Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women

Use of pain management in childbirth among migrant women in Iceland: A population-based cohort study

BACKGROUND

Immigration is rapidly increasing in Iceland with 13.6% of the population holding foreign citizenship in 2020. Earlier findings identified inequities in childbirth care for some women in Iceland. To gain insight into the quality of intrapartum midwifery care, migrant women's use of pain management methods during birth in Iceland was explored.

METHODS

A population-based cohort study including all women with a singleton birth in Iceland between 2007 and 2018, in total 48 173 births. Logistic regression analyses with odds ratios (ORs) and 95% confidence intervals (CIs) were used to investigate the relationship between migrant backgrounds defined as holding foreign citizenship and the use of pain management during birth. The main outcome measures were use of nonpharmacological and pharmacological pain management methods.

RESULTS

Data from 6097 migrant women were included. Migrant women had higher adjusted OR (aORs) for no use of pain management (aOR = 1.23 95% CI [1.12, 1.34]), when compared to Icelandic women. Migrant women also had lower aORs for the use of acupuncture (0.73 [0.64, 0.83]), transcutaneous electrical nerve stimulation (TENS) (0.92 [0.01, 0.67]), shower/bath (0.73 [0.66, 0.82]), aromatherapy (0.59 [0.44, 0.78]), and nitrous oxide inhalation (0.89 [0.83, 0.96]). Human Development Index (HDI) scores of countries of citizenship <0.900 were associated with lower aORs for the use of various pain management methods.

CONCLUSIONS

Our results suggest that being a migrant in Iceland is an important factor that limits the use of nonpharmacological pain management, especially for migrant women with citizenship from countries with HDI score <0.900.

A Cross-Sectional Survey of Labor Pain Control and Women's Satisfaction

Introduction: Pain experienced during labor is a symptom of contractile activity and is a physiological feature of the uterus that occurs at the appropriate stages of labor. For the majority of women, labor pain is the most severe pain they will ever experience, and therefore should be relieved. Objective: (1) To evaluate labor pain intensity before and after using non-pharmacological and pharmacological interventions; (2) to assess women’s satisfaction of labor pain management. Methods: A multicenter cross-sectional survey study was performed on 500 women who gave birth in different reference level hospitals (i.e., I, II, III). Pain intensity was assessed according the Numeric Rating Scale (range 0–10), whereas women’s satisfaction was measured with a 5 point Likert scale. Results: The use of both non-pharmacological (median 6.7 (5; 8) vs. 4.5 (3.3; 5.5)) and pharmacological methods (median 8 (7; 9) vs. 5 (3; 6)) resulted in a significant reduction in pain (p < 0.01). Water immersion and epidural anesthesia proved to be the most effective non-pharmacological and pharmacological methods, respectively. In hospitals of reference I, analgesic management was based primarily on the use of non-pharmacological techniques, less often mixed, i.e., non-pharmacological and pharmacological techniques (27.5%). On the other hand, in hospitals with higher referentiality, mixed methods were used more often (level II—65.8%; level III—81.2%). Pain intensity was significantly higher (p < 0.0001) in hospitals with reference level I (median 5 (4; 6)) than in the hospitals with reference level II (median 4.2 (3; 5)) or level III (median 4.2 (3.3; 5.4)). Epidural anesthesia was most often performed (60%) in the hospital of reference II. Women’s satisfaction (median 4 (3; 5)), inter alia, was associated with the effectiveness of applied methods. Conclusions: The study findings suggest that women giving birth in hospitals of higher referentiality have better control of labor pain due to access to pharmacological methods. Epidural anesthesia remains the gold standard for relieving labor pain. The choice of a specific method is determined by the degree of hospital and associated with the pain referentiality.

Intrapartum Analgesia-Have Women's Preferences Changed over the Last Decade?

Background: Global access to social media has supposedly changed women’s awareness about the pharmacological and alternative methods of pain relief during vaginal delivery. The purpose of the study was to analyze changes in women’s preference and opinion about different forms of labor analgesia over the past decade. Materials and methods: The study was designed as an anonymous survey with questions about women’s knowledge and preference of different forms of pain relief in labor. The survey was conducted in 2010 and 2020, with data collected from 1175 women in 2010 and 1033 in 2020. Results: There were no differences between 2010 and 2020 in the proportion of women who wanted to receive analgesia in labor, at, respectively 67.9% of women in 2010 and 73.9% in 2020. About 50% of women chose epidural analgesia as the only efficacious method of pain relief in labor both in 2010 and 2020. There were no differences between the two time-points in the distribution of chosen methods of pain relief. In total, 92.3% of women in 2010 and 94.9% in 2020 thought that they should have the possibility of independent choice of analgesia method before the delivery (p < 0.04). Conclusions: A high proportion of Polish women choose EDA over other pharmacological and nonpharmacological methods of pain relief in labor, and this preference has not changed over the last decade. Increasing women’s knowledge about different methods of intrapartum pain relief may lead to wider use of nonpharmacological methods of pain relief.

Knowledge, Attitude, and Practice towards Labor Pain Management and Associated Factors among Skilled Birth Attendants Working at Hospitals Found in Central, West, and North Gondar Zones, Northwest Ethiopia, 2019: A Multicenter Cross-Sectional Study

Introduction

Delivery of the infant into the arms of a conscious and pain-free mother is the most exciting and rewarding moment in maternal care services. Physical and mental care of women during delivery requires good knowledge and a positive insight to the needs and rights of the mothers. Little was known regarding skilled birth attendants' knowledge, attitude, and practice towards labor pain management in the study area. Hence, the current study aimed at assessing knowledge, attitude, and practice, and associated factors towards labor pain management among skilled birth attendants working at hospitals found in central, west, and north Gondar zones, northwest Ethiopia, 2019.

Method

A multicenter institution-based cross-sectional study was conducted from June 1 to 30, 2019. A census sampling technique was used to include a total of 336 skill birth attendants. A pretested standardized self-administered questionnaire was used to collect the data. The data were then entered into Epi Info 7.1.2 and exported to SPSS version 25 for analysis. Multivariable logistic regression analyses were undertaken to identify factors associated with outcome variables. The level of significance of the study was declared based on adjusted odds ratio with 95% confidence interval at a p value of ≤0.05.

Result

The proportion of skill birth attendants having good knowledge, a favorable attitude, and a good practice on labor pain relief methods was 47%, 41.96%, and 57.14%, respectively. Age of ≤30 years (AOR = 5.43; 95% CI: 1.25, 23.53), educational status of 2^nd degree and above (AOR = 3.56; 95% CI: 1.32, 9.60), working at a private primary hospital (AOR: = 6.55; 95% CI: 2.15, 19.93), and working at a referral hospital (AOR = 2.24 : 95% CI: 1.01, 4.93) are factors significantly associated with good knowledge while having good knowledge on labor pain relief methods (AOR = 2.26; 95% CI: 1.42, 3.60) and working at private primary hospitals (AOR = 7.01; 95% CI: 1.92, 25.65) had statistically significant association with favorable attitude and good practice on labor pain relief methods, respectively. Conclusion and Recommendations. Poor knowledge, unfavorable attitude, and poor practice towards labor pain management were found in this study. Strengthening the capacity of public health facilities and providing continuous professional development (CPD) training for the skilled birth attendants would be helpful in improving knowledge, attitude, and practice towards labor pain management.

The Effect of Massage Therapy Using Frangipani Aromatherapy Oil to Reduce the Childbirth Pain Intensity

BACKGROUND

Pain during labor is one of the worst pains experienced by women. If the woman cannot adapt to it, it may lead to uncoordinated uterine contractions causing a long-complicated labor with the possibility of death of the mother and baby.

PURPOSE

The aim of the study is to observe the effect of massage treatment using frangipani aromatherapy oil to reduce the childbirth pain intensity.

SETTING

Pembantu Dauh Puri Health Center Denpasar, Bali, Indonesia.

PARTICIPANTS

Pregnant women in labor.

RESEARCH DESIGN

A quasi-experimental research design was used with pretreatment and posttreatment groups and a control. The respondents were 70 pregnant women in labor in Pembantu Dauh Puri Health Center Denpasar, Bali, Indonesia. Data were collected during scheduled observation and were analyzed using the Mann-Whitney statistical test.

INTERVENTION

The participants in the treatment group were massaged with frangipani aromatherapy oil by rubbing and pressing the hand palms to the back region at thoracic vertebrae 10, 11, 12 and lumbar 1 levels. The women in the control group were massaged with virgin coconut oil in the same manner as that done to the treatment group.

MAIN OUTCOME MEASURE

This study aimed to investigate the potential of frangipani aromatherapy oil to be used as maternity care in helping pregnant women become more comfortable in the process of normal birthing, based on modified midwife examination form, which contain Numeric Rating Score (NRS), and interviews with the participants to measure the pain intensity.

RESULT

Before the massage treatment, most of the respondents experienced severe pain. While receiving massage without aromatherapy, respondents mostly still experienced severe pain. However, after a massage treatment using frangipani oil aromatherapy, most respondents experienced reduced pain. There was a statistically significant effect of massage treatment using frangipani aromatherapy oil on the childbirth pain intensity (p < .001).

CONCLUSION

In this study, massage treatment using frangipani oil aromatherapy decreased the childbirth pain intensity.

Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia

Background

A wide range of health care options are utilised by pregnant women in Australia. The out-of-pocket costs of maternity care in Australia vary depending on many factors including model of care utilised, health insurance coverage, and women’s decision to access health services outside of conventional maternity care provision.

Methods

Women from the 1973–78 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH) who identified as pregnant or as recently having given birth in 2009 were invited to complete a sub-study questionnaire investigating health service utilisation during their most recent pregnancy.

Results

A total of 1,835 women agreed to participate in the sub-study. The majority of women (99.8%) consulted with a conventional health care practitioner during pregnancy, 49.4% consulted with a complementary and alternative medicine practitioner at least once during pregnancy and 89.6% of the women used a complementary and alternative medicine product. Women reported an average of AUD$781.10 in out-of-pocket expenses for consultations with conventional health care practitioners, AUD$185.40 in out-of-pocket expenses for consultations with complementary and alternative medicine practitioners and AUD$179.60 in out-of-pocket expenses for complementary and alternative medicine products. From the study data we estimate Australian pregnant women spend over AUD$337 M on out-of-pocket health services.

Conclusion

While the majority of pregnant women in Australia may obtain health services via the publically-funded health care system and/or private health insurance coverage, our analysis identifies substantial out-of-pocket expenditure for health care by pregnant women – a trend in public spending for maternity care of importance to policy makers, health administrators, and health professionals.