Between pain and pleasure: Pregnant women’s knowledge and preferences for pain relief in labor, a pilot study from Zaria, Northern Nigeria

  • Saudi Journal of Anaesthesia, Volume 8, No. 5, Year 2014

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Study Justification:
– The study was conducted in response to the increasing awareness among women about their rights to better quality of care in labor.
– Pain relief in labor is a hot topic and there is a need to understand the knowledge, utilization, and preferences of pain relief methods among expectant mothers.
– The study aimed to design a labor analgesia program based on the findings.
Highlights:
– The study involved 124 antenatal clients in a teaching hospital over a 1-week period.
– Majority of the respondents had heard about pain relief methods, with epidural analgesia being the most common method.
– Only a small percentage of respondents had actually used any form of pain relief agent in labor.
– In the current pregnancies, a significant number of respondents consented to the use of pain relief, with epidural analgesia being the preferred method.
– Fear of adverse effects on self and infants was cited as a reason for non-consent by some respondents.
Recommendations:
– There is a need to educate expectant mothers about pain relief methods and address their fears and misconceptions.
– High-quality pain relief services should be provided in labor to dispel myths and misconceptions.
– A suitable labor analgesia protocol should be designed based on the preferences and needs of expectant mothers.
Key Role Players:
– Obstetricians and gynecologists
– Anesthesiologists
– Antenatal care nurses
– Health educators
– Policy makers
Cost Items for Planning Recommendations:
– Training programs for healthcare professionals on pain relief methods and counseling techniques
– Educational materials and resources for expectant mothers
– Equipment and supplies for pain relief services
– Research and development for designing a suitable labor analgesia protocol
– Monitoring and evaluation of the labor analgesia program

The strength of evidence for this abstract is 6 out of 10.
The evidence in the abstract is based on a pilot study with a small sample size and limited scope. To improve the strength of the evidence, a larger, more diverse sample should be used. Additionally, the study should include a control group for comparison. Finally, the study should consider conducting a follow-up to assess the long-term effects of pain relief methods on both the mother and the infant.

Background: Pain relief in labor remains a hot topic and these debates get louder by the day as more women become aware of their rights to better quality of care in labor. This study was conceived in a background where the practice of pain relief in labor is evolving and where women are seeking to fulfill their need for pain-free labor. Objective: To investigate the knowledge, utilization and preferences of methods of pain relief in labor by expectant mothers in order to design a labor analgesia program. Materials and Methods: A questionnaire-based descriptive study involving 124 antenatal clients in a teaching hospital over a 1 week period. Descriptive statistics were carried out using SPSS for windows version 17. Results: The mean age of clients was 28.8 years (standard deviation = 5.17) with median parity of two and mean gestational age was 31.5 weeks. Majority of the respondents (47.9%) were of Hausa/Fulani ethnicity and 97.6% had primary school level education. Majority (87.3%) had heard about pain relief methods with the hospital being the source in 79% of cases. The most common method ever heard about was epidural analgesia (69.4%). Only 4% (n = 5) of respondents remembered ever using any form of pain relief agent in labor, of which three received parenteral opioids. In their current pregnancies, 45.2% consented to the use of pain relief in labor; of which, epidural analgesia was preferred by 92.9% (n = 52). Fear of adverse effects on self and infants were cited as reasons for non-consent by some respondents while others had no reason. Conclusion: The study reveals a high awareness of pain relief methods which is not matched by utilization and low knowledge about side-effects, although fear of side-effects is a factor for under-utilization. There is a need to educate adequately as well provide high quality pain relief services in labor in order to dispel with myths, misconceptions and fears associated with the use of methods of pain relief in labor.

This study was carried out among women attending antenatal clinic in a tertiary health facility in northern Nigeria. Northern Nigeria is known for low levels of obstetric care utilization, high maternal mortality and low female education.[8] Majority of women deliver at home without the use of pain relief agents. Even the women that deliver within the health care facilities may have little or no access to labor pain relief information and services. The antenatal clinic used for this study is patronized by a diversity of clients, including the natives, mostly Hausa/Fulani women and settlers from other parts of Nigeria and beyond. With this client diversity, knowledge and choices for pain relief agents during labor could be diverse and information generated could be useful in designing a suitable labor analgesia protocol. The study was descriptive using a structured, pre-tested questionnaire in the English language consisting of socio-demographic questions and questions related to knowledge, preferences and utilization of most common pain relief agents available in the hospital. Antenatal care nurses were trained on the use of the questionnaire and administered it to the clients irrespective of their educational status. A total population survey was planned for the estimated 150 clients who utilize antenatal services weekly in the hospital. Each client was counseled about the study and served with the questionnaire after verbal consent was given. Consecutive clients were interviewed over a 1 week period in October 2011. Descriptive statistics were carried out on the data using SPSS for windows version 17 (SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc). Chi-square was use for the test as statistical significance, P < 0.05 was considered to be statistically significant.

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Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Education and awareness campaigns: Develop targeted educational programs to increase knowledge and awareness among pregnant women about pain relief methods during labor. This could include providing information about the benefits, risks, and availability of different pain relief options.

2. Training healthcare providers: Provide comprehensive training to healthcare providers, including antenatal care nurses, on pain relief methods during labor. This would ensure that they have the knowledge and skills to effectively counsel and support pregnant women in making informed decisions about pain relief.

3. Improving access to pain relief services: Ensure that healthcare facilities have the necessary infrastructure, equipment, and trained staff to provide pain relief services, such as epidural analgesia. This may involve investing in equipment, training anesthesiologists, and establishing protocols for the safe administration of pain relief agents.

4. Addressing misconceptions and fears: Develop strategies to address misconceptions and fears associated with the use of pain relief methods during labor. This could involve providing accurate information, addressing concerns about side effects, and sharing success stories from women who have had positive experiences with pain relief.

5. Collaboration and partnerships: Foster collaboration between healthcare facilities, community organizations, and government agencies to improve access to pain relief services. This could involve sharing resources, coordinating efforts, and advocating for policy changes that prioritize maternal health.

It is important to note that these recommendations are based on the specific context of the study conducted in northern Nigeria. Implementing these innovations would require careful consideration of the local healthcare system, cultural norms, and available resources.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health is to educate expectant mothers about the available pain relief methods during labor and address their concerns about side effects. This can be done through antenatal care clinics and other healthcare facilities. By providing comprehensive information and counseling, women can make informed decisions about pain relief options and increase their utilization of these services. Additionally, healthcare providers should ensure the availability of high-quality pain relief services, such as epidural analgesia, to meet the preferences and needs of expectant mothers. This will help dispel myths, misconceptions, and fears associated with the use of pain relief methods in labor, ultimately improving access to maternal health services and reducing maternal mortality rates.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Develop and implement comprehensive education programs to increase awareness among pregnant women about the importance of maternal health, including pain relief options during labor. This can be done through antenatal care clinics, community health centers, and outreach programs.

2. Improve availability of pain relief services: Ensure that healthcare facilities, especially in low-resource settings, have the necessary infrastructure, equipment, and trained healthcare professionals to provide pain relief options during labor. This may involve training healthcare providers on administering pain relief methods such as epidural analgesia and ensuring the availability of necessary medications.

3. Address cultural and social barriers: Conduct culturally sensitive awareness campaigns to address myths, misconceptions, and fears associated with pain relief methods during labor. Engage with community leaders, traditional birth attendants, and local influencers to promote the benefits and safety of pain relief options.

4. Enhance access to information: Develop and disseminate informational materials, such as brochures and posters, in local languages to ensure that pregnant women have access to accurate and reliable information about pain relief options during labor. Utilize various communication channels, including radio, television, and social media, to reach a wider audience.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Gather data on the current knowledge, preferences, and utilization of pain relief methods during labor among pregnant women in the target population. This can be done through surveys, interviews, or focus group discussions.

2. Intervention implementation: Implement the recommended interventions, such as awareness campaigns, training programs, and improved availability of pain relief services, in the target population. Ensure that the interventions are implemented consistently and monitored closely.

3. Post-intervention data collection: After a suitable period of time, collect data again to assess the impact of the interventions on improving access to maternal health. This can include measuring changes in knowledge, preferences, and utilization of pain relief methods during labor among pregnant women.

4. Data analysis: Analyze the data collected before and after the interventions to determine the effectiveness of the recommendations. This can involve statistical analysis, such as chi-square tests, to assess the statistical significance of any observed changes.

5. Evaluation and refinement: Evaluate the results of the simulation and identify areas for improvement. Refine the recommendations and interventions based on the findings to further enhance access to maternal health.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions on implementing effective strategies.

Statistics:
Citations: 17
Authors: 2
Identifiers:
DOI: 10.4103/1658-354X.144059
ISSN: 1658354X
Research Areas:
Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Nigeria
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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