THE ATTITUDES OF WOMEN DURING LABOUR
ABSTRACT
Most women who experience labor pain describe it as being extremely painful, which is why both pharmaceutical and non-pharmacological treatments are used to relieve it. Compared to more developed nations, LMICs have been found to have lower levels of awareness of labor pain treatment. The objective of the current study was to assess the knowledge and attitudes of 385 prenatal clinic patients at the University of Abuja Teaching Hospital in Nigeria between August and November 2022 regarding labor pain treatment.
In this cross-sectional study, information was gathered by questionnaires and a semi-structured interview. Stata SE13 was used to analyze the data. The bulk of the women were multigravidas and had secondary education or more (87 percent) (77 percent). Education and employment were the two main variables that affected knowledge (P = 0.001, CI 2.18 – 4.61) and (P = 0.001, CI 2.04 – 5.03). Health care professionals and the internet were the main sources of information about labor pain treatment. The majority of the women (74%) reported a need for labor pain alleviation during the following delivery. It was discovered that none of the independent variables under investigation had an impact on attitudes about labor pain treatment.
Pregnant women who frequent the antenatal clinic at the University of Abuja teaching hospital have little understanding of labor pain treatment; nevertheless, if they are aware that it is an option, most of them are prepared to use it during giving birth. Inclusion of such lessons as part of routine antenatal care as well as using the media i.e. television and online resources would greatly help in increasing women‟s knowledge on the matter.
Key words: Knowledge, Attitude, Labour pain relief, Antenatal
CHAPTER ONE
INTRODUCTION
1.1 Background of study
The physiological process of labor leads to the birth of the child. It comes with varied levels of pain. The International Association for the Study of Pain (IASP) defined pain as a personal sensory and emotional experience associated with real or potential tissue damage. The same group declared that access to pain treatment is a fundamental human right in the Montreal Declaration in September 2010. For many women, labor is characterized with excruciating pain. It’s been said to be one of the most intense types of (Lowe, 2002). The American Society of Anesthesiologists (ASA) and the American College of Obstetricians and Gynecologists (ACOG) acknowledged that “labor produces considerable pain for many women. There is no other situation in which it is thought to be acceptable for someone to be untreated for severe pain that is treatable with safe intervention while being treated by a doctor. (ACOG, 2004). Pharmacological (parenteral opioids and epidural analgesia [EA]) and non-pharmacological (back massage, delivery in water, acupressure, acupuncture, aromatherapy, and transcutaneous electrical nerve stimulation—TENS) techniques are used to lessen the pain of labor. In recent years, epidural labor analgesia (EA), one of these, has emerged as a popular and efficient means of reducing labor pain. Most people who receive it promptly report total relief from labor pain without having their initial stage of labor slowed down (Ramin, et al., 1995).
The World Health Organization (Kumar, 2007) acknowledges the significance of accurate pain diagnosis and treatment as a public health issue. Numerous research have been carried out in LMICs as well as rich nations. According to a study conducted in Pakistan, only 38.9% of respondents knew that labor pain could be reduced, and few women were aware of the benefits of epidural analgesia, which resulted in low patient demand for the treatment (Barakzai et al., 2010). Similar findings were made by Kapadia et al. (2013), who discovered that the majority of Indian mothers still experience excruciating labor pains as a result of a lack of awareness, accessibility, or knowledge of labor analgesic services. It was stated that there was a need to raise awareness of labor pain alleviation. Contrarily, a previous study by Biswas et al. (2002) on the knowledge of labor pain relief among antenatal women in the United Kingdom found that 93 percent of the women knew about epidural anesthesia as a form of labor pain relief and 60 percent of respondents who were multiparous had previously received an epidural. This shows that in developed settings as opposed to LMICs, there is a higher awareness of labor pain treatment. According to a Ugandan KAP study (Nabukenya et al., 2015), the majority of expectant moms would prefer labor analgesia but only a small percentage were aware of it. A large percentage of patients would take analgesia in labor if offered, according to similar data (Olayemi et al., 2003) from Nigeria, where they found that awareness of obstetric analgesia was rather low in the region. These findings are consistent with those made by Kumar (2007), who stated that patients with moderate to severe pain are frequently undertreated in both developing and wealthy nations because opioids, the primary form of pain management in such circumstances, are inaccessible. Even more than developing countries, low- and middle-income countries (LMICs) were impacted.
The overall fertility rate was 5.3, based on the Nigeria Demographic Health Survey (NDHS) from 2014. This suggests that if the current rate of age-specific fertility were to apply, a Nigerian woman who is beginning her childbearing years would probably give birth to 5 children by the end of her reproductive time. A Nigerian woman without access to analgesics is likely to go through extremely painful labor five times in her lifetime. According to ACOG, a woman’s request is sufficient justification for pain treatment during labor, thus it is essential that women are aware of their alternatives so they can choose the pain management method that they feel most comfortable with. No research have yet been conducted in Nigeria to ascertain the country’s attitudes and knowledge regarding labor pain treatment.
To enhance the quality of care at the top medical facility in Nigeria, this study sought to understand the knowledge and attitudes of pregnant women who attended antenatal clinic at University of Abuja Teaching Hospital about labor pain reduction.
1.2 Statement of the Problem
It seems that there is limited use of analgesia in labor in our context, despite the present global emphasis on pain management, whose proper diagnosis and management is a matter of public health concern (Kumar, 2007). The opioid painkillers Fentanyl and Pethidine are the primary analgesics utilized in the University of Abuja Teaching Hospital. Despite being the highest referral hospital, epidural analgesia—the gold standard—is not always easily available.
However, it appeared that not many of these substances were being taken based on anecdotal information gathered from a rough count in the Dangerous Drug Act (DDA) log. In the month of November 2016, 794 opioid vials were utilized (509 of Pethidine and 285 Fentanyl), A total of 4017 vaginal births were made throughout the time frame, yielding a shockingly low use of 19.8 percent. Low demand seems to be the cause of the low utilization. Culture and religion may also exacerbate this.
Given the foregoing, it was essential to investigate these concerns through the study in order to improve pain treatment in the labor ward at the University of Abuja teaching hospital.
1.3 Research Question
What is the knowledge and attitude towards labour pain relief amongst pregnant women attending antenatal clinic at UATH‟s Abuja Nigeria?
1.4 Objectives
- General Objective
To assess the knowledge and attitude regarding pain relief options amongst pregnant women attending antenatal clinic at UATH‟s Abuja Nigeria from August to October 2022
- Specific objectives
- To determine knowledge of labour pain relief amongst pregnant women attending antenatal clinic at UATH‟s Abuja Nigeria
- To determine the attitude towards labor pain relief
- To examine factors influencing knowledge and attitude towards labor pain relief
1.5 Significance of Study
There is an urgent need to investigate the situation at UATH given that every woman deserves to experience the greatest level of comfort possible during the labor process and that access to pain treatment is a fundamental Human right (Montreal Declaration). The knowledge gained will serve as a foundation for labor analgesia strategy and as a data source for future research on the topic.
1.6 Study Limitation
The study was based in an urban setup and restricted to the highest health institution in the country and hence may not give a complete reflection of the country situation.
1.7 Organization of the dissertation
This dissertation shows information pertaining to the knowledge and attitude of antenatal women towards labour pain relief. Chapter 1 gives an overview of labour pain and its relief from a global, regional and local perceptive, a statement of the problem and the objectives of the study. Chapter 2 is a review of existing literature on the nature of labour pain, types of pain relief, knowledge and attitude towards pain relief in labour. Chapter 3 describes the methodology of the study whilst Chapter 4 goes on to outline the results in tables and brief narratives. Chapter 5 is a discussion of the study findings and conclusion, with recommendations based on the study findings. Included in the appendix are he consent forms, questionnaire and letters of permission from the Hospital and Research Ethics Committee.
REFERENCES
ACOG Practice Bulletin (2002) Clinical Management Guidelines for Obstetrician- Gynecologists. (Goetz, L.M) Obstet Gynecol 100(1): 177-19 [Online] Available From https://www.ncbi.nlm.nih.gov/pubmed/12100826 [22/12/16]
ACOG Committee Opinion (2004) Pain Relief During Labor. No.295. Obstet Gynecol; 104(1):213. [Online] Available From https://www.ncbi.nlm.nih.gov/pubmed/15229040 [22/12/16]
Anim-Somuah, M, Smyth, R, Howell, C. (2005) Epidural Versus Non-Epidural or No Analgesia in Labour. The Cochrane Database of Systematic Reviews, (4): CD000331. DOI: 10.1002/14651858.CD000331
Apondi ,C. (2012) A Survey of Knowledge and Attitude and Practice Regarding Labour Analgesia Among Obstetricians at the Kenyata National Hospital. Unpublished MSc Anaesthesia dissertation. University of Nairobi.
Barakzai A, Haider G, Yusuf F, Haider A, Muhammad N. (2010) Awareness of Women Regarding Analgesia During Labour. J Ayub Med Coll Abbottabad; 22(1): 73-5. [Online] Available From: http://www.ayubmed.edu.pk/JAMC/PAST/22-1/Barakzai.pdf [20/12/18] Biswas, G, Hariharan, V. (2002) A survey of antenatal women on their knowledge of pain relief methods in labour. Royal Coll Anaesth. 11: 530–1.
Hanem, F, Alqantani, J, Almobaya, N, Aldosari, M, Alnajay, H. (2013) Women‟s Awareness and Attitude Toward Epidural Analgesia. Journal of Biology and Healthcare. 3(6). [Online] Available From www.isitte.org [20/12/18].
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