Reliability and validity of the Acceptance Symptom Assessment Scale in assessing labour pain

Tools for assessing labour pain: a comprehensive review of research literature

ABSTRACT

The experience of pain associated with labour is complex and challenging to assess. A range of pain measurement tools are reported in the literature. This review aimed to identify current tools used in research to assess labour pain across the past decade and to evaluate their implementation and adequacy when used in the context of labour pain. A literature search was conducted in databases MEDLINE and Cumulative Index of Nursing and Allied Health Literature, using search terms relating to labour, pain, and measurement. A total of 363 articles were selected for inclusion. Most studies (89.9%) assessed pain as a unidimensional experience, with the most common tool being the Visual Analogue Scale, followed by the Numerical Rating Scale. Where studies assessed pain as a multidimensional experience, the most common measurement tool was the McGill Pain Questionnaire. Only 4 studies that used multidimensional tools selected a tool that was capable of capturing positive affective states. Numerous variations in the implementation of scales were noted. This included 35 variations found in the wording of the upper and lower anchors of the Visual Analogue Scale, some assessment tools not allowing an option for "no pain," and instances where only sections of validated tools were used. It is clear that development of a standardised pain assessment strategy, which evaluates the multidimensions of labour pain efficiently and effectively and allows for both positive and negative experiences of pain to be reported, is needed.

[Pain assessment during birth : Which assessment tools comprehensibly depict the labor pains during physiological birth?]

BACKGROUND

Labor pain is a complex phenomenon, which is influenced by many factors. Therefore, an effective pain management during birth requires an assessment of the labor pains; however, there is currently no standardized and valid tool to assess labor pains.

OBJECTIVE

The aim of this article is to demonstrate which assessment instruments are available for labor pains during a physiological birth and how comprehensibly they depict the pain.

MATERIAL AND METHODS

The study is an integrative review of the literature based on a literature search conducted in the electronic databases PubMed and CINAHL. To ensure the quality of the review article, COSMIN, AMSTAR 2 and the instrument for assessment of qualitative research of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) were used as assessment instruments.

RESULTS

Taking the various inclusion and exclusion criteria into consideration, five studies could be included. The following assessment instruments were identified: visual analog scale (VAS), the acceptance symptom assessment scale (ASAS), the angle labor pain questionnaire (A-LPQ), the rating scale of pain expression during childbirth (Escala de Valoración de la Expresión del Dolor durante el Trabajo de Parto, ESVADPA) and the coping with labor pain algorithm (CWLA). These were supplemented by a study on the perspectives of women.

CONCLUSION

None of the assessment instruments found could assess the birth pain in its full complexity. Therefore, midwives have to rely on their competence to evaluate labor pain on an individual basis. Further research is necessary to identify the relevant influencing factors of labor pains and to be able to develop suitable instruments.

Evaluation of Pregnancy, Delivery, and Postpartum Effectiveness of Maternity School Trainings Organized Based on the Guideline of Ministry of Health in Turkey: A Comparative Study

Background

There are uncertainties and contradictions in the literature about the effectiveness of maternity schools. The purpose of this study is to determine the effectiveness of prenatal trainings performed in an institutional and disciplined manner.

Methods

This study was prospectively conducted between 2018 and 2019, and 245 primiparous pregnant women who gave birth in our hospital were examined. On a volunteer basis, a study group (n = 108) was created including patients who attended the maternity school trainings and a control group was created including patients who did not attend these trainings (n = 137). Both groups were compared in terms of caesarean section rates, active phase periods of birth, visual analogue scale (VAS) during active labor, Edinburgh Postnatal Depression Scale (EPDS) score, time from birth to first skin contact, newborn Apgar scores, and admission rates to the neonatal intensive care unit.

Results

Cesarean section rates were significantly lower in the maternity school group (21.1% versus 29.19%). In the maternity school group, the active phase period of delivery was shorter (p < 0.001), VAS was lower during active labor (p < 0.001), and EDPS score was lower (p < 0.001). Education level was higher in the maternity school group than in the control group (p < 0.001).

Conclusions

Institutional and disciplined antenatal pregnancy trainings provide significant benefits during pregnancy, delivery, and postpartum period depression by especially reducing the rates of cesarean section and postpartum depression.

Development and Validation of a Rating Scale of Pain Expression during Childbirth (ESVADOPA)

One of the most representative symptoms during childbirth is pain, which is one of the most prominent concerns of pregnant women. There are different instruments to assess pain, all of which require interrupting the woman, thus interfering with the intimacy of childbirth. This study seeks to develop and validate a rating scale of the expression of childbirth pain that does not require the mother’s attention and respects her privacy during labor. The study was conducted at a regional hospital in a border town in southern Spain between November 2018 and September 2019. Scale items were developed following a review of the scientific literature, and experts judged the content validity. After a pilot test, the scale was psychometrically evaluated. The psychometric tests consisted of internal consistency analysis, exploratory factor analysis, and determination of the content, construct, and convergent validity. The scale was evaluated by 36 experts in the field and was then applied to 55 women during the active phase of childbirth. The final version of the Rating Scale of Pain Expression during Childbirth (in Spanish, Escala de Valoración de la Expresión del Dolor durante el Trabajo de Parto—ESVADOPA) consists of six items in two dimensions. The scale had a Cronbach’s alpha coefficient of 0.78, and the content validity measured by Aiken’s V co-efficient was also 0.78. The exploratory factor analysis yielded two dimensions that explained 68.08% of the total variance. For convergent validity, a comparison was made with the visual analogue scale, yielding a medium–high value of 0.641. As indicated by the internal consistency and by the content and construct validity outcomes, the ESVADOPA successfully measures pain expression during childbirth and represents a suitable tool for pain expression during birth without the need for intervention or the need for the mother to speak the same language as the midwife.

A Critical Analysis of Women’s Descriptions of Labor Pain Based on the McGill Pain Questionnaire

OBJECTIVE: The purpose of this article was to examine childbirth (labor) pain language through an analysis of the McGill Pain Questionnaire (MPQ) descriptors.

METHOD: Language was extracted from 6 studies which used MPQ descriptors (and originally formed part of a larger interpretive review of pain assessment). MPQ descriptors are considered rich language data because they provide insight into the different qualities and dimensions of pain. An applied linguistic approach, which examines language in its real world context (in this instance, childbirth and midwifery) was used to analyze maternal language.

FINDINGS: The MPQ descriptors conveyed sensory, affective, evaluative, and miscellaneous dimensions of the labor pain experience. Words were classified according to the semantic category of the descriptors (the associated meanings of pain words), parity, stage of labor, and the location of pain. Generalizations cannot be made from this small sample of maternal language; however, this analysis provides an introduction to maternal MPQ descriptors and gives insight into a possible association between maternal MPQ descriptors and words which may be used to represent other female pain events.

CONCLUSION: The descriptors analyzed in this article revealed a rather homogeneous language; yet, they provided insight into the qualities and intensity of labor pain across women of different parity. Pain can be quantified in a numeric-verbal language, but the use of a pain measurement tool alone may lead to assumptions or underestimations of the individual nature of a woman’s labor, which may impact on her pain management. An acknowledgment of a woman’s labor as intimate and emotive is also needed, which is captured in the spontaneous language of her own account of labor.

Assessment and documentation of women's labour pain: A cross-sectional study in Swedish delivery wards

BACKGROUND

A woman's pain during labour plays a dominant role in childbirth. The midwife's role is to assess the degree of pain experienced during labour. When professionals respond to labour pain with acknowledgement and understanding, the woman's sense of control and empowerment is increased, which could contribute to a positive experience of childbirth. The aim of this study is to describe how labour pain in Swedish delivery wards is assessed and documented.

METHODS

This quantitative descriptive study was designed as a national survey performed through telephone interviews with the representatives of 34 delivery wards in Sweden.

RESULTS AND CONCLUSION

The majority of the participating delivery wards assessed and documented women's labour pain, but in an unstructured manner. The wards differed in how the assessments and documentation were performed. In addition, almost all the delivery wards that participated in the survey lacked guidelines for the assessment and documentation of the degree of pain during labour. The findings also showed that the issue of labour pain was sometimes discussed in the delivery wards, but not in a structured or consistent way.

Midwifery students' conceptions of worst imaginable pain

BACKGROUND

The Visual Analogue Scale (VAS) is one of the most widely used pain assessment scales in clinical practice and research. However, the VAS is used less frequently in midwifery than in other clinical contexts. The issue of how people interpret the meaning of the VAS endpoints (i.e. no pain and worst imaginable pain) has been discussed. The aim of this study was to explore midwifery students' conceptions of 'worst imaginable pain'.

METHODS

A sample of 230 midwifery students at seven universities in Sweden responded to an open-ended question: 'What is the worst imaginable pain for you?' This open-ended question is a part of a larger study. Their responses underwent manifest content analysis.

RESULTS

Analysis of the midwifery students' responses to the open-ended question revealed five categories with 24 sub-categories. The categories were Overwhelming pain, Condition-related pain, Accidents, Inflicted pain and Psychological suffering.

CONCLUSIONS

The midwifery students' conceptions of 'worst imaginable pain' are complex, elusive and diverse.