivity, rather than trait anxiety significantly predicts labor pain intensity. We also
encountered rather inconsistent data regarding the role of trait anxiety in pain expectancies. Namely, some studies found that
trait anxiety correlated significantly with pain expectancies, while other implied it as a correlate of actual pain intensities.

What this study adds

• This is the first study that investigated the role of trait and state anxiety and anxiety sensitivity in expected, experienced and
recalled labor pain. The results suggest that anxiety is related to labor pain expectancies, while anxiety sensitivity physi-
cal concerns dimension shares a significant relationship with actual sensory labor pain. The findings from this research
emphasize the role of anxiety sensitivity in the perception of labor pain and it has potential role in recalled labor pain.

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