Knowledge And Awareness Of Pregnant Women On Non Pharmacological Techniques For Pain Relief During Childbirth In Selected Health Centers In Osogbo, Osun State

Medical and Health Science Project and Seminar Material

Knowledge And Awareness Of Pregnant Women On Non Pharmacological Techniques For Pain Relief During Childbirth In Selected Health Centers In Osogbo, Osun State


Abstract


The study was conducted to determine the perception, actual practices and perceived barriers among health-care providers regarding non-pharmacological pain relief during labor as well as explore women’s opinion towards their labor pain management experience. This was a cross sectional study of 88 health-care providers such as doctors, registered nurses and interns and 400 healthy puerperal women who experienced uncomplicated normal deliveries performed in selected health centers in osogbo, osun state.

Data were collected using self-administered structured questionnaires and each participant was invited to share his/her experiences in a one-to-one interview format. Analysis of data obtained showed that participants on most of the pain relief methods samples reported that they knew of different types of non-pharmacological pain relief methods and expressed their agreement toward their different benefits. On the other hand, lack of time, regulatory issues, lack of knowledge, patient unwillingness and strong beliefs in analgesia were recorded as the highest barrier percentage, while women who went through childbirth reported moderate levels of satisfaction regarding their birth experience. Role and benefits of non-pharmacologic methods of pain relief during labor cannot be ignored. There are many barriers preventing non-pharmacological pain therapies from being used related to hospital regulations and policies. In addition, most women denoted that they were able to cope with labor pain through non-pharmacological management.


Table of Content


Chapter One:

Introduction

  • 1.1 Background of the study
  • 1.2 Statement of the problem
  • 1.3 Objective of the study
  • 1.4 Research questions
  • 1.5 Significance of the study
  • 1.6 Scope of the study
  • 1.7 Limitation of the study
  • 1.8 Organizations of the study

Chapter Two:

Review of Literature


Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the study
  • 3.3 Sample size determination
  • 3.4 Sample size selection technique and procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of data collection
  • 3.7 Method of data analysis
  • 3.8 Validity of the study
  • 3.9 Reliability of the study
  • 3.10 Ethical consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Interpretation of Result

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE 

Chapter One


Introduction

1.1 Background to the Study

Pain during labor is a physiological phenomenon. The evolution of pain during the first stage of labor is associated with ischemia of the uterus during contractions. In the second stage, pain is caused by the stretching of the vagina and perineum and compression of pelvic structures (Ralph, Yarnell & John, 2004). However, pain sensation is a response of the total personality to the birthing experience and is therefore a subjective phenomenon. Labor is not a permanent practice and pain relief in childbirth is subject to many social and cultural modifiers which are continuously changing. Today both modalities are available. In the former, the main emphasis of pharmacological methods is largely on the elimination of the physical sensation of labor pain; whereas in the latter, the non-pharmacological methods, the emphasis is largely on preventing suffering (Hodnett 2002). Narcotics and sedatives may be used during the first stage of labor to help the mother relax, while regional anesthesia lessens or completely blocks the pain in a specific area of the body (Paech et al. 2002). With either narcotic pain relief or regional anesthesia, the mother can stay awake and play an active role in the birth. Besides conventional approaches, many complementary or alternative methods have been used effectively; these methods emphasize the interaction between mind, body and environment (Leeman et al. 2003). In addition, positioning a woman in labor and providing her with support from a doula (i.e. doula is a nurse who provides continuous support to the laboring woman throughout the stages of labor, similar to a mid-wife) is considered an important part of natural pain relief methods (Tournaire & Theau-Yonneau 2007). In order to provide the best pain management available and obtain the best outcomes, nurses need to be able to combine nonpharmacological pain management as a complementary therapy. Many physicians believe that the main determinant of maternal satisfaction with childbirth is major pain relief during labor and invariably, pharmacological pain relief is resorted to as the only method known to us. Lack of emotional support and excessive medical intervention regarding parturient women care are factors that may be related to increased intensity of pain (Zwelling, Johnson & Allen 2006). The most important factor associated with increased maternal satisfaction was the degree of participation in decision-making among health-care providers during labor (Hodnett 2002). Therefore, health-care providers’ attitudes and knowledge of non-pharmacological pain management therapies need to be assessed. At the same time, considering women’s perceptions towards their birth experience provides health-care providers with directions to assist women in having empowered birth experiences.

Researchers observe that there is no single universal method of labour pain management that fits all circumstances and meets all parturients’ needs,8 thus parturient preferences in the use of the two labour pain relief methods vary in different settings and cultures, from those preferring pharmacological methods, to those preferring non-pharmacological methods, and those who had no idea which method is useful, to those who would relinquish their autonomy of choice to their doctor.It is recommended that the method used should be individualised to each woman’s wishes, needs, and circumstances. Furthermore, women should feel free to choose any pain management they feel would help them most during labour, and can switch from non-pharmacological to pharmacological choice, or combine methods.

Preferences and practices also vary among skilled birth attendants regarding the use of pharmacological and non-pharmacological methods. While, Roets, Moru and Nel1 found that although Lesotho midwives said they were taught non-pharmacological methods of pain management, they use these methods inadequately during the first stage of labour due to shortage of staff, lack of privacy and space, a high midwife-mother ratio, culture, and hospital policies. Tasnim16 found that the majority of healthcare providers in Bangladesh report using non- pharmacological pain relief methods for women in labour. Only 6.2% of them thought women with labour pain should receive an analgesic drug.


1.2 statement of the Problem

In Nigeria, although skilled birth attendants (doctors, nurses, and midwives) report knowledge of both methods of labour pain reliefs, the use of pharmacological methods is unpopular, except parenteral opioids. Reasons elicited for not giving labour analgesia include non-availability of most pharmacological methods, clients’ inability to bear the cost and lack of skilled human resources, and equipment to administer the labour analgesia. However, 54.5% caregivers were reported to have no reasons.8 A more recent study reports that the routine prescription and utilization of obstetric analgesia by obstetricians in Nigeria is still low; only 49% of the study respondents offered obstetric analgesia.Among users, only 13.3% offered obstetric analgesia routinely to parturients, 29.1% sometimes and 6.6% on clients’ 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%).
However, reports from South-Eastern and South-Western Nigeria show that an appreciable number (18.3% to 52%) of parturients use some forms of non-pharmacological methods.6,9,18,19 One wonders if the women’s use of the non-pharmacological methods in labour was their preference or that of skilled birth attendants because of unpopular use of pharmacological methods.

Furthermore, anecdotal reports from midwifery students suggest that some of the labouring women they observed were not responsive to the midwives’ promptings to use the non-pharmacological labour pain relief methods, while those who did respond were not performing them correctly. The question that informed this study was: To what extent do pregnant women know and desire non-pharmacological methods to control labour pain? Lack of knowledge and ineffective use of non-pharmacological methods for labour pain control may not only lead to undesirable and unsatisfying results but may actually worsen the situation. There is dearth of empirical work from Nigeria relating directly to the level of knowledge and desire of prenatal women to use non-pharmacological methods of pain relief in labour and childbirth. This study assessed the knowledge of and willingness to use non-pharmacological methods of labour pain reliefs by pregnant women receiving antenatal care at a high volume, specialist maternity hospital in Enugu, South-Eastern Nigeria. This is a prelude to bridging any knowledge gap and increasing the women’s usage of chosen strategies at the appropriate time.


1.3 Objective of the Study

The main objective of this study is to evaluate the Knowledge And Awareness Of Pregnant Women On Non Pharmacological Techniques For Pain Relief During Childbirth In Selected Health Centers In Osogbo, Osun State.

Specifically, the study aims;

  1. To evaluate the Utilization of non-pharmacologic pain relief methods
  2. To examine the benefits of non-pharmacological pain relief methods
  3. To investigate the barriers that interfere with the utilization of non-pharmacological methods

1.4 Research Question

The study aims to answer the following research questions

  1. What is the level of utilization of non-pharmacologic pain relief methods ?
  2. What are the benefits of non-pharmacological pain relief methods ?
  3. What are the barriers that interfere with the utilization of non-pharmacological methods ?

1.5 significance of the Study

Since every woman deserves to be as comfortable as possible during the process of labour, and access to pain management is a fundamental Human right, against the background of limited usage of analgesia as noted from the crude count, there is great need to explore the situation at UTH. The information acquired will create a basis for strategizing on labour analgesia as well as forming a data base for reference in future studies on the same.


1.6 Scope of the Study

The study aims to investigate the the Knowledge And Awareness Of Pregnant Women On Non Pharmacological Techniques For Pain Relief During Childbirth In Selected Health Centers In Osogbo, Osun State. Specifically, the study will cover all Pregnant Women in Osun State Government Hospital.


1.7 Limitation of study

Finance,inadequate materials and time constraint were the challenges the researchers encountered during the course of the study.


1.9 Organizations of the Study

The chapter one consist of the introductory part of the study which includes the study background, the statement of the research problem, the study objective and scope of the study.

The second chapter is a critical review of other literatures relevant to the study and its objectives including the theoretical framework for the study. While the third chapter is methods of data collection, sampling and data analysis used in conducting the study. The fourth chapter centres around the research findings including an analysis of how it relates to previous findings. The fifth chapter consists of the summary of findings, conclusion and recommendations base on the study objectives.


Chapter Five


Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the Knowledge And Awareness Of Pregnant Women On Non Pharmacological Techniques For Pain Relief During Childbirth In Selected Health Centers In Osogbo, Osun State. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Study

In this study, our focus was on the Knowledge And Awareness Of Pregnant Women On Non Pharmacological Techniques For Pain Relief During Childbirth In Selected Health Centers In Osogbo, Osun State. The study is was specifically focused on examining the the Utilization of non-pharmacologic pain relief methods; examining the benefits of non-pharmacological pain relief methods and investigating the barriers that interfere with the utilization of non-pharmacological methods.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 450 responses were validated from the enrolled participants where all respondent are health workers and Pregnant Women Osun State government hospital.


5.3 Conclusions

With respect to the analysis and the findings of this study, the following conclusions emerged;
Medical practitioners are well oriented regarding different types of pain relief methods. Non-pharmacological pain management therapies have the potential to be extremely beneficial for labor pain management. There are many barriers preventing non-pharmacological pain therapies from being used related to hospital regulations and policies. Some traditional professional boundaries need revision in order to improve maternity care. In addition, most women denoted that they accepted labor pain as a physiological process, and were capable of coping with it through non-pharmacological management.


5.4 Recommendation

Based on the findings the researcher recommends that;

  1. To strengthen lessons on labour pain relief, given by health workers during antenatal visits/contacts.
  2. To strengthen the use of the internet and television for health education even on matters pertaining to pregnancy and labour pain relief so as to increase awareness in the general public and possibly alleviate any fears and concerns.
  3. A follow-up multicenter studies to determine the knowledge and attitude of both health workers and pregnant women towards labour pain relief and its administration.

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