Knowledge, and use of labour pain relief methods and associated factors among obstetric caregivers at public health centers of East Gojjam zone, Amhara region, Ethiopia: a facility based cross- sectional study

"…We never considered it important…": a qualitative study on perceived barriers on use of non-pharmacological methods in management of labour pain by nurse-midwives in eastern Tanzania

BACKGROUND

A significant number of women experience labour without effective pain management and thus suffer from unbearable labour pain to the extent they term labour as the most agonizing event in their lives. Unresolved labour pain can lead to stress, fear, and confusion, which may compromise placental perfusion and lead to birth asphyxia. Although various pharmacological and non-pharmacological labour pain management methods exist, the use of non-pharmacological methods (NPMs) to manage labour pain has remained low in low-resource settings. This paper explored the barriers for using NPMs to manage labour pain by nurse-midwives in eastern Tanzania.

METHODS

We conducted an exploratory qualitative study with 18 nurse-midwives purposefully recruited from the labour wards of two selected district hospitals in eastern Tanzania. Qualitative content analysis guided the data analysis.

RESULTS

Two categories illustrating barriers to using NPMs were generated: individual-level and institutional-level barriers. Individual-level barriers include (i) limited competencies of nurse-midwives on the use of NPMs for managing labour pain, (ii) inadequate exposure to labour pain management practices, (iii) misconceptions about labour pain relief, and (iv) a lack of opportunities for knowledge acquisition. The institutional barriers include (i) a critical staff shortage amidst many clients and (ii) an unfavourable healthcare facility environment.

CONCLUSION

The implementation of NPMs for labour pain management by nurse-midwives in eastern Tanzania faces several institutional and individual barriers. We recommend addressing both supply- and demand-side barriers. Strengthening nurse midwives' competencies in NPMs adoption and use and improving the facility environment to ensure privacy during labour can be a starting point for addressing supply-side issues. We recommend dispelling myths and misconceptions through health promotion education to address demand-side barriers.

Healthcare Providers' Utilization of Nonpharmacological Methods in Managing Labor Pain: An Integrative Review

BACKGROUND

The management of labor pain is a critical aspect of maternal care, with implications for the well-being of both the mother and the newborn. Nonpharmacological pain management (NPPM) offers a safe and more accessible option to labor pain management in African healthcare settings.

OBJECTIVE

This review aims to determine the facilitators of and barriers to using NPPM during labor among healthcare professionals (HCPs) in Africa.

METHODS

This integrative review was done using articles that focused on NPPM and published between 2013 and 2023. Databases searched include PubMed, CINAHL, SCOPUS, and EMBASE. Content analysis was done independently by two reviewers using inductive coding to generate categories.

FINDINGS

Three main themes emerged: Perceived barriers to the utilization of NPPM among HCPs, categories that emerged under this theme include lack of training, resource limitation, lack of priority, cultural norms and beliefs, and lack of awareness. The second theme is potential facilitators to the utilization of NPPM among HCP, the categories generated include healthcare provider' knowledge, positive attitude of healthcare providers, family support, infrastructure/working environment, experiences of HCPs, and client preferences. The third theme that emerged is the most utilized methods of NPPM among HCPs, with back massage and psychological support being the most used, whereas music and exercise were the least NPPM methods used by HCPs.

RECOMMENDATIONS AND IMPLICATIONS FOR CARE

The findings from this study show that the attitudes and knowledge of HCPs about NPPM can either be a facilitator or a barrier in its utilization. In the clinical setting, HCPs need to be sensitized on the benefits of using these methods of pain management during labor to encourage use. Interventions designed based on the findings from this study can promote a more holistic approach to labor pain management in African healthcare settings.

Labor pain management practices and associated factors in Ethiopia: A systematic review and meta-analysis

BACKGROUND

The pain that women experience during labor and childbirth is the central feature of parturition in humans. Despite improvement in the development of standards for pain assessment and treatment, labor pain is mostly ignored especially in low- and middle-income countries resulting in unmeasured suffering from childbirth for mothers.

OBJECTIVES

We aimed to provide a comprehensive estimation of the pooled magnitude and associated factors of labor pain management practices in Ethiopian public health facilities.

SEARCH STRATEGY

A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Electronic databases including Google Scholar, Web of Science, Excerpta Medica Database (EMBASE), PubMed/MEDLINE, and Scopus were searched from database inception to June 30, 2023.

SELECTION CRITERIA

The inclusion criteria were established prior to article review and follows the population, intervention, comparison and outcome criterions.

DATA COLLECTION AND ANALYSIS

We evaluated publication bias by means of funnel plots and Egger's test. Heterogeneity between studies was assessed using I2 statistics. For each associated factors in meta-regressions, the pooled odds ratio (OR) and its 95% confidence interval (CI) were extracted. A P value of 0.05 was used to determine the significance of the small study effect.

MAIN RESULTS

Our search terms yielded 17 studies with 5735 participants. The pooled prevalence of labor pain management practices in Ethiopia was 45.73% (95% CI: 39.13, 52.32; I2 = 96.4). Having adequate knowledge regarding labor pain management (OR: 3.74; 95% CI: 2.74, 5.11; I2 = 53.8%), a favorable attitude toward labor pain management (OR: 2.90; 95% CI: 2.03, 4.14; I2 = 63.8%), availability of labor analgesics (OR: 3.23; 95% CI: 2.18, 4.79; I2 = 46.2%), and clinical experience of 10 or more years (OR: 3.45; 95% CI: 2.06, 5.78; I2 = 19.0%) were factors that were statistically associated with the use of labor pain management practices.

CONCLUSION

We concluded that the routine practices of labor pain management by obstetric health providers in Ethiopia are still low. Therefore, it remains important to call for holistic and inclusive interventions targeting maternity health providers and hospital officials to update their long-standing practices.

REGISTRATION

Registered in PROSPERO under protocol number CRD42023429140.

Knowledge, Attitude, and Practices of Labor Analgesia Amongst Obstetric Residents: A Cross-Sectional Survey

BACKGROUND

Labor analgesia plays a crucial role in ensuring a comfortable and positive birthing experience. It provides physiological benefits to both the mother and the child. Knowledge, awareness, and communication between the anesthesiologist and the obstetrician are essential for the safe conduct of labor analgesia. We conducted this cross-sectional online survey amongst obstetric residents to assess their knowledge, attitude, and practices of labor analgesia.

METHODS

A structured questionnaire consisting of 19 questions was circulated amongst obstetric residents of various hospitals via electronic mode of communication. The responses were analyzed using statistical methods.

RESULTS

Among the obstetric residents that we surveyed, 75.7% of them only sometimes employed labor analgesia for their patients. The most commonly employed methods of pain relief are opioids and non-steroidal anti-inflammatory drugs (NSAID). Most of them feel that pain-free labor is necessary because it makes the whole labor process a pleasurable one. Labor analgesia was mostly advocated at patients' request and demand. The barrier to using labor analgesia was most commonly found to be the non-availability of labor analgesia services.

CONCLUSION

Despite the increasing awareness of labor analgesia there still lies a gap between the attitude toward it and the practice of it. Further education to rectify the misconceptions and barriers needs to be taken for providing beneficial services to pregnant females.

Pharmacological labour pain interventions: South African midwives' perspective

BACKGROUND

Women of childbearing age feel great about giving birth, but the pain could be excruciating depending on their pain tolerances. Midwives requires obstetrical knowledge and skills such as pain management during labour and safety. We explored midwives' perspectives on the utilisation of pharmacological pain alleviation interventions during labour in selected hospitals in Matjhabeng Municipality, Free State province, South Africa. A qualitative study was undertaken, involving a sample of ten midwives, using a semi-structured interview guide. The interviews were audio-recorded and transcribed verbatim. Tesch's open coding data analysis method was applied to analyse the data. The midwives were restricted to use Pethidine and Phenergan prescribed by doctors for labour pain relief, which disrupted labour pain management and obliged them either to wait for a physician or follow telephone instructions. According to the midwives, women taking Pethidine and Phenergan encountered adverse effects and discomfort. Midwives identified high workload, inadequate personnel, lack of skill and knowledge, lack of medication availability, and lack of infrastructure as the primary challenges of administering pharmacological methods to women in labour. The lack of standing orders, which delays the administration of medications pending a physician's prescription, constituted an additional difficulty. In the instance that Pethidine and Phenergan were unavailable or ineffective for some women, the midwives recommended that women be administered alternative pharmacological pain relievers. They also advocated for institutionalization of pharmacological guidelines allowing them to use their discretion when treating labour pain. Midwives can only utilise a few standardised and regulated pharmacological medications for labour pain management. The midwives' ability to administer pharmacological pain relief during labour was hampered by a high workload burden, insufficient staff, lack of skill and understanding, drug unavailability, and inadequate infrastructure. Midwives advocated for supported guidelines that would allow them to treat labour pain at their discretion. Intersectoral stakeholders are required to improve midwife skills and attitudes. Health facilities need to train and supply analgesics to midwives. Midwives ought to be familiar with pharmacological pain relievers.

Labour pain relief practice by maternal health care providers at a tertiary facility in Kenya: An institution-based descriptive survey

BACKGROUND

Although pain relief is a crucial component of modern obstetric care, it remains a poorly established service in sub-Saharan countries such as Kenya. Maternal health care providers have an extensive role to play in meeting the analgesic needs of women during childbirth. This study sought to examine the practice of labour pain relief among Kenyan maternal health care providers.

METHODS

This was an institution-based, cross-sectional, descriptive survey. The study included midwives, obstetricians, and anaesthesiologists (n = 120) working at the second-largest tertiary facility in Kenya. A structured, self-administered questionnaire was used. The labour pain relief practice, knowledge, attitude, and perceived barriers to labour pain management were described.

RESULTS

One hundred and seventeen respondents participated in the study representing a response rate of 97.5%. More than half of maternal health care providers routinely provided the service of labour pain relief (61.5%). Sixty-four (88.9%) respondents reported providing pharmacological and non-pharmacological methods, while 11.1% provided only pharmacological ones. The most common pharmacological method prescribed was non-opioids (12.8%). The most preferred non-pharmacological method of pain management was touch and massage (93.8%). Regional analgesia was provided by 3.4% of the respondents. More than half of the respondents (53%) had poor knowledge of labour pain relief methods. Almost all (94%) of the respondents had a positive attitude towards providing labour pain relief. Non-availability of drugs and equipment (58.1%), lack of clear protocols and guidelines (56.4%), and absence of adequate skilled personnel (55.6%) were reported as the health system factors that hinder the provision of labour analgesia.

CONCLUSIONS

More than half of maternal health care providers routinely relieve labour pain. Epidural analgesia is still relatively underutilized. There is a need to develop institutional labour pain management protocols to meet the analgesic needs of women during childbirth.

Nonpharmacological pain relief for labour pain: knowledge, attitude, and barriers among obstetric care providers

Background

Labor pain is considered the worst pain in a woman's life. Hence, pain control should be essential to labor management at any level. There is scarce information, and there are gaps regarding the knowledge, attitude, and barriers to the utilization of nonpharmacological approaches for pain relief in Saudi Arabia. Therefore, the current study aims to evaluate nonpharmacological pain relief (NPPR)-related knowledge, attitudes, and barriers among obstetric care providers in Najran, Saudi Arabia.

Methods

A cross-sectional analytical study was performed at maternity departments in Maternal and Children Hospital (MCH), Najran, Saudi Arabia, from April 1 to May 26 2023. The study involved 186 obstetric care providers (OPCs), physicians (19), nurses (144), and midwives (23). A structured self-reported questionnaire was used to collect data and involves five main sections: demographic data, work-related data, nonpharmacological pain relief-related attitude, perceived barriers, and knowledge quiz. The adjusted odds ratio (AOR) along with 95% CI was estimated to determine the factors associated with nonpharmacological pain relief-related knowledge and attitude using multivariate analysis in the binary logistic regression.

Results

Over three-quarters (79%) of obstetric care providers had adequate knowledge of nonpharmacological pain relief methods. The majority (85.5%) of the participants had a positive attitude toward NPPR in labour pain management, with the mean scores ranging from 3.55-4.23 for all sub-items. Obstetric care providers acknowledged that patient belief, lack of time, and workload were the strongest barriers to offering nonpharmacological pain relief methods for labour pain 67.6%, 64.5%, and 61.3%, respectively. In binary logistic regression analysis, the in-service training related to nonpharmacological pain relief (AOR = 5.871 (2.174-15.857), p = 0.000), (AOR = 3.942 (1.926-11.380), p = 0.013) and years of work experience (AOR = 1.678 (1.080-2.564), p = 0.019), (AOR = 1.740 (1.188-2.548), p = 0.003) were significantly associated with obstetric care providers' knowledge and attitudes regarding nonpharmacological pain relief (p ≤ 0.05).

Conclusion

Although most OPCs have adequate knowledge and a positive attitude regarding NPPR, they need motivational strategies to enhance their utilization. In addition, an effort should be made to decrease OPCs' workload to provide more time for NPPR application and patient education. Training courses and in-service training can play an important role in enhancing NPPR knowledge and attitude and, consequently, its application. Also, in each working unit, the policymakers should provide clear guidelines and policies that enhance and control the utilization of NPPR.

Non-pharmacological labor pain relive methods: utilization and associated factors among midwives and maternity nurses in Najran, Saudi Arabia

BACKGROUND

Traditionally, pharmacological pain relief methods have been the most acceptable option for controlling labor pain, accompanied by numerous adverse consequences. Non-pharmacological labor pain relive methods can reduce labor pain while maintaining an effective and satisfying delivery experience and delaying the use of pharmacological methods. This study explores the utilization of non-pharmacological labor pain relive methods and its associated factors among midwives and maternity nurses.

METHODS

A cross-sectional research was conducted in Maternal and Children Hospital/Najran, Saudi Arabia, from April to May 2023 and incorporated a convenience sample of 164 midwives and maternity nurses. The data was collected using a self-reported questionnaire composed of five sections; basic data, facility-related factors, non-pharmacological labor pain relive utilization and attitude scales, and knowledge quiz. A logistic regression was used to determine the associated factors with non-pharmacological labor pain relive utilization.

RESULTS

The results revealed that 68.3% of participants utilized non-pharmacological labor pain relive methods. The midwives and maternity nurses helped the parturient to tolerate labor pain by applying the non-pharmacological labor pain relive methods, including; positioning (55.5%), breathing exercises (53.7%), comfortable and relaxing environment (52.4%), therapeutic communication (47%), positive reinforcement (40.9%), relaxation (40.2%), and therapeutic touch (31%). In addition, working unit, providers-patient ratio, working hours, non-pharmacological labor pain relive training, years of experience, and non-pharmacological labor pain relive attitude were significant determinants of non-pharmacological labor pain relive utilization (P < 0.05).

CONCLUSIONS

High non-pharmacological labor pain relive utilization was significantly associated with nurses' older age and higher education, working in the delivery room, lower nurse-patient ratio, lower working hours, in-services training, increased years of experience, and positive attitude. The study sheds light on the importance of handling the pre-mentioned factors to enhance non-pharmacological labor pain relive utilization.

Women's Knowledge about Pharmacological and Non-Pharmacological Methods of Pain Relief in Labor

This study aimed to assess knowledge about non-pharmacological pain-relief methods in labor among women who have given birth at least once. This cross-sectional study was conducted using an online survey among 466 adult women. The minimum sample size was estimated based on the number of labor admissions in the year before the study in Poland. The survey included questions about respondents' sociodemographics and knowledge of pain-relief methods. The knowledge score was calculated using the sum of correct answers. Non-parametric Spearman's correlation, Kruskal-Wallis and Wilcoxon variance tests were used. Antenatal classes (313/68.9%) and the Internet (248/54.6%) were the most common sources of knowledge. The most popular pharmacological pain-relief methods included epidural anesthesia (386/85.0%) and nitrous oxide (301/66.3%). Massage and breathing techniques were the most commonly known non-pharmacological methods (405/89.2% and 400/88.1%, respectively). The knowledge score about non-pharmacological methods was significantly higher as compared to the pharmacological methods score (r_c = 0.85; p < 0.001). Respondents' age correlated with knowledge about non-pharmacological methods (r_s = -0.10_,p = 0.026) but did not correlate with knowledge about pharmacological methods. Educational level correlated with knowledge about pharmacological (r_s = -0.13_,p = 0.007) and non-pharmacological (r_s = 0.14, p = 0.003) methods concerning pain relief in labor. No correlation was found between respondents' knowledge and gravidity, number of vaginal or cesarean deliveries, and hospital referral levels for previous deliveries. Our findings support the need to implement educational programs to increase evidence-based knowledge about pain-relief methods during labor in women.

Factors Affecting Opinion of Women Regarding the Use of Epidural Anesthesia During Labor in the Eastern Region of Saudi Arabia

Objectives Epidural anesthesia (EA) is one of the most popular and efficient techniques for labor pain relief. Women's preferences and awareness about EA have been investigated worldwide through various studies. The level of awareness varies from region to region in Saudi Arabia. Consequently, the aim of this study is to understand the views of women regarding EA in the eastern region of Saudi Arabia and how this affects decision-making with regard to EA. Methods This cross-sectional study was conducted in the eastern region of Saudi Arabia from July-September, 2021, through a self-administered online questionnaire. The study included Saudi females aged 18 years and older living in the eastern region of Saudi Arabia. Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). A p-value less than 0.05 was considered statistically significant. Results A total of 499 participants were included in the study. Nearly half of them were between the age of 25-35 years (46.9%, n = 234). The mean of the awareness score was 3.66 with SD = 1.491. It was observed that age was related to awareness. Women older than 45 years of age were found to be less aware. Additionally, the number of children these women had further affected their awareness; those who had four children or more tended to be less aware. The effect of regular antenatal care visits was clear, as pregnant women who maintained regular antenatal care visits showed more awareness. As for income, there was a notable increase in awareness with an increase in income. Participants who had had a previous delivery with EA were found to be more aware. Likewise, educational status also impacted their awareness. Women with a high school certificate or below were found to be less aware. Lastly, it was observed that a majority of the participants chose not to request an EA upon their next delivery (60.5%, n = 302). Conclusion The results demonstrated that awareness of EA in the study area is acceptable. The most important predictors for awareness about EA were age, educational status, income, number of children, regular antenatal visits, and previous delivery with EA. It was concluded that women who were aware were more likely to take EA.

Respectful maternity care in health centers of Addis Ababa city: a mixed method study

OBJECTIVE

The study aims to assess quality of obstetric and newborn care including respectfulness of the maternity care.

DESIGN

The study used explanatory sequential mixed methods design .

SETTING

This study was conducted in 50 health centres in Addis Ababa city administration January 25 to April 31, 2021.

METHODS

During the quantitative phase 500 women in postpartum period were interviewed using structured questionnaire. In the second phase in-depth interview was conducted with 20 midwives and 13 health centre managers. The quantitative data was analysed using Statistical Package for Social Sciences (SPSS). The qualitative data was analysed using Colaizzi's seven step process.

RESULTS

Only 24.6% of women had respectful maternity care (RMC). Only 46% of women had effective communication during child birth. Only 9.6% of women had emotional support during child birth. Majority of women were encouraged to mobilize, take food and be on labor position of their choice. However, only 22.4 and 18.8% of women respectively had a companion of choice and any pharmacologic pain relief during child birth. One in seven women (15%) had one form of disrespect and abuse during child birth.

CONCLUSION

Ensuring respectful maternity care needs strong policy direction to health facilities, public education on their right to respectful maternity care, training of care givers and monitoring care through engagement of frontline staff and clients.

Utilization of pharmacological labour analgesia: a survey of obstetric care providers in eastern Ethiopia

BACKGROUND

Despite a crucial role played by obstetric care providers (OCPs) in providing pain relief methods during labour, the evidence suggests that there is a large number of women in Ethiopia who did not have access to pain relief methods. Moreover, to the best of the investigators' knowledge, evidence is scarce regarding the utilization of pharmacological labour pain management methods in the study area. Thus this study was carried out to determine the practice of pharmacological labour pain management methods among OCPs in Harari regional state health facilities in Ethiopia.

METHODS

A facility-based cross-sectional study was conducted from 20 May to 10 June 2021 in Harari regional state health facilities. All (n=464) OCPs in Harari regional state health facilities were included in the study. Data were collected using a structured questionnaire adapted from previous studies. The data were entered into Epi-data version 3.1 statistical software. Statistical analysis was carried out using SPSS for Windows version 22. Bivariate and multivariate logistic regression analyses were employed to determine the association between independent variables and the outcome variable. A p-value <0.05 was used to establish statistical significance.

RESULTS

In this study, 464 OCPs participated. The overall utilization of pharmacological labour pain relief methods was 50.9% (95% confidence interval [CI] 45.8 to 55.8). The main barriers to labouring mothers receiving pain relief include high patient flow (54.4%), the limited number of staff (51.9%) and a lack of knowledge and skill (32.9%). Being female (adjusted odds ratio [AOR] 2.07 [95% CI 1.31 to 3.26]), not having training (AOR 1.60 [95% CI 1.02 to 2.53]) and having an unfavourable attitude (AOR 9.1 [95% CI 5.34 to 15.35]) were the predictors of utilization of pharmacological labour pain management methods.

CONCLUSIONS

The study revealed that half of the OCPs utilized the pharmacological labour pain management method. In general, this study identified that variables like sex, training and the attitude of OCPs were factors associated with the utilization of pharmacological labour pain management methods. The health facilities should provide training to enhance the skill of OCPs and equip themselves with sufficient analgesic drugs.

Obstetrics care providers attitude and utilization of non-pharmacological labor pain management in Harari regional state health facilities, Ethiopia

Background

In a woman’s life, labor pain is the most severe pain that they have ever faced. In Ethiopia, the provision of pain relief in labor is often neglected. Furthermore, evidence strongly urged that further research is needed on non-pharmacological labor pain management. Therefore, obstetrics care providers’ attitudes and utilization of non-pharmacological labor pain management need to be assessed.

Method

A facility-based cross-sectional study was conducted from May 20 to June 10, 2021, in Harari regional state health facilities, Ethiopia. All obstetric caregivers in Harari regional state health facilities were included in the study. A structured questionnaire adapted from the previous studies was used to collect data. The data was entered into Epi-data version 3.1 statistical software. Statistical analysis was carried out by using SPSS for windows version 22. Multivariate linear regression analysis was employed to determine the association between independent variables and the outcome variable.

Result

The overall utilization of non-pharmacological labor pain relief methods was 59.3% [(95% CI (53.9,63.4)]. Three hundred five (65.5%) of the study participants had unfavorable attitudes. Females compared to males (β = − 0.420; 95% CI: − 0.667, − 0.173), clinical experience (β = − 0.201; 95% CI: − 0.268, − 0.134), knowledge sum score (β =0.227: 95%; CI: 0.18,0.247), and attitude sum score (β = 0.376; 95% CI: 0.283, 0.47) were showed significantly association with utilization of non-pharmacological labor pain management.

Conclusion

The overall utilization of non-pharmacological labor pain relief methods was relatively good compared to other studies done in Ethiopia but all women’s need for labor relief methods should not be ignored. In this study sex of the respondents, clinical experience, individual preference, attitude and knowledge were factors associated with the utilization of non-pharmacological labor pain management. All stake holds need to work together to improve the attitude of health providers and to increase the utilization of non-pharmacologic labor pain management.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04717-9.

Use of non-pharmacological methods in managing labour pain: experiences of nurse-midwives in two selected district hospitals in eastern Tanzania

Background

Labour pain usually brings with it many concerns for a parturient and her family. The majority of the women in labour pain may require some sort of pain relief method during this period, be it pharmacological or non-pharmacological. In Tanzania, the use of non-pharmacological methods to relief labour pain remains low among nurse-midwives. We analysed the experiences of nurse-midwives in the use of non-pharmacological methods to manage labour pain, in two selected districts of Pwani and Dar es Salaam regions in eastern Tanzania. This paper describes Non-pharmacological Methods (NPMs) currently used by nurse-midwives, the facilitators, myths and fears related to the use of NPMs.

Materials and Methods

An exploratory qualitative study using in-depth interviews was conducted with 18 purposively recruited nurse-midwives working in labour wards in two selected district hospitals in Pwani and Dar es Salaam regions in eastern Tanzania. Qualitative conventional content analysis was used to generate categories describing the experience of using non-pharmacological methods in managing labour pain.

Results

This study revealed that nurse-midwives encouraged women to tolerate labour pain and instructed them to change positions and to do deep breathing exercises as a means to relief labour pain. Nurse-midwives’ inner motives facilitated the use of non-pharmacological strategies for labour pain relief despite the fear of using them and myths that labour pain is necessary for childbirth.

Conclusion

This study generates information about the use of non-pharmacological strategies to relief labour pain. Although nurse-midwives are motivated to apply various non-pharmacological strategies to relief labour pain, fear and misconceptions about the necessity of labour pain during childbirth prohibit the effective use of these strategies. Therefore, together with capacity building the nurse-midwives in the use of non-pharmacological strategies to relief labour pain, efforts should be made to address the misconceptions that may partly be of socio-cultural origin.

Non-pharmacological labor pain management practice and associated factors among skilled attendants working in public health facilities in Gamo and Gofa zone, Southern Ethiopia: A cross-sectional study

Background

Labor pain management is crucial to ensure the quality of obstetric care but it is one of the neglected areas in obstetrics. This study aimed to assess the practice of labor pain management and associated factors among skilled attendants working in public health facilities in Southern, Ethiopia from November 1–January 26, 2019.

Methods

An Institution-based cross-sectional study design was conducted from November 1–January 26, 2019. A simple random sampling technique was used to select a total of 272 obstetric care providers. Data were collected using pretested, and structured questionnaires. Data were entered to Epi data version 3.1 statistical software and exported to SPSS 22 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify associated factors. P-value <0.05 with 95% confidence level were used to declare statistical significance.

Result

Overall, 37.5% (95%CI: 32%, 43%) of health care providers had a good practice on non-pharmacological labor pain management. Clinical experience of 5 years and above (AOR = 2.91, 95%CI: 1.60, 5.42), favorable attitude (AOR = 2.82, 95%CI: 1.56, 5.07), midwife profession (AOR = 1.45, 95%CI: 1.98, 4.27), and working in satisfactory delivery rooms (AOR = 3.45, 95%CI: 2.09, 7.43), were significantly associated with a health professional good practice of labor pain management.

Conclusion

This study showed that the practice of non-pharmacological labor pain management was poor in public health facilities in Gamo and Gofa zone. It was observed that having a favorable attitude, having ≥5 years of work experience, being a midwife by professional, and having a satisfactory delivery room were found to be significant predictors of the practice of non -pharmacological labor pain management. Therefore, all health facilities and concerned bodies need efforts to focus on providing training to midwives on non-pharmacological labor pain management practice.

Obstetric analgesia utilization in labor pain management and associated factors among obstetric care providers in the West Shewa Zone, Central Ethiopia

Objectives:

Labor pain is the worst pain that almost every woman experiences during childbirth. Labor pain management plays a crucial role in promoting maternal-wellbeing, contributing enormously to maternal satisfaction with the childbirth experience and the high quality of services. Although there have been previous studies, they have primarily been conducted at referral or general hospitals located in urban settings. Thus, this study aimed to assess the utilization of labor pain analgesia and associated factors among obstetric care providers at all levels of health facilities in central Ethiopia.

Methods:

A multicenter institution-based cross-sectional study design was employed from 1 July to 30 September 2020. Simple random sampling using the lottery method was employed to select 399 obstetric care providers. The data were entered into Epi-data version 4.2 and analyzed using SPSS version 26. Bivariate and multivariable logistic regression analysis were used to identify the associated factors. The adjusted odds ratio with its 95% confidence interval and p value ⩽ 0.05 were used to identify associated factors.

Results:

The overall utilization of obstetric analgesia was 46% (95% confidence interval: 41.2%–50.8%). Being a Midwife (adjusted odds ratio: 2.10, 95% confidence interval: 1.27–3.47), having heard of the World Health Organization pain ladder (adjusted odds ratio: 2.95, 95% confidence interval: 1.73–5.01), having favorable attitude (adjusted odds ratio: 1.89, 95% confidence interval: 1.17–3.05), the expectation of obstetric care providers about labor pain (adjusted odds ratio: 3.26, 95% confidence interval: 1.27–8.36), having training on labor pain management (adjusted odds ratio: 2.51, 95% confidence interval: 1.03–6.07), and presence of chance for preference of obstetric analgesia for mothers in the facility (adjusted odds ratio = 2.30, 95% confidence interval: 1.33–3.98) were identified as factors significantly associated with the practice of obstetric analgesia among obstetric care providers.

Conclusion:

The overall use of labor pain management methods among obstetric care providers is low. Professional category, provider attitude, labor pain severity expectations, and having training were found to be factors associated with the use of obstetric analgesia. Therefore, working on adapting and disseminating the harmonized guideline and protocols on labor pain management and provision of training for obstetric care providers on labor pain management techniques were recommended.

Survey on knowledge, attitude and practice of labor analgesia among health care providers at Debre Markos Comprehensive Specialized Hospital, Ethiopia 2021. A cross-sectional study

Background

Childbirth is among the most painful experiences a woman has during their childbearing years. Despite improvement in the development of standards for pain assessment and treatment, labor pain is mostly ignored especially in low and middle-income countries.

Objectives

To assess the knowledge, attitude, and practice of labor analgesia among health care providers at Debre-Markos comprehensive specialized hospital, Ethiopia,.

Methods

After ethical approval was obtained from the ethical review board, institutional-based cross-sectional study was conducted in June 2021, written consent was taken from each health care provider (HCP) before data collection, and structured self-administered questionnaires were used. The collected data were coded and analyzed using SPSS version 22. Descriptive statistics were computed to determine frequencies and percentages finally data were presented using texts, tables, and graphs.

The study is registered with a research unique identifying number of 7407 found with the link address https://www.researchregistry.com/browse-the registry#home/?view_2_search = 7407&view_2_page = 1 and reported in line with STROCSS 2021.

Results

A total of 112 health care providers have participated with 70.5%, 29.5% being males and females respectively. This study was found that most gynecologists/obstetricians, 75% of general practitioners, and more than half (57.1%) of integrated emergency surgery and obstetrics (IESO) have good knowledge about labor analgesia, while the majority (58.3%) of midwives found to have poor knowledge. Although 75% of general practitioners and 71.4% of IESO have a good attitude towards obstetric and labor pain management, only 55.6% of midwives and 51.2% of graduating medical students were found to have a good attitude. Among health care providers (HCP), 60.3% of graduating medical students, 75% of general practitioners, 74.1% of IESO, and most of the seniors were found to have good practice of labor analgesia.

Conclusion

There is a wide gap among health care providers in knowledge, attitude, and practice of labor analgesia. Training health care providers about safe, efficient, and affordable labor analgesia is crucial to improving health care.

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Childbirth is among the most painful experiences a woman has during their childbearing years.

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Despite improvement in pain assessment and treatment, labor pain is mostly ignored especially in low and middle-income countries.

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There is a wide gap among health care providers in knowledge, attitude, and practice of to manage labor pain.

Utilization of Obstetric Analgesia for Labor Pain Management and Associated Factors among Obstetric Care Providers in Public Hospitals of Addis Ababa, Ethiopia: A Cross-Sectional Study

BACKGROUND

In low-income countries, pain-free labor initiative is an emerging concept and still parturient undergoes through painful labor; this is not different in Ethiopia; despite the national direction to use analgesia for labor pain and strong demand from the women, evidence on utilization of obstetric analgesia for labor pain management in Ethiopia is scarce. The objective of this study was to assess level of obstetric analgesia utilization and associated factors among obstetric care providers in public hospitals in Addis Ababa, Ethiopia.

METHODS

An institution-based cross-sectional study was used. All obstetric care providers working in labor and delivery units in public hospitals in Addis Ababa were included. The data were collected using a self-administered structured questionnaire. After checking for completeness, data were entered into Epi-data 3.1 and analyzed using SPSS 20. Bivariate and multivariable logistic regressions were used to identify factors associated with utilization of obstetric analgesia.

RESULT

Of 391 obstetric care providers included in the study, 143 (36.6%; 95% CI: 31.5-40.9%) reported providing labor analgesia. Having adequate knowledge (AOR 2.7; 95% CI: 1.37-5.23), ten and more years of work experience (AOR 4.3; 95% CI: 1.81-10.13), and availability of analgesics (AOR 3.3; 95% CI: 1.99-5.53) were significantly associated with providing labor analgesia.

CONCLUSION

Slightly more than 3 in 10 obstetric care providers reported providing labor analgesics to women. Training of providers and ensuring adequate supply of analgesics is required to make sure that women in labor would not suffer from labor pain.

Pain in the Prehospital Setting in Rwanda: Results of a Mixed-Methods Quality Improvement Project

Introduction

Pain is a universal human experience tied to an individual's health but difficult to understand. It is especially important in health emergencies. We performed a two-step quality improvement project to assess pain management by the SAMU ambulance service in Kigali, Rwanda, examining how pain is assessed and treated by ambulance staff to facilitate development of standardized guidelines of pain management in the prehospital setting, which did not exist at the time of the study.

Materials and Methods

Deidentified ambulance service records from December 2012 to May 2016 were analyzed descriptively for patient demographics, emergency conditions, pain assessment, and medications given. Then, anonymized, semistructured interviews of ambulance staff were conducted until thematic saturation was achieved. Data were analyzed using a grounded theory approach.

Results

SAMU managed 11,161 patients over the study period, of which 6,168 (55%) were documented as reporting pain and 5,010 (45%) received pain medications. Men had greater odds of receiving pain medications compared to women (OR = 3.8, 95% CI (3.5, 4.1), p < 0.01). Twenty interviews were conducted with SAMU staff. They indicated that patients communicate pain in different ways. They reported using informal ways to measure pain or a standardized granular numeric scale. The SAMU team reviewed these results and developed plans to modify practices.

Conclusions

We reviewed the existing quality of pain management in the prehospital setting in Kigali, Rwanda, assessed the SAMU staff's perceptions of pain, and facilitated standardization of prehospital pain management through context-specific guidelines.