DOI: 10.14457/tu.the.2022.1067
title: The effectiveness of an integrated symptom-related fatigue management program (ISFMP) on pain, anxiety, fatigue score, and lactate levels in low-risk pregnant women during childbirth

description: Background: Fatigue is typically viewed as a common symptom, which often occurs in conjunction with pain and anxiety during childbirth. Fatigue accumulates throughout the labor period as a snowball effect that results in negative effects on laboring women. Health professionals often underestimate the importance of investigating these symptoms. This study aimed to investigate the effectiveness of the Integrated Symptoms-Related Fatigue Management Program (ISFMP) on pain, anxiety, fatigue scores and lactate levels in low-risk pregnant women during childbirth. Method: A quasi-experimental design was used for the study from August 2021 to March 2022 at Prachuap Khiri Khan Hospital in Thailand. Sixty-five low risk pregnant women at 32 to 41+ 6 weeks of gestation were randomly assigned to either the comparison group or the intervention group. The participants in the intervention group participated in the ISFMP from the last trimester until two hours postpartum. This program promotes education, consultation, nursing support, free mobilization, and natural pushing, depending on the needs of participants. A visual analogue scale was used to evaluate the pain, anxiety, and fatigue scores; Lactate Pro 2 was used to evaluate lactate levels. Anxiety fatigue scores and lactate levels were measured at four time points (last trimester, active labor, immediately after childbirth, and two hours postpartum). Only pain was measured at three time points, excluding the last trimester. Data were analyzed using statistical software SPSS version 26, and independent t-test, chi-square testing, repeated measures ANOVA, and repeated measures MANOVA were used. The significance level was set at p &lt; .05.Results: After participating in the program, the participants in the experimental group had significantly higher anxiety (p = .003), fatigue (p &lt; .001) and pain (p &lt; .001) scores, as well as lactate levels during active labor (p &lt; .001), significant lower anxiety scores at immediately after childbirth (p &lt; .001), and at two hours postpartum (p &lt; .001). Fatigue scores were significantly lower at two hours postpartum (p &lt; .001), but there was no difference in fatigue scores at immediately after childbirth, while lactate levels were significantly higher immediately after childbirth (p &lt; .001) and at two hours postpartum (p &lt; .001). Pain scores were significantly lower at immediately after childbirth (p &lt; .001), and at two hours postpartum (p &lt; .001). The anxiety scores in the experimental group were lower than those of the comparison group at four time points (p &lt; .001). The fatigue scores in the experimental group were lower than those of the comparison group at three time points, except during active labor (p &lt; .001). The pain scores in the experimental group were lower than those of the comparison group at two time points (p &lt; .001), except immediately after childbirth. There were no differences in lactate levels between the two groups at four time points. Conclusion: The ISFMP resulted in decreasing in pain, anxiety, and fatigue scores, varying at each time point, but did not affect the lactate levels in either group. Therefore, midwives should promote the ISFMP in pregnant women for normal childbirth.