Painless labour: how far have we travelled?

Bajwa, Sukhwinder Kaur; Bajwa, SukhminderJit Singh; Singh, Kamaljit; Singh, Anita

doi:10.4038/sljog.v32i4.3992

Cited by 3 publications

(5 citation statements)

References 55 publications

(43 reference statements)

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“…The role of obstetricians in making this a reality cannot be overemphasized and a pain-free labor is very vital if this is to be achieved (5). It is important that the woman receive enough information about the various options of pain relief and be guided into making an informed choice (18).…”

Section: Discussionmentioning

confidence: 99%

Epidural Analgesia for Management of Labour Pain: Determinants and Deterrents Among Obstetricians in Nigeria

Anozie¹,

Lawani²,

Mamah³

et al. 2018

International Journal of Women’s Health and Reproduction Scienc

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Introduction Pain perception in labor is extremely variable among women depending on the parturient pain threshold and reaction to pain (1). For the majority of women, labor pain is considered severe and may be likened in severity to complex regional pain syndrome or amputation of a digit without anaesthesia (2). According to the American College of Obstetricians and Gynecologists and the American Society of Anaesthesiologists, there is no circumstance where it is acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under the care of a physician (2). The development of modern analgesia and in particular regional analgesia marked a major turning point in pain management during labor and delivery. Epidural analgesia is considered as the most effective method of pain relief and recommended as the first choice analgesia for women during labor and delivery (3,4). The level of awareness and practice of labor analgesia, particularly epidural analgesia in sub-Saharan Africa is still rudimentary and obstetricians undoubtedly have an important role to play in this regard. In 2012, a survey of the practice of labor analgesia a m o n g t h e obstetricians in Nigeria revealed that only 49% of the respondents offered analgesia to women in labor and of these, a paltry 2% used epidural analgesia (5). Pain management in labor is an important component of active management of labor and even though not all women request pain relief in labor, the obstetrician has a duty to discuss the options, benefits and risks associated with various methods of labor analgesia with the parturient irrespective of his or her belief (6, 7). Optimal pain control in labor is more likely to result in a satisfactory birth experience for the parturient and her care provider (8-12). A critical step in achieving this milestone is to survey the level of awareness of epidural analgesia, determinants and deterrents of its use among obstetricians practicing in Nigeria. Currently, there is no available literature documenting the utilization pattern, determinants and deterrents of epidural analgesia among obstetric care providers such as obstetricians in Nigeria. This study, therefore,

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Section: Discussionmentioning

confidence: 99%

Epidural Analgesia for Management of Labour Pain: Determinants and Deterrents Among Obstetricians in Nigeria

Anozie¹,

Lawani²,

Mamah³

et al. 2018

International Journal of Women’s Health and Reproduction Scienc

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“…4 Epidural labour analgesia is considered as superior to opioids. 7 It does not increase the incidence of caesarean deliveries and has no ill effect on the neonate. 8 There may be some prolongation of labour duration which can be reduced if low dose regimens are used.…”

Section: Discussionmentioning

confidence: 99%

Attitude of obstetricians regarding labour analgesia and limitations in practising it

Kannan

Rengasamy

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Parturient experience labour pain of varying degrees which intensifies as labour progresses. Providing adequate pain relief during labour is important for positive experience of child birth.Methods: This cross-sectional survey was conducted among obstetricians working in five teaching hospitals in Tamil Nadu in 2015. Obstetricians working in these medical colleges were given structured questionnaire to be filled by them. It had questions regarding the obstetricians knowledge, experience and attitude towards labour analgesia and limitations in its practise.Results: Majority of them considered epidural labour analgesia as most effective (91%).Only 55% of them have had practical experience of conducting deliveries under epidural. Parenteral injection of opioid (tramadol hydrochloride) or NSAIDs remain the most commonly practised method. 82% of the participants don’t discuss about labour analgesia services while providing antenatal care.Conclusions: Obstetricians should sensitize the antenatal women regarding labour pain and its management. Supportive role should be provided by midwives. Where resources are limited non-pharmacological means of pain relief should also be encouraged.

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“…seem to be 'non-invasive and safer' but there is not much research evidence available on their effectiveness. 1,6,7 The pharmacological methods of labour pain relief include inhalational analgesics such as nitrous oxide and opioids in addition to the regional techniques such as epidural, spinal and combined spinal-epidural block. 6,7 Of them the epidural is the most commonly used and recommended since it has been shown to be significantly better in pain management than the rest.…”

Section: Introductionmentioning

confidence: 99%

“…1,6,7 The pharmacological methods of labour pain relief include inhalational analgesics such as nitrous oxide and opioids in addition to the regional techniques such as epidural, spinal and combined spinal-epidural block. 6,7 Of them the epidural is the most commonly used and recommended since it has been shown to be significantly better in pain management than the rest. 8 Epidural analgesia has also undergone further improvement to reduce the side effects over the recent years with the advancements in the field of medicine.…”

Section: Introductionmentioning

confidence: 99%

“…9 During epidural analgesia, mothers are not sedated and they will retain both the ability to walk during the first stage of labour and to push effectively during the second. 6,7 Due to its hypotensive effect it prevents further increase in maternal blood pressure and helps in the management of pre-existing medical conditions such as preeclampsia. 7,9 While studies have shown that epidural analgesia during labour can give rise to several adverse reactions including increased duration of the second stage of labour, increased need for instrumental delivery, urine retention and maternal pyrexia etc., some of the research findings are ambiguous, mainly because the effects of epidural analgesia cannot be isolated during a delivery.…”

Section: Introductionmentioning

confidence: 99%

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Is knowledge and attitude on epidural analgesia during labour satisfactory among pregnant women attending antenatal clinics in Colombo District?

Delwatta

Kaushalya

Shehan

et al. 2019

Sri Lankan J Anaesthesiol

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Labour pain management is a major challenge in maternity care. Epidural analgesia provides safe and effective pain relief during labour. The objective was to assess the knowledge, attitudes and associated factors towards epidural analgesia during labour among pregnant women in Colombo region, Sri Lanka.This was a descriptive study conducted at two selected hospitals in Colombo Sri Lanka. The sample size was 260 and those below 18yrs were excluded. Participants were provided with a pretested questionnaire. Ethical approval was obtained from Faculty of Medical Sciences, University of Sri Jayewardenepura. Both knowledge and attitude were given separate scores and were categorized as 'good' or 'poor' based on their mean.Within the study population, 41.9% had heard of labour analgesia. Among them, only 6.7% had good knowledge and 15.6% had a positive attitude towards labour epidural analgesia. The patients with good knowledge about labour epidural analgesia had good attitude towards the procedure (p<0.05) and there was a positive association between those who had heard of analgesia and their sources of information.However, as the total level of knowledge and attitudes towards labour epidural analgesia was poor, it is recommended that the health care workers issue pamphlets carrying necessary information following discussions with the pregnant women. After admission they should be given clear information about risks and benefits of the procedure and a post-partum feedback would help in quality improvement.

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Painless labour: how far have we travelled?

Cited by 3 publications

References 55 publications

Epidural Analgesia for Management of Labour Pain: Determinants and Deterrents Among Obstetricians in Nigeria

Epidural Analgesia for Management of Labour Pain: Determinants and Deterrents Among Obstetricians in Nigeria

Attitude of obstetricians regarding labour analgesia and limitations in practising it

Is knowledge and attitude on epidural analgesia during labour satisfactory among pregnant women attending antenatal clinics in Colombo District?

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