Pain relief in labor: a survey of awareness, attitude, and practice of health care providers in Zaria, Nigeria

Abstract

Background:The purpose of this study was to assess the attitudes of maternal health care providers to pain relief during labor in Zaria, Nigeria.Methods:This was a multicenter, collaborative, cross-sectional pilot study of provider perspectives concerning pain relief during labor. A structured, self-administered, questionnaire was completed by 95 consenting maternal health care providers at three high-volume facilities in Zaria, an ancient northern Nigerian city. Descriptive statistics was performed on the data.Results:Most respondents (94.8%) agreed that pain relief is needed during labor. Only 2.1% of respondents were undecided about the provision of pain relief during labor and 3.2% were of the opinion that pain relief was not necessary during labor. Most respondents (93.7%) had attended a woman in labor in the 4 weeks preceding the survey. Of these, 56.8% had counseled a parturient in labor. Most of the counseling (42.1%) took place during labor. Less than half of the respondents (48.4%) had administered pain relief in labor in the preceding 4 weeks and systemic opioids was the most commonly form of pain relief. Among the respondents who did not offer pain relief agents in labor, the majority (54.5%) had no reason for not offering it. Unavailability of methods, inability to afford the cost of pain relief, lack of knowledge and skills, as well as lack of essential equipment to provide the procedure were also given by respondents as reasons for not offering pain relief.Conclusion:Even though maternal health care providers in this environment have a positive attitude to pain relief in labor, most women go through labor without the benefit of analgesia. There exists a gap between provider attitudes to pain relief in labor and practice of the same, with many providers having no genuine reason(s) for not offering pain relief to their clients during labor. Providers need to align their practice to their attitudes, and need to be helped to do this through training as well as enhancing their ability to think critically about their practice.

Perceptions and Practice of Labor Pain-Relief Methods among Health Professionals Conducting Delivery in Minia Maternity Units in Egypt

“…In a study by Nwasor et al, a positive attitude toward the use of pain-relief agents during labor, coupled with the high awareness of the agents used, was found to be in conflict with the practice of providers. Fewer than half of the respondents (48.4%) provided any form of pain relief in labor even though almost 95% of them had attended a patient in labor in the 3 months preceding the survey [12]. In our study, the majority (89.7%) of HPs understood that women should expect pain during labor, and most of them (78.2%) believed that pain relief in labor is necessary.…”

Obstetric analgesia for vaginal birth in contemporary obstetrics: a survey of the practice of obstetricians in Nigeria

“…These findings are not encouraging, especially when it is expected that women should be offered among other things, effective pain relief during labour [5]. It however, compares favorably with reports from some tertiary hospitals in Nigeria, like in Zaria where a user rate of 48.8% was reported [12] and 38.9% in Benin, south-south of the country [20] but was much higher than the 22.1% of parturients reported to have received analgesia in labour in Enugu southeast Nigeria [21] and the 11% from the northeast of Nigeria [22]. It is noteworthy that, in this study, only about 13.3% offered pain relief routinely to parturients.…”

Skilled health attendants’ knowledge and practice of pain management during labour in health care facilities in Ibadan, Nigeria

“…Pain in labour has been reported by researchers as severe, agonizing and unbearable [5][6][7][8] . Experience of labour pain has been found to differ in people and culture; it is greatly influenced by cultural and religious beliefs 9 . Regardless of culture, personality or religious beliefs, labour pain experienced by women could be devastating and has been found to be emotionally laden and psychologically disturbing to the health of women 9 .…”