Non-pharmacological labor pain management and associated factor among skilled birth attendants in Amhara Regional State health institutions, Northwest Ethiopia

"…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.

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.

Comparisons of nonpharmaceutical analgesia and pharmaceutical analgesia on the labor analgesia effect of parturient women

OBJECTIVE

We aimed to compare the labor analgesia effects of nonpharmaceutical analgesia and pharmaceutical analgesia on parturient women.

METHODS

One hundred and four parturient women with spontaneous births were selected and randomly divided into pharmaceutical and nonpharmaceutical analgesia groups. Before and after analgesia, the Visual Analogue Scale (VAS), parturient satisfaction with analgesia, serum pain stress factors (substance P [SP], neuropeptide Y [NPY], nerve growth factor [NGF], and prostaglandin E2 [PGE2]), duration of labor, vaginal bleeding at 2 h postpartum, postpartum urinary retention and dysuria incidence, Apgar score of 1 min and 5 min after birth, and neonatal cord blood gas analysis (pH, partial pressure of oxygen [PO₂ ], partial pressure of carbon dioxide [PCO₂ ], and lactate [Lac]) were compared in the two groups.

RESULTS

VAS scores were lower and the analgesia satisfaction was higher in the pharmaceutical analgesia group than in the nonpharmaceutical analgesia group (all p < .05). Serum levels of SP, NPY, NGF, and PGE2 in the pharmaceutical analgesia group were lower than those in the nonpharmaceutical analgesia group (all p < .05). The first and second stages of labor were longer and the bleeding volume at 2 h postpartum was greater in the pharmaceutical analgesia group than those in the nonpharmaceutical analgesia group (all p < .05). Reduced Lac and PCO₂ levels and increased PO₂ level were found in the pharmaceutical analgesia group in comparison to the nonpharmaceutical analgesia group (all p < .05).

CONCLUSION

This study demonstrates that the analgesic effect and neonatal condition of the pharmaceutical analgesia are better than the nonpharmaceutical analgesia, but the labor duration and postpartum bleeding volume of the pharmaceutical analgesia are greater than those of the nonpharmaceutical analgesia.

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.