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

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.

Building confidence and trust in Ireland's National Maternity Services Workforce -What matters most and how?

National surveys on care experiences are increasingly adopted as regulatory mechanisms for improving care quality and increasing public trust in healthcare services. Based on data collected as part of Ireland's 2020 National Maternity Experience Survey, this study investigates care-related factors that contribute most to confidence and trust in the professional workforce (or carers) within Irish maternity services. The survey covered the full spectrum of maternity care and received 3,206 responses which were analysed using structural equation modelling. Results show that trust in carers may be enhanced through greater attention to the quality of interpersonal aspects of maternity care in a few core areas. We found that factors related to dignity and respect (β=0.270), involvement in decision-making (β=0.186), pain management (β=0.172), and communication (β=0.151) are core determinants of confidence and trust in the professional workforce of maternity services. Perceived quality of care in these four aspects increased on average, with the women's age. Women under 29 rated their experiences in these areas as significantly lower than the average. Women with a disability also rated their experiences significantly lower than average in three core areas. Our results suggest that trustworthy, equitable, and high-quality maternity care requires ongoing development of interpersonal skills within the maternity services professional workforce particularly in caring for younger women (under 29 years) and those with a disability.