Dutch women in midwife-led care at the onset of labour: which pain relief do they prefer and what do they use?

Trudy Klomp,Antoine Lm Lagro-Janssen,Ank De Jonge,Eileen K Hutton

doi:10.1186/1471-2393-13-230

Abstract

BackgroundPain experienced during labour is more extreme than many other types of physical pain. Many pregnant women are concerned about labour pain and about how they can deal with this pain effectively.The aim of this study was to examine the associations among low risk pregnant women’s characteristics and their preferred use and actual use of pain medication during labour.MethodsOur study is part of the DELIVER study: a dynamic prospective multi-centre cohort study. The data for this study were collected between September 2009 and March 2011, from women at 20 midwifery practices throughout the Netherlands. Inclusion criteria for women were: singleton pregnancies, in midwife–led care at the onset of labour and speaking Dutch, English, Turkish or Arabic. Our study sample consisted of 1511 women in primary care who completed both questionnaire two (from 34 weeks of pregnancy up to birth) and questionnaire three (around six week post partum). These questionnaires were presented either online or on paper.ResultsFifteen hundred and eleven women participated. Prenatally, 15.9% of women preferred some method of medicinal pain relief. During labour 15.2% of the total sample used medicinal pain relief and 25.3% of the women who indicated a preference to use medicinal pain relief during pregnancy, used pain medication. Non-Dutch ethnic background and planned hospital birth were associated with indicating a preference for medicinal pain relief during pregnancy. Primiparous and planned hospital birth were associated with actual use of the preferred method of medicinal pain relief during labour. Furthermore, we found that 85.5% of women who indicated a preference not to use pain medication prenatally, did not use any medication.ConclusionsOnly a small minority of women had a preference for intrapartum pain medication prenatally. Most women did not receive medicinal pain relief during labour, even if they had indicated a preference for it.Care providers should discuss the unpredictability of the labour process and the fact that actual use of pain medication often does not match with women’s preference prenatally.

Highlights

Pain experienced during labour is more extreme than many other types of physical pain
Our study showed that women with a non-Dutch ethnic background were more likely to indicate a preference for medicinal pain relief prenatally compared to women with a Dutch ethnic background
We found that women with a non-Dutch ethnic background were more likely to indicate a preference for, and to use the preferred medicinal pain relief

Summary

Introduction

Pain experienced during labour is more extreme than many other types of physical pain. Many pregnant women are concerned about labour pain and about how they can deal with this pain effectively. Labour pain is more extreme than many other types of physical pain [3,4] and many pregnant women are concerned about the pain of labour and about how they can deal with it effectively [4]. Christiansen et al [10] and Hodnett et al [11] reported an association between involvement in decision making and satisfaction with the experience of childbirth. Involvement in decision making and the ability to choose between different methods of pain relief contributes to childbirth satisfaction [12]

Objectives

Methods

Results

Discussion

Conclusion