Survey of Current Practice of Labour Analgesia Among Obstetricians in Nigeria: Implications For Pain-free Labour Initiative (original) (raw)
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Background: Contemporary obstetrics in sub-Saharan Africa is yet to meet the analgesic needs of most women during child birth for a satisfactory birth experience and expectedly, obstetricians have a major role to play in achieving this. Methods: This was a questionnaire-based, cross-sectional study of 151 obstetricians and gynecologists that attended the 46th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abakaliki, southeast Nigeria in November, 2012. SOGON is the umbrella body that oversees the obstetric and gynecological practice in Nigeria. Data was collated and analyzed with Epi-info statistical software, and conclusions were drawn by means of simple percentages and inferential statistics using Odds Ratio, with P-value < 0.05 at 95% Confidence Interval (CI) taken to be statistically significant. Results: Of the 151 participants, males predominated; 110 (72.9%) practiced in government-owned tertiary hospitals in urban locations. Only 74 (49%) offered obstetric analgesia. Among users, only 20 (13.3%) offered obstetric analgesia routinely to parturients, 44 (29.1%) sometimes and 10 (6.6%) on patients’ requests. The commonest analgesia was opioids (41.1%). Among non-users, the commonest reasons adduced were fear of respiratory distress (31.1%), cost (24.7%) and late presentation in labour (15.6%). Conclusion: The routine prescription and utilization of obstetric analgesia by obstetricians in Nigeria is still low. Obstetricians are encouraged to step up its use to make childbirth a more fulfilling experience for parturients.
International Journal of Women's Health and Reproduction Sciences
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,
Journal of Pain Research, 2011
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.
Denial of pain relief during labor to parturients in southeast Nigeria
International Journal of Gynecology & Obstetrics, 2011
Objective: To evaluate the experiences of parturients with regard to pain relief during labor in Enugu, Nigeria. Methods: Women attending the prenatal clinics of 3 maternity care centers were interviewed via pre-tested interviewer-administered questionnaires between August 2010 and January 2011. Both open and closed questions were asked to evaluate the opinions and experiences of the respondents with regard to labor analgesia in previous pregnancies. Results: Overall, 34.1% of respondents were aware of their right to labor pain relief. Only 33.5% of maternal requests for labor pain relief were granted. Women who did not request labor analgesia indicated ignorance and fear of labor caregivers as their major reasons. Conclusion: Most women in southeast Nigeria are unaware of their right to pain relief in labor. Ignorance and fear of unfavorable reactions from labor caregivers are hindering women from requesting labor analgesia. There is a need to address the issue of refusal of maternal requests for labor pain relief because it constitutes a violation of the fundamental right of the parturient and an unnecessary breach of medical ethics.
Experience of Analgesia during Labour in a Sub-Saharan Hospital Setting
Open Journal of Anesthesiology
The pain experienced during labour varies from one person to another. The objective of this study is to evaluate the experience of analgesia during labour in three maternity hospitals in Cameroon. Methodology: This was a crosssectional analytical study conducted over 4 months, from 1 December 2019 to 31 March 2020, at the Yaoundé Gynaecological-Obstetric Hospital, the Yaoundé Central Hospital and the Douala General Hospital. We compared 35 parturients who delivered vaginally under analgesia and 79 parturients who delivered without analgesia. The data collected were compared using Chi 2 and Fischer tests with a significance level of P < 0.05. Results: Parturients aged 30-40 years (P = 0.03), public sector employees (P = 0.002) and private sector employees (P < 0.0001). Parturients with a minimum monthly income of 200,000 FCFA (P < 0.0001; OR = 8 IC = 95%). were likely to use analgesia during labour The frequency of delivery under analgesia was 30.7%. The pain was less severe in the VAS of parturients on APD during expulsion (1.6 ± 1.0 versus 5.4 ± 0.9; P < 0.001). We observed paresthesias of the lower limbs more frequently in the exposed women (RR = 5.
With the advance in health care delivery, obstetric analgesia is now routinely administered in most developed countries; however, in developing countries including Nigeria, childbirth is still a painful natural process for most women. This study was conducted to assess the awareness and willingness of women within the reproductive age to utilize non-pharmacological obstetric analgesia in reducing labour pain. An explanatory mixed method design was utilized for the study. For the quantitative component, a validated interviewer administered questionnaire was administered to 247 randomly selected women that delivered at AKTH who were attending immunization clinics. The qualitative study utilized an interview guide to conduct 4 key informant interviews with core health care personnel. Quantitative data was analyzed using descriptive statistics while content analysis was used to analyze the qualitative data. Results showed that the respondents have a mean age of 28.30 ± 7.5 years. Less than one fifth 42 (17%) of the respondents were aware of the use of non-pharmacological analgesics in reducing labour pain. An overwhelming majority of the respondents 234 (94.7%) indicated their willingness to use of non-pharmacological obstetric analgesia. More than three quarter 195 (78.9%) of the respondents stated that they will prefer non-pharmacological obstetric analgesia to any other form of pain relief in labour. It was concluded that although majority of respondents were willing to utilize the non-pharmacologic analgesia in reducing labour pains if made available, the level of awareness was ironically low. The study therefore recommends the need to include the teaching of non-pharmacologic analgesia during antenatal sessions. This is with view of increasing the level of awareness of non-pharmacological analgesia among women.
Awareness and Perception of Epidural Labor Analgesia Amongst Parturient in South Eastern Nigeria
Clinical Medicine Research
This study was carried out to assess the awareness, perceptions, acceptance, and the level of utilization of epidural analgesia in relation to other methods of labor pain relief among prospective parturient attending the antenatal clinic in south eastern Nigeria. Women attending the antenatal clinic were interviewed using interviewer administered questionnaires containing both open and closed questions, to evaluate their awareness, perceptions, acceptance and level of utilization of labor analgesia in general and epidural analgesia in particular. Data were analysed using SPSS Statistics Version 21.0. The study included 150 women with mean age of 29.63±5.02. Most of the respondents (94.7%) had at least secondary school education. More than half the respondents (62.7%) knew about labor analgesia and 38.7% knew about epidural labor analgesia. Source of knowledge to vast majority (75.6%) were doctors and nurses. Majority of the multiparous respondents (81.27%) had moderate or severe pain in the previous confinement and only 53% had pain relieve. Of those who had pain relieve, two third hard breathing exercises while 4.8% had epidural analgesia. Majority of the respondents (72.7%) would want to have labor analgesia, and 53.3% desired epidural in their next delivery. There is poor level of awareness and utilization of epidural labor analgesia by women attending an antenatal clinic in south eastern Nigeria.
Magna Scientia Advanced Research and Reviews
Background: Epidural labor analgesia has become prevalent in high income countries, but its use in low and middle income countries such as Nigeria is poorly studied. Objectives: To determine the rate of demand, indications, post-dural puncture headache rate and factors affecting demand for epidural analgesia among women in labor. Method: This was a across sectional analytical study of women in labor who were managed at Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria from 1st January 2017 to 31st December 2017. Data was obtained from women’s case files from Medical record department, labor ward, and Anesthesiology departmental records. Information obtained included total number of deliveries, mode of delivery, those that received epidural: date and time of placement, indication and number of side effects. Univariate analysis models were applied to evaluate the association between patient demographic, socioeconomic factors, clinical and demand for labor epidural analgesia. ...
Desire for pain relief in labour in Northeastern Nigeria
Journal of public health and epidemiology, 2009
Labour pain is a distressing and psychologically traumatizing experience to the parturient but little data exist in the Northeastern part of Nigeria regarding pain relief in labour, despite its many advantages. To determine the knowledge, desire and access to pain relief in labour as well as perception of labour pain. This is a cross sectional study of two hundred and fifty five women in two tertiary institutions in north-eastern Nigeria. Patients attending the antenatal clinics or staying in the lying in ward of the hospital after delivery were interviewed and questionnaires filled. One hundred and ninety (74.5%) were undelivered while 65(25.5%) were in the immediate postpartum period. One hundred women were interviewed at the University of Maiduguri Teaching Hospital (UMTH) while 155 were interviewed at the Federal medical Centre Gombe. The interviews centred on their perception of pain and duration of labour. The mean age and parity were 27.6 ± 5.7 and 2.8 ± 2.1 respectively. Abo...
Background: Labour analgesia has rapidly gained popularity in obstetric practice. Low usage in the developing world has raised concern. Objectives: To assess the knowledge, attitude and use of labour pain relief methods in women attending antenatal clinic in Nairobi. Design: A prospective study. Setting: Aga Khan University Hospital, a teaching and referral hospital in Nairobi, Kenya. Subjects: Two hundred and two consecutive expectant mothers attending antenatal clinic at the Aga Khan University Hospital, Nairobi. Results: Fifty six per cent of the participants had knowledge about labour pain relief methods. Friends, the antenatal clinic and books/leaflets were the major source on information. Ninety per cent indicated they would intend to have some form of labour pain relief at their next delivery. Eighteen percent had been offered some form of pain relief at their last delivery with 82% of those offered having effective pain relief (P< 0.001). Conclusions: While most of our participants were well educated, level of knowledge of labour analgesia is still low. Use of labour analgesia is also still quite low in comparison to the western World. It is recommended that obstetricians and anaesthetists participate in knowledge dissemination and setup of dedicated labour analgesia services in this region.