Survey of Current Practice of Labour Analgesia Among Obstetricians in Nigeria: Implications For Pain- free Labour Initiative.
AbstractLabour pain has been described as the worst possible pain known to mankind. It is more excruciating than cancer pain, phantom pain or toothache. Failure to relieve pain of any cause has been regarded as a violation of fundamental human rights. This study aimed to evaluate the current obstetrics analgesia practice among physicians in Nigeria, identify constraints to the practice and recommend solutions to improve the provision of such service to parturients. This descriptive cross-sectional questionnaire-based study on the availability and practice of intra-partum analgesia services was conducted among practitioners at the Departments of Obstetrics and Gynecology of 3 tertiary health institutions located in 3 of the 6 geopolitical zones of Nigeria. Of the 120 questionnaires distributed to the participants, 81 (67.5%) of the respondents returned completed questionnaires. The age range of the respondents was 25-44 years with a mean age of 30.8 and a male to female ratio (M: F) of 1.7: 1. Majority of the respondents, 76 (93.8%) believed that intra-partum analgesia was important, epidural analgesia was the most known method of intra-partum analgesia by 86.4% of the participants and epidural analgesia was the most preferred, 61.7% of respondents. Majority of respondents, 66 (81.5%), did not have an institutional policy or protocol on intra-partum analgesia. Doctors working in the same centre responded differently to the questions in the distributed questionnaires; and this is suggestive of lack of departmental harmonisation of clinical practice in the form of Standard Operating Protocol on intra-partum analgesia. Although there is a high level of knowledge of intrapartum analgesia among physicians, inconsistencies in its practice exist within and between tertiary hospitals in Nigeria. Notable absence of institutional policies on intra-partum analgesia at the practice facilities of the respondents was also observed.
ACOG Committee opinion #295. Pain relief during labour. Obstset Gynecol 2004:104;213
Berg A, Yuval D, Ivancovsky M, Zalcberg S, Dubani A, Benbassat J (2001). Patient perception of involvement in medical care during labor and delivery. Isr Med Assoc J. 3(5):352-356
Bergh I, Soderlund T, Vinterskog L, Martensson LB (2012). Reliability and validity of the Acceptance Symptom Assessment Scale in assessing labour pain. Midwifery. 28:e684-e688
Billert H (2007). Tokophobia-a multidisciplinary problem. Ginekol Pol. 78(10):807-811
Chigbu CO, Onyeka TC (2011). Denial of pain relief during labour to parturients in South-East Nigeria Int J Gynaecol Obstet. 114: 226–228
El-Wahab N, Robinson N (2011). Analgesia and anaesthesia in labour. Obstet Gynaecol Reprod Med. 21:137–141
Hodnett ED (2002). Pain and women’s satisfaction with the experience of childbirth: A systematic review. Am J Obstet Gynecol. 186:S160–S172.
Howell CJ (2000). Epidural versus non-epiduralanalgesia for pain relief in labour. Cochrane Database Syst Rev. 2:CD000331.
Imarengiaye CO, Ande AB (2006). Demand and utilization of labour analgesia service by Nigerian women. J Obstet and Gyn. 26(2):130-132
James JN, Prakash KS, Ponniah M (2012). Awareness and attitudes towards labour pain and labour pain relief of urban women attending a
private antenatal clinic in Chennai, India. Ind J Anaesth. 56(2):195-198.
Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP (2012). Pain management for women in labour: an overview of systematic reviews. Cochrane Database of Systematic Reviews. (3):CD009234. DOI: 10.1002/14651858.
Lee K, Ho KM (2004). Obstetric regional analgesia services in New Zealand: a national survey. N Z Med J. 117(1206): U1177
Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S(2003). The Nature and Management of Labour Pain: Part I. Non-pharmacologic Pain Relief. Am Fam Physician. 68(3): 1109-1112.
Lowe NK (1996). The pain and discomfort of labour and birth. J Obstet Gynecol Neonatal Nurs. 25(1): 82-92
Lowe NK (2002). The nature of labour pain. Am J. Obstet Gynecol. 186(5):S16-24
Melzack R, Taenzer P, Feldman P, Kinch RA (1981). Labour is still painful after prepared childbirth training. CMAJ. 125:357-363.
Melzack R (1984). The myth of painless childbirth.
Mugambe JM, Nel M, Hiemstra LA, Steinberg WJ (2007). Knowledge of, and attitude towards pain relief during labour of women attending the
antenatal clinic of Cecilia Makiwane Hospital, South Africa. South African Family Practice. 49(4):16a16d.
Mung’ayi V, Nekyon D, Karuga R (2008).Knowledge, attitude and use of labour pain relief methods among women attending antenatal clinic
in Nairobi. East Afr Med J. 85(9):438-441
NICE Intrapartum care (2014). Care of healthy women and their babies during childbirth. Clinical guideline 190. Methods, evidence and
recommendations. Available at https://www.nice.org.uk/guidance/cg190/resour
Nystedt A, Edvardsson D, Willman A (2004). Epidural analgesia for pain relief in labour and childbirth – a review with a systematic approach. J
Clin Nurs. 13:455–466.
Ogboli-Nwasor E, Adaji S, Bature S, Shittu O (2011).Pain relief in labour: A survey of awareness,attitude, and practice of health care providers in
Zaria, Nigeria. J Pain Res. 4:227–232.
Okeke CI, Menah NA, Cole SU, Osibogun A (2005).Knowledge and perception of obstetric analgesia among prospective parturients at the Lagos University teaching hospital. Niger Postgrad Med J.
Oladokun A, Morhasson-Bello IO, Eyelade OR, Adedokun BO, Akinyemi JO, Adewole IF (2007). Awareness and desirability of the Nigerian
Antenatal women about analgesia during childbirth. Nig J Med. 47(4):85-88
Olayemi O, Aimakhu CO, Udoh ES (2003). Attitudes of patients to obstetric analgesia at the University College Hospital, Ibadan. Nigeria. J Obstet Gynaecol. 23(1):38-40
Saisto T, Halmesmaki E (2003). Fear of childbirth: a neglected dilemma. Acta Obstet Gynecol Scand. 82(3):201-208
Wadhwa R, Chilkoti G, Saxena AK (2015). Current Clinical Opinions, Attitudes and Awareness of Interns Regarding Post-operative and Cancer Pain Management in A Tertiary Care Centre. Indian J Palliat Care. 21(1):49-55