# Situation: A 22-year-old primigravida at 39 weeks' gestation comes to a Basic Emergency Obstetric and Newborn Care (BEmONC)-capable birthing facility of a Rural Health Unit (RHU) because of contractions. Her prenatal course has been normal, and the fetus is in a vertex presentation. The client is very frightened and tense. The nurse explains why reducing her fear can help her labor progress. Which explanation is correct?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629575  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 22-year-old primigravida at 39 weeks' gestation comes to a Basic Emergency Obstetric and Newborn Care (BEmONC)-capable birthing facility of a Rural Health Unit (RHU) because of contractions. Her prenatal course has been normal, and the fetus is in a vertex presentation.

The client is very frightened and tense. The nurse explains why reducing her fear can help her labor progress. Which explanation is correct?

## 보기

1. Fear raises oxytocin release, which causes overly strong contractions
2. Fear raises progesterone levels, which directly block uterine contractions
3. Fear increases endorphin release, which slows the rate of cervical dilation
4. Fear raises catecholamines, which reduce uterine blood flow and slow labor **✔ 정답**

**정답: 4**

## 해설

In the fear-tension-pain cycle, anxiety raises catecholamines, which increase muscle tension and can reduce uterine blood flow and slow labor. More tension then increases pain, which increases fear. Support and information break the cycle, which is why the psyche is counted among the factors of labor.

## 심화 해설

Why reducing fear helps labor progress

The correct explanation is that fear raises catecholamines, which reduce uterine blood flow and slow labor. This is the physiologic core of the fear–tension–pain cycle first described by Grantly Dick-Read and still used as a framework for intrapartum nursing care [1].

When a laboring woman is frightened, her sympathetic nervous system activates and releases catecholamines — primarily epinephrine and norepinephrine. These hormones prepare the body for “fight or flight,” but that response works against efficient labor in three connected ways:

Catecholamines cause vasoconstriction of uterine blood vessels, which reduces oxygen delivery to the uterine muscle and can weaken contraction effectiveness. At the same time, increased muscle tension from anxiety makes the pelvic and perineal muscles less compliant, increasing resistance to fetal descent. The result is slower cervical dilation and a longer labor.

The cycle then feeds itself: slower, more painful labor increases fear, which raises catecholamines further, which increases tension and pain. Breaking any segment of this cycle — through education, purposeful activity, or supportive care — can shift the labor toward a more positive trajectory [1].

| Option | Physiologic claim | Why it is incorrect |
| --- | --- | --- |
| 1 | Fear raises oxytocin, causing overly strong contractions | Fear does not primarily raise oxytocin. Oxytocin drives rhythmic contractions, but the fear response is catecholamine-driven and tends to impair, not strengthen, effective labor. |
| 2 | Fear raises progesterone, which blocks uterine contractions | Progesterone does maintain uterine quiescence, but acute fear does not raise progesterone as its main effect. The relevant acute stress hormones are catecholamines. |
| 3 | Fear increases endorphins, slowing cervical dilation | Endorphins are released with pain and stress, but they act as endogenous analgesics and are not the primary mechanism by which fear slows labor. |
| 4 | Fear raises catecholamines, reducing uterine blood flow and slowing labor | Correct. This directly explains the fear–tension–pain cycle and the rationale for reducing anxiety in labor. |

Watch out! Do not confuse the hormonal effects of fear with those of normal labor. Oxytocin and endorphins are part of the physiologic labor process, but the specific hormone that mediates the negative effect of fear on labor progress is catecholamines.

Key point! The psyche is considered one of the factors of labor because emotional state directly alters neurohormonal responses. A frightened, tense primigravida is at risk for prolonged labor not because of weak contractions alone, but because sympathetic activation compromises uterine perfusion and increases muscle resistance.

Supportive nursing interventions that reduce anxiety — such as calm reassurance, continuous presence, and nonpharmacologic comfort measures like effleurage back massage — have been shown to lower anxiety scores and shorten mean labor duration in primigravida mothers . Similarly, nurse-led childbirth preparedness sessions improve childbirth self-efficacy and reduce anxiety, pain intensity, and labor duration among primiparous women . These findings align with the conceptual model of intervening in labor pain by breaking the fear–tension–pain cycle through education, purposeful activity, and supportive care [1].References (research sources)

- [1]Pain in labor: a conceptual model for intervention.Research articleMozingo JN (1978) · DOI: 10.1111/j.1552-6909.1978.tb00925.x

## 임상 시나리오

Fear-Tension-Pain Cycle in LaborWhy reducing anxiety improves labor progress
Anxiety activates the sympathetic nervous system, releasing catecholamines such as epinephrine and norepinephrine. These hormones cause uterine vasoconstriction, reducing uterine blood flow and oxygen delivery to the uterine muscle, which weakens contraction effectiveness and slows labor.

Increased muscle tension from fear makes pelvic and perineal muscles less compliant, increasing resistance to fetal descent and slowing cervical dilation. The resulting slower, more painful labor feeds back into greater fear, perpetuating the cycle.

CautionBreaking any part of the cycle through education, purposeful activity, or supportive care can shift labor toward a positive trajectory. The psyche is counted among the factors of labor, so continuous emotional support is a nursing priority.

## 핵심 개념

- **Fear-tension-pain cycle** — Anxiety raises catecholamines, increasing muscle tension and pain, which further increases fear and slows labor.
- **Catecholamines** — Epinephrine and norepinephrine released during sympathetic activation; cause uterine vasoconstriction and increased muscle tension.
- **Uterine blood flow** — Reduced by catecholamine-induced vasoconstriction, impairing oxygen delivery and contraction effectiveness.
- **Psychosocial factors of labor** — The psyche is one factor affecting labor; support and information can break the fear-tension-pain cycle.
- **BEmONC** — Basic Emergency Obstetric and Newborn Care; a facility level providing essential obstetric and newborn interventions.

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