Labour pain relief: survey on the awareness of methods and attitude among health care providers in the Gambia

Abstract

Background: The joy and fulfillment of delivering a healthy baby cannot be overemphasized though it can be a painful experience for women. In high income countries, pain relief is an integral part of intrapartum care, however in low and middle income countries like the Gambia, it is overlooked due to the debate over the need, its benefits, disadvantage, traditional beliefs and practices. This study aimed to determine the awareness of methods and attitude to pain relief in labour among obstetric health care providers in the Gambia. Methodology: A descriptive cross-sectional study was conducted, 285 participants were sampled from 22 health facilities of different levels in The Gambia using multi stage sampling technique. Self-administered structured close ended questionnaires inquired on health care provider's socio-demographic information, awareness and concerns regarding labour pain relief and attitude towards pain relief in labour. A likert scale was used to measure their attitude concerning labour pain relief. Data were coded, entered and analyzed by SPSS version 23.0. Continuous variables were summarized using mean and standard deviation. Categorical variables were summarized using proportions. Frequency tables and bar charts were used to display summary of analyzed data. Study lasted 6 weeks. Results: Respondents were 285 obstetric health care providers of different cadre, from tertiary-121(43%), secondary-118(41%), and primary-46(16%) health facilities. The mean age of participants was 33 (SD-7) years. More than half were aware of pethidine (59%), epidural (58%) and morphine (51.9%) as pharmacological labour analgesia. Popular non-pharmacological methods were touch and massage (76%), continuous emotional and physical support during labour (68%), and breathing techniques (55%). Attitude to labour pain relief was positive among respondents-88.8%, and 72% felt that pain relief should be routinely offered to women in labour, 97% felt that continuous emotional support was needed during labour. Concerns about labour pain relief of which respondents were aware of are that it affects the baby's breathing and reduce uterine contraction. Conclusion-There was a high proportion of obstetric health care providers unaware of labour pain relief methods both pharmacological and non-pharmacological. The commonly mentioned methods were the pain relief methods commonly used in the setting. This may be due to the gap in the training midwifery curriculum, insufficient time and material dedicated to the concerned topic in the training of health care providers. The attitude towards relieving labour pain is strongly positive.