Background
Materials and methods
Study design and setting
Participants
Topic guide
Data collection
Analysis
Ethics
Results
Participants’ characteristics
Emerging themes
Enabling factors and opportunities
Positive attitudes and awareness of pain relief
THEME 1: Enabling factors for providing pain relief | ||
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Sub-theme | Quote | |
Positive attitudes | Q 1 | “If there are pain relief drugs to give the mothers, let it come and be provided to the mothers so that they deliver peacefully. I could see that it’s better and good, and it will be helpful to the mother.” (Nurse-midwife, KII) |
Q 2 | “I think [pain relief] should be part of management for those women who would wish to get that service.” (Specialist registrar in O&G, KII) | |
Q 3 | “I think it is good to provide [pain relief] because the labour pain is too much, and you go through the pain for hours and hours.” (Consultant Obstetrician and Gynaecologist, KII) | |
Knowledge of pain relief options | Q 4 | “We are taught to allow the woman to walk; that could help to minimize the pain, also if there is a chance, the woman must be massaged on the back.” (Nurse-midwife, KII) |
Q 5 | “You can do back rubbing, or […] ambulation, like sitting and walking or positioning; there is also partner involvement and […] bathing.” (Consultant Obstetrician and Gynaecologist, KII) | |
Q 6 | “I was reading in the internet that in some settings they have water birth delivery, that this is something to reduce pain.” (Midwife, KII) | |
Q 7 | “There is acupuncture, that can be used to relief the pain, but we don’t have anyone who is familiar with it.” (Midwife, FGD) | |
Current practice | Q 8 | “To the mother in labour pain, I reassure her, I massage her […] I tell her to breath in and out to get relief and sometimes when she is tired, I encourage her; if she’s feeling like to bath, then I encourage her to bath.” (Nurse-midwife, KII) |
Q 9 | “If she comes with a husband, or mother or mother-in-law, sometimes it is helpful, as you can call the relative […] to talk with the woman sometimes it helps to release the suffering.” (Specialist registrar in O&G, KII). | |
Q 10 | “Once the woman is contracting more and the cervix is not growing well with the contractions, we give buscopan or hyoscine, so at least the pain is a little bit reduced and the cervix is moving on.” (Midwife, KII) | |
Q 11 | “During labour, I think mostly we use buscopan and paracetamol.” (Specialist registrar in O&G, KII) | |
Q 12 | “For Caesarean sections, the protocol is pethidine for 24 h, thereafter we do give the paracetamol.” (Midwife, KII) | |
Q 13 | “When you have an episiotomy, it must be lignocaine, local analgesia and sutured.” (Consultant Obstetrician and Gynaecologist, KII) |
Current use of pain relief
Barriers and challenges
Health system barriers
THEME 2: Barrier to providing pain relief | ||
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Sub-theme | Quote | |
Shortage of staff | Q 14 | “Let’s say we have four patients to monitor labour and all of them are in pain so you, you are the only one who is there in room 3 [pre-labour room], this is your location, you are the only healthcare provider, so how could you manage to help everyone; go and massage everyone who is in such pain, who is experiencing more pain?” (Midwife, KII) |
Q 15 | “[…] I mean the shortage of nurses, or staff become a major challenge because you may find, maybe you’re allocated to a certain room, five or ten mothers are in labour, you are, you’re there by yourself …it becomes difficult.” (Nurse-midwife, FGD) | |
Privacy | Q 16 | “We need to keep the privacy, and if you have a lot of relatives around and only a small curtain, there is no privacy to patients, no secret for them…we need more space.” (Nurse-midwife, KII) |
Limited education and opportunity | Q 17 | “I think maybe there a lack of trained personnel for [epidural], because it is not used here and no-one is experienced to teach us.” (Specialist registrar in Anaesthetics, KII) |
Q 18 | “I think shortage of resources, especially we don’t have the catheters and monitors, you know for every patient you need a continuous tocographic machine for every patient, we don’t have these resources.” (Specialist registrar in O&G, KII) | |
Q 19 | “Teaching about pain management is not part of formal classes in medical school, because even when we learnt about labour, the slides on pain management was just one so, no, not much emphasis on pain management.” (Specialist registrar in O&G, KII) | |
Q 20 | “I’ve read about epidural, but I’ve no experience with epidural.” (Specialist registrar in O&G, KII) | |
Q 21 | “I know there are different methods of labour analgesia and epidural is one of them; but you can also give nitrous oxide but I’ve not much experience because I’ve just observed in some few centres abroad but I’ve not been trained on that.” (Consultant Obstetrician and Gynaecologist, KII) | |
Negative beliefs, fears, malpractices | Q 22 | “There is a belief that this pain, we need to know how much pain this patient is experiencing at least at the beginning of the labour to be able to assess and evaluate the progress of labour.” (Junior doctor, KII) |
Q 23 | “Once you give someone pethidine (she) may be dizzy, may feel like sleeping, so once someone is dizzy, and feel like sleeping all the time, how does she push?” (Midwife, KII) | |
Q 24 | “…the other thing is pain relief can cause harm to babies, they can sedate them, you’ll have an inactive baby, you can’t use it…” (Consultant Obstetrician and Gynaecologist, KII) | |
Q 25 | “…Whatever is available, like the opioids analgesics, they are not really recommended before a woman gives birth because that will also give respiratory depression to the babies, so before they deliver there is very little you can do…” (Specialist registrar in O&G, KII) | |
Q 26 | “They will go through labour and pain must be there so to deliver a baby, if there is no pain that means, there can’t be a baby without pain.” (Nurse midwife, KII) | |
Q 27 | “I’ve not practiced pain relief during labour because we assume that it should be there, and we take it as a normal, [but] of course it’s not normal but we take it as if every woman should experience this.” (Specialist registrar in O&G, KII) | |
Q 28 | “It happens sometimes the woman may get a tear; we normally give infiltration before starting repairing but some healthcare providers, they just stitch it without giving it, even if the mother is screaming, they just say “shut up her”, and just proceed, so it happens.” (Specialist registrar in Anaesthesia, KII) | |
Q 29 | “During episiotomy, sometimes they do not actually provide the lignocaine, local anaesthesia during the cutting but it is written in the book, it is written there.” (Nurse-midwife, FGD) | |
Limited availability of protocols | Q 30 | “We don’t have a proper, pain management protocol for women who are delivering normally; we don’t give them analgesia.” (Specialist registrar in O&G, KII) |
Q 31 | “For those of who had vaginal deliveries once they complain of severe pain we just give them diclofenac injection, maybe a start dose and observe; if the pain continues we give paracetamol.” (Junior doctor, KII) | |
Q 32 | “I have not seen a protocol anywhere, but we’ve just learned it from our senior that this is how we do things, this is how we manage this.” (Junior doctor, KII) |
Limited education and opportunity to practice pain relief methods
Negative beliefs, fears and malpractices
Recommendations on how to improve pain relief management
THEME 3: Recommendations for providing pain relief | ||
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Sub-theme | Quote | |
Education for healthcare providers | Q 33 | “I think we need to get education and to be educated on how and what specific pain relief should be given during labour pain, because sometimes you just start, you don’t know what to give. If we get that education I think it will be very helpful to us.” (Specialist registrar in Anaesthetics, KII) |
Q 34 | “I suggest our health facility should liaise with the Government to promote more healthcare providers to go to anaesthetic school, because what we’re having here now it is a problem of shortage of this kind of profession.” (Nurse-midwife, FGD) | |
Increased staff numbers | Q 35 | “We really need the number of staff to be the same as the number of women who are labouring.” (Specialist registrar in O&G, KII) |
Cultural appropriate protocols | Q 36 | “It’s better if everyone in the Department comes with something, then we discuss, we share, we know why we are doing this, in our setting, rather than copy from somewhere else.” (Specialist registrar in O&G, KII) |
Research | Q 37 | “I think we should do a study on women […] you can ask them what they really want during labour, if they really want analgesia or don’t. That will give us the way to set the service.” (Specialist registrar in Anaesthetics, KII) |
Education for women | Q 38 | “To improve our health education at the clinic, to tell the mothers, they should know that during labour they will feel pain; […] because having that in your mind you can tolerate the pain.” (Nurse, KII) |