Abstract
Background: Pain in labour is perceived differently for every individual. We can improve the outcomes and patient satisfaction with intrapartum care by ensuring adequate education and appropriate use of requested pain relief options. Encouraging informed personal control contributes to a women’s overall satisfaction. Aims: To assess current practice and identify improvement areas in the perception, planning and use of pain relief options, and how this impacts satisfaction of pain relief in labour. Methods: 114 retrospective anonymous patient questionnaires were returned by women delivering by spontaneous vaginal delivery, instrumental delivery or emergency caesarean section at Nambour General Hospital between April and July 2011. Data were collated and analysed using STATA. Results: 83% and 65% of women had their pain relief options explained antenatally and on admission respectively. 92% reported their pain relief was adequately provided. There was a significant difference (p << 0.001) between those reporting “very good” or “good” satisfaction when compared to those reporting “fair” or “poor” with regards to a change from their method of planned pain relief. However, no significant difference (p = 0.62) between the “same as planned” group and the “different than planned” group, highlighting that most women were satisfied irrespective of whether their plan changed or not. However, if they were unsatisfied, this correlated with a change in their plan. Conclusions: Education of pain relief options for labour antenatally and on birth suite admission, with adequate discussion and documentation of their wishes encourages informed planning and use of pain relief. This promotes personal choice and control, resulting in improved overall satisfaction of pain relief in labour.
Highlights
BackgroundPain in labour is perceived differently by every woman, and is dependent on many factors, including physical, emotional, cognitive, social and cultural influences
Nambour General Hospital (NGH) is a secondary level hospital in Queensland catering for around 2800 births per annum
In the UK, the General Medical Council publication “Duties of a Doctor” states that doctors have a duty to “take steps to alleviate pain and distress”, and The American College of Obstetrics and Gynaecology (ACOG) point out that labour is unique in medicine because “there is no other circumstance in which it is considered acceptable to experience pain that is amenable to safe relief while under a physician’s care” [6] [7]
Summary
Pain in labour is perceived differently by every woman, and is dependent on many factors, including physical, emotional, cognitive, social and cultural influences. Pain during childbirth is often regarded differently from pain in other clinical circumstances, with some hypothesizing that pain is a “good” pain which induces an important physiological process in labour namely, the release of natural endorphins, that help women cope with high levels of pain [2]. Further it has been shown that “one on one” maternity care by a known carer has been shown to reduce analgesic requirements [9] Given these varying views, it would seem preferable to individualise pain relief provided to each woman in labour according to her clinical circumstances. The Cochrane overview of systematic reviews considering pain management in labour concluded that women should feel free to choose whatever pain management they feel would help them best, and highlighted that evidence shows pharmacological pain relief is effective, it can be associated with adverse effects for the mother and baby [11]
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