Abstract
BackgroundEngagement in decision making is a key priority of modern healthcare. Women are encouraged to make decisions about pain relief in labour in the ante-natal period based upon their expectations of what labour pain will be like. Many women find this planning difficult. The aim of this qualitative study was to explore how women can be better supported in preparing for, and making, decisions during pregnancy and labour regarding pain management.MethodsSemi-structured interviews were conducted with 13 primiparous and 10 multiparous women at 36 weeks of pregnancy and again within six weeks postnatally. Data collection and analysis occurred concurrently to identify key themes.ResultsThree main themes emerged from the data. Firstly, during pregnancy women expressed a degree of uncertainty about the level of pain they would experience in labour and the effect of different methods of pain relief. Secondly, women reflected on how decisions had been made regarding pain management in labour and the degree to which they had felt comfortable making these decisions. Finally, women discussed their perceived levels of control, both desired and experienced, over both their bodies and the decisions they were making.ConclusionThis study suggests that the current approach of antenatal preparation in the NHS, of asking women to make decisions antenatally for pain relief in labour, needs reviewing. It would be more beneficial to concentrate efforts on better informing women and on engaging them in discussions around their values, expectations and preferences and how these affect each specific choice rather than expecting them to make to make firm decisions in advance of such an unpredictable event as labour.
Highlights
Engagement in decision making is a key priority of modern healthcare
Understanding what a patient expects of their interactions with healthcare professionals and what involvement they want in decisions about healthcare, often referred to as health expectations, is becoming increasingly important [4]
The data from the interviews identified three key issues related to decision making about pain relief in labour
Summary
Women are encouraged to make decisions about pain relief in labour in the ante-natal period based upon their expectations of what labour pain will be like. One of the key priorities of modern healthcare is to encourage engagement in decision making [1], with an acknowledged right for all patients to have an active role in decisions that affect their healthcare [2,3]. Understanding what a patient expects of their interactions with healthcare professionals and what involvement they want in decisions about healthcare, often referred to as health expectations, is becoming increasingly important [4]. As well as considering health expectations generally, health professionals who care for pregnant women have the additional challenge of ensuring they provide support to women to shape their expectations within a framework that is achievable, while at the same time ensuring they support them adequately with their labour and birth [7]
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