Effect of Psychological Interventions on Maternal Outcomes Undergoing Cesarean (PIMAC)

• Self depression assessment scale (SDS) [ Time Frame: One day prior surgery ] [ Designated as safety issue: Yes ]
  Scorings of SDS by the patient herself
• Visual analog scale of pain (VAS pain) [ Time Frame: Five min before surgery (-5 min) ] [ Designated as safety issue: Yes ]
  Patient self assessed pain scorings with a 100 mm (0-100) scale
• Saliva cortisol level [ Time Frame: One day prior surgery ] [ Designated as safety issue: No ]
  Saliva cortisol levels will be measured with EIA
• Vital signs [ Time Frame: One day prior surgery ] [ Designated as safety issue: Yes ]
  Blood pressure, heart rate, respiratory rate, oral temperature
• SAS scorings [ Time Frame: 15 min intraoperation ] [ Designated as safety issue: Yes ]
  Scorings of SAS by patient herself
• SAS scorings [ Time Frame: 30 min postoperation ] [ Designated as safety issue: Yes ]
  Scorings of SAS by the patient herself
• SDS scoring [ Time Frame: 15 min intraoperation ] [ Designated as safety issue: Yes ]
  Scorings of SDS by patient herself
• SDS scoring [ Time Frame: 30 min postoperation ] [ Designated as safety issue: Yes ]
  Scorings of SDS by patient herself
• VAS pain scoring [ Time Frame: Immediately of surgery (0 min) ] [ Designated as safety issue: Yes ]
  VAS scorings of pain by a 100 mm scale
• VAS pain scoring [ Time Frame: 5 min after surgery begin (+5 min) ] [ Designated as safety issue: Yes ]
  Scorings of VAS pain by a 100 mm scale
• VAS pain scoring [ Time Frame: Immediately at the end of surgery (this time changed individually) ] [ Designated as safety issue: Yes ]
  Scorings of VAS pain by a 100 mm scale
• VAS pain scoring [ Time Frame: 3 h after surgery ] [ Designated as safety issue: Yes ]
  Scorings of VAS pain by a 100 mm scale
• Saliva cortisol level [ Time Frame: 15 min intraoperation ] [ Designated as safety issue: No ]
  Saliva cortisol level will be measured with EIA
• Saliva cortisol level [ Time Frame: 30 min postoperation ] [ Designated as safety issue: No ]
  Saliva cortisol level will be measured with EIA
• Vital signs [ Time Frame: 15 min intraoperation ] [ Designated as safety issue: Yes ]
  Blood pressure, heart rate, respiratory rate, oral temperature
• Vital signs [ Time Frame: 30 min postoperation ] [ Designated as safety issue: No ]
  Blood pressure, heart rate, respiratory rate, oral temperature

• Self depression assessment scale (SDS) [ Time Frame: One day prior surgery, 15 min intraoperation, 30 min postoperation ] [ Designated as safety issue: Yes ]
  Scorings of SDS by the patient herself
• Visual analog scale of pain (VAS pain) [ Time Frame: Five min before surgery (-5 min); immediately of surgery (0 min); 5 min after surgery begin (+5 min); immediately at the end of surgery (this time changed individually); 3 h, 6 h,12 h and 24h after surgery ] [ Designated as safety issue: Yes ]
  Patient self assessed pain scorings with a 100 mm (0-100) scale
• Saliva cortisol level [ Time Frame: One day prior surgery, 15 min intraoperation, 30 min postoperation ] [ Designated as safety issue: No ]
  Saliva corticol levels will be measured with ELSA
• Vital signs [ Time Frame: One day prior surgery, 15 min intraoperation, 30 min postoperation ] [ Designated as safety issue: Yes ]
  Blood pressure, heart rate, respiratory rate, oral temperature
• SAS scorings [ Time Frame: 15 min intraoperation ] [ Designated as safety issue: Yes ]
  Scorings of SAS by patient herself
• SAS scorings [ Time Frame: 30 min postoperation ] [ Designated as safety issue: Yes ]
  Scorings of SAS by the patient herself

Pregnancy induced psychosis is an essential factor that influencing maternal health postpartum. When gravidas, especially nulliparas, facing labor and delivery, they will undoubtedly encounter burden from their own and surrounding facts. Maternal psychosis takes a large part of women's psychological disorders. No matter which way, either spontaneous or surgical, they would choose, many factors influence their psychological state. Cesarean section poses higher risks for women than vaginal delivery. Therefore, how to seek effective methods to alleviate parturients' psychological stress response possesses pivotal clinical implications. Herein the investigators proposed that different linguistic interventions given pre-, intra- or post-operatively would produce different effect on maternal psychology and internal stress level.

• Other: Language
  Plain language without psychological intervention
• Other: Language
  Psychological linguistic intervention will be given
  Other Name: Psycholinguistic

• Sham Comparator: Plain language
  Conventional plain language will be given without any psychological intervention
  Intervention: Other: Language
• Active Comparator: Pre-psycho-language
  Prior surgery psychological linguistic intervention
  Intervention: Other: Language
• Active Comparator: Intra-psycho-language
  Intraoperative psychological linguistic intervention
  Intervention: Other: Language
• Active Comparator: Post-psycho-language
  Postoperative psychological linguistic intervention
  Intervention: Other: Language
• Active Comparator: Combined language
  Psychological linguistic intervention will be given in a combination of pre-, intra- and post-operatively
  Intervention: Other: Language

Inclusion Criteria:

• Chinese gravidas
• Gestational age >=36 wk
• Nulliparas
• Undergoing selective Cesarean section

Exclusion Criteria:

• With recognition problem
• Used or using centrally acting drugs
• With chronic pain
• Refusal participation
• With existed psychiatric disorders
• With history of psychological diseases
• Contraindications for neuraxial anesthesia