Labor Pain Management Research Articles

Literatur Review: The Effect of Lemon Aromatherapy on Labor Pain

Background: Labor pain is one of the clinical manifestations of fetal delivery characterized by an increase in the intensity and frequency of uterine contractions that can cause continuous pain and can be on a severe scale. Management of labor pain can be done by aromatherapy. The aromatherapy that can be used is lemon, which has natural ingredients that can reduce pain in labor. This study aimed to obtain representation and analyze articles about lemon aromatherapy for labor pain. Methods: This research is a literature review by searching international journals/articles in the google scholar database. Three keywords used are “lemon aromatherapy”, “citrus limon aromatherapy”, and “labor pain”. The articles selected by the step of literature review and PRISMA Flow Diagram. Data analysis is performed by presenting research journals/papers in a review table. Results: The results of the 5 articles analyzed have relevance to the research problem and state that The use of lemon aromatherapy during labor can help to greatly lessen discomfort. Conclusion: Lemon aromatherapy can minimize labor pain, so further research is needed to develop methods /standards for health facilities and future studies.

Optimal Diaphragmatic Breathing Patterns through Exercise Can Light Some Medical Problems

Breathing is an absolute human need. In an emergency, airway and breathing are the main problems that must be addressed immediately. Empirically, breathing techniques that people do in general are varied. Of all breathing patterns, it is believed that there must be the most optimal. One of them is diaphragmatic breathing (DB). DB plays the role of the diaphragm as the main muscle that performs the activity of inhaling and exhaling. Optimal breathing patterns, including certain DB, have the ability to relieve several medical problems. The aim of this study was to examine whether an optimal DB pattern could alleviate some medical problems. We conducted a literature study on 40 references consisting of 27 journals and 13 other appropriate literature sources. We searched library resources using the PubMed search engine through keywords: effectiveness of breathing, DB, and breathing exercises. Literature analysis was based on requirements, including inclusion and exclusion criteria. There were 26 journals which met the criteria. Optimal DB pattern can be a solution for chronic obstructive pulmonary disease (COPD), asthma, chronic stroke, congestive heart failure (CHF), gastroesophageal reflux disease (GERD), cerebral palsy (CP), labor pain management, and anxiety. It can be therapeutic to relieve some medical problems.

Different Doses of Ropivacaine either with Sufentanil or with Dexmedetomidine for Labor Epidural Anesthesia regarding Painless Childbirth: A Retrospective, Multicenter Study

Introduction: Sufentanil is used with ropivacaine in labor pain management but it can have respiratory depression. Dexmedetomidine is effective to maintain hemodynamic stability in parturient women and allow awake intubation. However, dexmedetomidine is suggested only in patients with major cardiovascular disease that mandates stable hemodynamics (Reference ID: 3987541-USFDA). The objective of the study was to compare different doses of ropivacaine either with sufentanil or with dexmedetomidine for epidural anesthesia regarding labor pain management. Methods: Parturient women have received 0.125% ropivacaine with 0.5-μg/mL sufentanil (SR1 cohort, n = 115), or 0.08% ropivacaine with 0.5-μg/mL sufentanil (SR2 cohort, n = 109), or 0.125% ropivacaine with 0.5-μg/mL dexmedetomidine (DR1 cohort, n = 124), or 0.08% ropivacaine with 0.5-μg/mL dexmedetomidine (DR2 cohort, n = 135) for epidural anesthesia during vaginal delivery or cesarean section. Results: At 2-h postpartum, the visual analog scale score of parturient women of the DR2 cohort was fewer than that of parturient women of the SR1 (p < 0.0001, q = 4.162) and the SR2 (p < 0.0001, q = 7.568) cohorts and statistically the same as that of parturient women of the DR1 cohort (p < 0.0001, q = 3.087). Bradycardia and itching were reported in parturient women of the DR2 and the DR1 cohorts while nausea, vomiting, and urinary retention at 6 h were reported in parturient women of the SR1 and the SR2 cohorts. In the DR2 cohort, there were fewer numbers of parturient women with bradycardia (4 vs. 19, p < 0.0001, q = 6.613) and hypotension (2% vs. 1%) than those in the DR1 cohort. The child born by women of the DR2 cohort had high partial arterial pressure of oxygen than those born by women of the DR1 (p < 0.0001, q = 18.663), the SR1 (p < 0.0001, q = 29.366), and the SR2 (p < 0.0001, q = 24.039) cohorts. Discussion/Conclusion: Epidural 0.08% ropivacaine with 0.5-μg/mL dexmedetomidine is an effective and safe anesthetic regimen for hypertensive parturient women and their newborns. Level of Evidence: III. Technical Efficacy Stage: 4.

Obstetrics care providers attitude and utilization of non-pharmacological labor pain management in Harari regional state health facilities, Ethiopia

BackgroundIn a woman’s life, labor pain is the most severe pain that they have ever faced. In Ethiopia, the provision of pain relief in labor is often neglected. Furthermore, evidence strongly urged that further research is needed on non-pharmacological labor pain management. Therefore, obstetrics care providers’ attitudes and utilization of non-pharmacological labor pain management need to be assessed.MethodA facility-based cross-sectional study was conducted from May 20 to June 10, 2021, in Harari regional state health facilities, Ethiopia. All obstetric caregivers in Harari regional state health facilities were included in the study. A structured questionnaire adapted from the previous studies was used to collect data. The data was entered into Epi-data version 3.1 statistical software. Statistical analysis was carried out by using SPSS for windows version 22. Multivariate linear regression analysis was employed to determine the association between independent variables and the outcome variable.ResultThe overall utilization of non-pharmacological labor pain relief methods was 59.3% [(95% CI (53.9,63.4)]. Three hundred five (65.5%) of the study participants had unfavorable attitudes. Females compared to males (β = − 0.420; 95% CI: − 0.667, − 0.173), clinical experience (β = − 0.201; 95% CI: − 0.268, − 0.134), knowledge sum score (β =0.227: 95%; CI: 0.18,0.247), and attitude sum score (β = 0.376; 95% CI: 0.283, 0.47) were showed significantly association with utilization of non-pharmacological labor pain management.ConclusionThe overall utilization of non-pharmacological labor pain relief methods was relatively good compared to other studies done in Ethiopia but all women’s need for labor relief methods should not be ignored. In this study sex of the respondents, clinical experience, individual preference, attitude and knowledge were factors associated with the utilization of non-pharmacological labor pain management. All stake holds need to work together to improve the attitude of health providers and to increase the utilization of non-pharmacologic labor pain management.

Use of non-pharmacological methods in managing labour pain: experiences of nurse-midwives in two selected district hospitals in eastern Tanzania

BackgroundLabour pain usually brings with it many concerns for a parturient and her family. The majority of the women in labour pain may require some sort of pain relief method during this period, be it pharmacological or non-pharmacological. In Tanzania, the use of non-pharmacological methods to relief labour pain remains low among nurse-midwives. We analysed the experiences of nurse-midwives in the use of non-pharmacological methods to manage labour pain, in two selected districts of Pwani and Dar es Salaam regions in eastern Tanzania. This paper describes Non-pharmacological Methods (NPMs) currently used by nurse-midwives, the facilitators, myths and fears related to the use of NPMs.Materials and MethodsAn exploratory qualitative study using in-depth interviews was conducted with 18 purposively recruited nurse-midwives working in labour wards in two selected district hospitals in Pwani and Dar es Salaam regions in eastern Tanzania. Qualitative conventional content analysis was used to generate categories describing the experience of using non-pharmacological methods in managing labour pain.ResultsThis study revealed that nurse-midwives encouraged women to tolerate labour pain and instructed them to change positions and to do deep breathing exercises as a means to relief labour pain. Nurse-midwives’ inner motives facilitated the use of non-pharmacological strategies for labour pain relief despite the fear of using them and myths that labour pain is necessary for childbirth.ConclusionThis study generates information about the use of non-pharmacological strategies to relief labour pain. Although nurse-midwives are motivated to apply various non-pharmacological strategies to relief labour pain, fear and misconceptions about the necessity of labour pain during childbirth prohibit the effective use of these strategies. Therefore, together with capacity building the nurse-midwives in the use of non-pharmacological strategies to relief labour pain, efforts should be made to address the misconceptions that may partly be of socio-cultural origin.

Non-pharmacological labor pain management practice and associated factors among skilled attendants working in public health facilities in Gamo and Gofa zone, Southern Ethiopia: A cross-sectional study.

Labor pain management is crucial to ensure the quality of obstetric care but it is one of the neglected areas in obstetrics. This study aimed to assess the practice of labor pain management and associated factors among skilled attendants working in public health facilities in Southern, Ethiopia from November 1-January 26, 2019. An Institution-based cross-sectional study design was conducted from November 1-January 26, 2019. A simple random sampling technique was used to select a total of 272 obstetric care providers. Data were collected using pretested, and structured questionnaires. Data were entered to Epi data version 3.1 statistical software and exported to SPSS 22 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify associated factors. P-value <0.05 with 95% confidence level were used to declare statistical significance. Overall, 37.5% (95%CI: 32%, 43%) of health care providers had a good practice on non-pharmacological labor pain management. Clinical experience of 5 years and above (AOR = 2.91, 95%CI: 1.60, 5.42), favorable attitude (AOR = 2.82, 95%CI: 1.56, 5.07), midwife profession (AOR = 1.45, 95%CI: 1.98, 4.27), and working in satisfactory delivery rooms (AOR = 3.45, 95%CI: 2.09, 7.43), were significantly associated with a health professional good practice of labor pain management. This study showed that the practice of non-pharmacological labor pain management was poor in public health facilities in Gamo and Gofa zone. It was observed that having a favorable attitude, having ≥5 years of work experience, being a midwife by professional, and having a satisfactory delivery room were found to be significant predictors of the practice of non -pharmacological labor pain management. Therefore, all health facilities and concerned bodies need efforts to focus on providing training to midwives on non-pharmacological labor pain management practice.

The knowledge and attitudes of health professionals working in mother-friendly hospitals about complementary therapy and supportive care methods.

INTRODUCTIONIt is important that the healthcare professionals who are with the mother at the moment of birth and afterwards, know and apply effective complementary treatment and supportive care methods, and also know their effects and limitations. The aim of this study is to determine the knowledge levels and attitudes of health personnel about complementary therapy and supportive care methods to be used in the management of labor pain and postpartum period.METHODSA cross-sectional study included 142 midwives/nurses and physicians working in the delivery room and maternity services of mother-friendly hospitals in Manisa, Turkey, between August 2018 and April 2019. The questionnaire consisting of 25 questions evaluated the knowledge and attitudes of the participants about complementary therapy and supportive care methods.RESULTSIt was found that 30.6% of the healthcare professionals participating in the study used complementary treatment and supportive care methods in their patients. The least heard method was chiropractic (6.6%), the best-known method was hydrotherapy (water birth) (5.8%) and the most used method was massage (14.0%). It was determined that the mean total attitude score of the healthcare workers on complementary treatment and supportive care methods was 18.57 ± 5.12 (range: 8–40). It was found that the education levels of healthcare professionals (z= -2.144, p<0.05) and the institutions affect (χ2=23.417; p<0.05) the attitude scores.CONCLUSIONSOne out of every two healthcare professionals did not have information about complementary treatment and supportive care methods. Healthcare professionals mostly have positive opinions about these methods.

The characteristics and effectiveness of pregnancy yoga interventions: a systematic review and meta-analysis

BackgroundYoga is a popular mind-body medicine frequently recommended to pregnant women. Gaps remain in our understanding of the core components of effective pregnancy yoga programmes. This systematic review and meta-analysis examined the characteristics and effectiveness of pregnancy yoga interventions, incorporating the FITT (frequency, intensity, time/duration and type) principle of exercise prescription.MethodsNine electronic databases were searched: MEDLINE, PsycINFO, EMBASE, CINAHL, WHOLiS, AMED, ScieLo, ASSIA and Web of Science. Randomised control trials and quasi-experimental studies examining pregnancy yoga interventions were eligible. Covidence was used to screen titles, abstracts, and full-text articles. Outcomes of interest were stress, anxiety, depression, quality of life, labour duration, pain management in labour and mode of birth. The Cochrane Collaboration’s Risk of Bias Assessment tool was used to assess methodological quality of studies and GRADE criteria (GRADEpro) evaluated quality of the evidence. Meta-analysis was performed using RevMan 5.3.ResultsOf 862 citations retrieved, 31 studies met inclusion criteria. Twenty-nine studies with 2217 pregnant women were included for meta-analysis. Pregnancy yoga interventions reduced anxiety (SMD: -0.91; 95% CI: − 1.49 to − 0.33; p = 0.002), depression (SMD: -0.47; 95% CI: − 0.9 to − 0.04, P = 0.03) and perceived stress (SMD: -1.03; 95% CI: − 1.55 to − 0.52; p < 0.001). Yoga interventions also reduced duration of labour (MD = − 117.75; 95% CI − 153.80 to − 81.71, p < 0.001) and, increased odds of normal vaginal birth (OR 2.58; 95% CI 1.46–4.56, p < 0.001) and tolerance for pain. The quality of evidence (GRADE criteria) was low to very low for all outcomes. Twelve or more yoga sessions delivered weekly/bi-weekly had a statistically significant impact on mode of birth, while 12 or more yoga sessions of long duration (> 60 min) had a statistically significant impact on perceived stress.ConclusionThe evidence highlights positive effects of pregnancy yoga on anxiety, depression, perceived stress, mode of birth and duration of labour.Systematic review registration: PROSPERO, CRD42019119916. Registered on 11th January 2019.

Nonpharmacological labor pain management methods and risk of cesarean birth: A retrospective cohort study.

Nonpharmacological labor pain management methods (NPLPMM) are noninvasive, low-cost practices that may play a role in reducing the rates of unnecessary cesarean birth. We aimed to evaluate whether the NPLPMM is associated with the mode of birth. We conducted a retrospective cohort study with clinical records of all women admitted for birth from January 2013 to December 2017. Records of women who had spontaneous labor or received induction or augmentation of labor during hospitalization were eligible for the study. We estimated the risk ratios for cesarean birth in general linear models using the Poisson regression with adjustments for the following variables: age, ethnicity, schooling, parity, gestational age, previous cesarean birth, spontaneous labor before admission, or induction/augmentation of labor. Within the total of 3,391 medical records, 40.1% had the use of a nonpharmacological labor pain management method registered. Cesarean rate among the study population was 44.2%. The use of NPLPMM decreased the risk of cesarean birth by 78% (OR=0.22; 95% CI 0.19-0.26). History of a previous cesarean birth (RR=2.63; 95% CI 2.35-2.64), the lack of use of NPLPMM (RR=2.46; 95% CI 2.22-2.72), and primiparity (RR=2.09; 95% CI 1.86-2.34) were the strongest risk factors for cesarean birth in the cohort. The use of NPLPMM may be an effective strategy to reduce unnecessary cesarean birth. Further studies to identify the efficacy of each method may help health professionals to offer more appropriate methods at different stages of labor.

Postoperative Cesarean Pain Management and Opioid Use Disorder: Anticipate the Need for Higher Opioid Doses and Communicate Expectations With Patients and the Obstetric Team.

Peripartum care coordination for the obstetric patient on medications for opioid use disorder (OUD) can be challenging and is best accomplished by a multidisciplinary team. The benefits of buprenorphine, methadone, or naltrexone initiation or continuation in pregnancy are well established and beyond the scope of this commentary; instead, we narrow the focus on planning for sufficient pain management in labor and during recovery from cesarean delivery. Conversations about postoperative pain management should begin in the antepartum period, and likely do for the 15%-20% of individuals with a history of cesarean delivery who schedule a repeat cesarean. Nevertheless, 18%-20% of pregnant individuals deliver via primary cesarean delivery, underscoring the need for universal antepartum counseling on the possibility of undergoing and recovering from an unanticipated major abdominal surgery. The optimal intrapartum and postpartum pain regimen for individuals with OUD remains incompletely characterized as research on this topic is limited. Enhanced understanding of the unique needs of postpartum individuals with OUD will aid in closing knowledge gaps and elevate the standard of care in this population.

A Cross-Sectional Survey of Labor Pain Control and Women's Satisfaction.

Introduction: Pain experienced during labor is a symptom of contractile activity and is a physiological feature of the uterus that occurs at the appropriate stages of labor. For the majority of women, labor pain is the most severe pain they will ever experience, and therefore should be relieved. Objective: (1) To evaluate labor pain intensity before and after using non-pharmacological and pharmacological interventions; (2) to assess women’s satisfaction of labor pain management. Methods: A multicenter cross-sectional survey study was performed on 500 women who gave birth in different reference level hospitals (i.e., I, II, III). Pain intensity was assessed according the Numeric Rating Scale (range 0–10), whereas women’s satisfaction was measured with a 5 point Likert scale. Results: The use of both non-pharmacological (median 6.7 (5; 8) vs. 4.5 (3.3; 5.5)) and pharmacological methods (median 8 (7; 9) vs. 5 (3; 6)) resulted in a significant reduction in pain (p < 0.01). Water immersion and epidural anesthesia proved to be the most effective non-pharmacological and pharmacological methods, respectively. In hospitals of reference I, analgesic management was based primarily on the use of non-pharmacological techniques, less often mixed, i.e., non-pharmacological and pharmacological techniques (27.5%). On the other hand, in hospitals with higher referentiality, mixed methods were used more often (level II—65.8%; level III—81.2%). Pain intensity was significantly higher (p < 0.0001) in hospitals with reference level I (median 5 (4; 6)) than in the hospitals with reference level II (median 4.2 (3; 5)) or level III (median 4.2 (3.3; 5.4)). Epidural anesthesia was most often performed (60%) in the hospital of reference II. Women’s satisfaction (median 4 (3; 5)), inter alia, was associated with the effectiveness of applied methods. Conclusions: The study findings suggest that women giving birth in hospitals of higher referentiality have better control of labor pain due to access to pharmacological methods. Epidural anesthesia remains the gold standard for relieving labor pain. The choice of a specific method is determined by the degree of hospital and associated with the pain referentiality.

Survey on knowledge, attitude and practice of labor analgesia among health care providers at Debre Markos Comprehensive Specialized Hospital, Ethiopia 2021. A cross-sectional study

BackgroundChildbirth is among the most painful experiences a woman has during their childbearing years. Despite improvement in the development of standards for pain assessment and treatment, labor pain is mostly ignored especially in low and middle-income countries. ObjectivesTo assess the knowledge, attitude, and practice of labor analgesia among health care providers at Debre-Markos comprehensive specialized hospital, Ethiopia,. MethodsAfter ethical approval was obtained from the ethical review board, institutional-based cross-sectional study was conducted in June 2021, written consent was taken from each health care provider (HCP) before data collection, and structured self-administered questionnaires were used. The collected data were coded and analyzed using SPSS version 22. Descriptive statistics were computed to determine frequencies and percentages finally data were presented using texts, tables, and graphs.The study is registered with a research unique identifying number of 7407 found with the link address https://www.researchregistry.com/browse-the registry#home/?view_2_search = 7407&view_2_page = 1 and reported in line with STROCSS 2021. ResultsA total of 112 health care providers have participated with 70.5%, 29.5% being males and females respectively. This study was found that most gynecologists/obstetricians, 75% of general practitioners, and more than half (57.1%) of integrated emergency surgery and obstetrics (IESO) have good knowledge about labor analgesia, while the majority (58.3%) of midwives found to have poor knowledge. Although 75% of general practitioners and 71.4% of IESO have a good attitude towards obstetric and labor pain management, only 55.6% of midwives and 51.2% of graduating medical students were found to have a good attitude. Among health care providers (HCP), 60.3% of graduating medical students, 75% of general practitioners, 74.1% of IESO, and most of the seniors were found to have good practice of labor analgesia. ConclusionThere is a wide gap among health care providers in knowledge, attitude, and practice of labor analgesia. Training health care providers about safe, efficient, and affordable labor analgesia is crucial to improving health care.

Meta-Analysis: Are Acupressure and Birthing Ball Exercise Associated with Labor Pain?

Background: Management of pain in labor is identified as one of the most important topics related to pregnancy and childbirth. Acupressure and birthing ball exercise are one of the non-pharmacological methods of managing labor pain to help mothers cope with the labor process. This management can relieve pain sensations by increasing the woman's well-being, comfort, and sense of control in labor. This study aims to estimate the effect of acupressure and birthing ball exercise on labor pain. Subjects and Method: This was a systematic review and meta-analysis conducted using PRISMA flow diagrams. Search articles through journal databases including: PubMed, Science Direct, Google Schoolar and SpingerLink by selecting articles published in 2010-2021. The key­words used are (“labor pain” OR labor pain) “AND (“acupressure” OR “acupressure hegu”) AND (“birthing ball” OR “birthing ball exercise”) AND “randomized controlled trial”. Inclusion criteria were full paper articles with Randomized Controlled Trial (RCT) research methods, the size of the relation­ship used with Mean SD, the intervention given was acupressure and birthing ball exer­cise, research subjects were mothers in the first stage of active labor. Eligible articles were ana­lyzed using the Revman 5.3 application. Results: Meta-analysis of 16 articles showed results for acupressure (SMD -1.29; 95% CI= -2.35 to 0.24; p=0.02) and birthing ball exercise (SMD -0.73; 95% CI= -1.56 to 0.11; p=0.09). Conclusion: Acupressure and birthing ball exercise each have an effect on reducing labor pain.

Obstetric analgesia utilization in labor pain management and associated factors among obstetric care providers in the West Shewa Zone, Central Ethiopia

Objectives:Labor pain is the worst pain that almost every woman experiences during childbirth. Labor pain management plays a crucial role in promoting maternal-wellbeing, contributing enormously to maternal satisfaction with the childbirth experience and the high quality of services. Although there have been previous studies, they have primarily been conducted at referral or general hospitals located in urban settings. Thus, this study aimed to assess the utilization of labor pain analgesia and associated factors among obstetric care providers at all levels of health facilities in central Ethiopia.Methods:A multicenter institution-based cross-sectional study design was employed from 1 July to 30 September 2020. Simple random sampling using the lottery method was employed to select 399 obstetric care providers. The data were entered into Epi-data version 4.2 and analyzed using SPSS version 26. Bivariate and multivariable logistic regression analysis were used to identify the associated factors. The adjusted odds ratio with its 95% confidence interval and p value ⩽ 0.05 were used to identify associated factors.Results:The overall utilization of obstetric analgesia was 46% (95% confidence interval: 41.2%–50.8%). Being a Midwife (adjusted odds ratio: 2.10, 95% confidence interval: 1.27–3.47), having heard of the World Health Organization pain ladder (adjusted odds ratio: 2.95, 95% confidence interval: 1.73–5.01), having favorable attitude (adjusted odds ratio: 1.89, 95% confidence interval: 1.17–3.05), the expectation of obstetric care providers about labor pain (adjusted odds ratio: 3.26, 95% confidence interval: 1.27–8.36), having training on labor pain management (adjusted odds ratio: 2.51, 95% confidence interval: 1.03–6.07), and presence of chance for preference of obstetric analgesia for mothers in the facility (adjusted odds ratio = 2.30, 95% confidence interval: 1.33–3.98) were identified as factors significantly associated with the practice of obstetric analgesia among obstetric care providers.Conclusion:The overall use of labor pain management methods among obstetric care providers is low. Professional category, provider attitude, labor pain severity expectations, and having training were found to be factors associated with the use of obstetric analgesia. Therefore, working on adapting and disseminating the harmonized guideline and protocols on labor pain management and provision of training for obstetric care providers on labor pain management techniques were recommended.

Midwives' utilization of nonpharmacological pain relief measures for labor pain management: A descriptive cross-sectional study

Objectives: This study sought to examine midwives' utilization of nonpharmacological pain relief measures in labor pain management and to test the relationship between midwives' knowledge and utilization of nonpharmacological pain relief measures for labor pain management in secondary health facility in Calabar, Cross River State, Nigeria.Materials and Methods: A descriptive cross-sectional design was used for the study. The study was rooted in Katherine Kolcaba's Comfort theory. Totally, 67 participants were recruited for the study using the purposive sampling technique. A self-made structured questionnaire was used to obtain participants' information on knowledge, utilization, and predictors of nonpharmacological pain relief measures. Results: Although 41 (61.2%) of the participants had knowledge about nonpharmacological pain relief measures, few did not know some of the cognitive-behavioral and environmental measures in labor pain management. There was 35.8% (24/67) for utilization of cognitive-behavioral measures and 55.2% (37/67) for psychological/emotional measures for labor pain management by respondents, respectively. Fifty (74.6%) of respondents agreed that predictors such as lack of knowledge, lack of updates and training, work experience, best practice guidelines, and equipment were hindrances to utilization. There was statistically significance in relationship between the level of knowledge and utilization of nonpharmacological pain relief measures (r = 0.6, P < 0.05).Conclusion: The utilization of nonpharmacological measures for labor pain management is low, thus it is recommended that frequent education, training updates on effective labor pain management, provision of clinical guidelines on labor pain management, and enrichment of midwifery training curriculum are imperative to ensure quality labor pain management and positive health outcome.

The attitudes of obstetric caregivers towards labour pain relief methods and associated factors at public health centers of East Gojjam zone, Amhara Region, Ethiopia: Institutional based cross-sectional study.

Introductionlabour pain relief is a key factor for maternal satisfaction during childbirth. However, in developing countries, labour pain management is not a well-established service mainly due to negative attitudes of health care providers resulting in unmeasured suffering from childbirth for mothers. Thus, this study was aimed to assess attitude of obstetric caregiver towards labour pain management and associated factors at public health centers of East Gojjam zone.Methodsinstitutional-based cross-sectional study was conducted from March 1-30, 2018. Three hundred and nine sampled obstetric caregivers have participated, with a 96.8%(299) response rate. Data were collected with structured pretested questionnaires. Data were entered into Epi data 4.2 versions and bivariate and multivariate logistic regression was carried out using SPSS 23 versions with 95 % CI to determine the association between dependent and independent variables.Resultsout of the study participants, 128 (42.8%) had a negative attitude towards managing labour pain. Knowledge (AOR =3.785, 95 % CI: 2.251,6.365), training (AOR=2.923, 95% CI: 1.266, 6.749) and Companion (AOR=1.834, 95% CI: 1.055, 3.189) had significantly associated with attitude of obstetric caregiver towards labour pain relief methods.Conclusionthe result of this study showed that there is still a negative attitude towards labour pain management among obstetric caregivers in the study setting. Providing knowledge-based in-service training for obstetric caregivers to change their attitude towards labour pain relief methods is advisable.

Unmet Birth Expectations and Birth Trauma among Adolescents.

To assess and compare birth expectations of younger and older age adolescents and explore if unmet expectations predict psychological birth trauma (PBT). This secondary analysis expands findings of a previous study (N = 303) which classified adolescents' perceptions of birth into four main themes. The previous study used a mixed-methods approach providing data related to birth expectations. For the current study, expectations were determined by themes as met or unmet by three reviewers. Of 116 useable written narrations, responses of younger (ages 13-17) versus older (ages 18-19) adolescents were compared and explored for impact on PBT. Birth expectations for both age groups were more often unmet than met. Despite a smaller cohort, younger adolescents provided more remarks than older adolescents. There were no differences between groups on unmet birth expectations (p = .16). Unmet expectations most often related to pain with older adolescents more inclined to state poor pain management. Younger adolescents more often feared dying. Unmet expectations did not predict PBT. Comprehensive prenatal care can allow for early, open conversations to assess labor knowledge and misconceptions, fear of birth, existing supports, and overall birth expectations, with a premier focus on expected labor pain and pain management. Multiparous adolescents should receive prenatal assessments of posttraumatic stress (PTS) symptoms (a recognized predictor of posttraumatic stress syndrome) potentially originating from a previous traumatic birth. Following birth, symptoms of acute stress and PTS should be assessed of all adolescents, especially if experienced numerous unmet labor expectations.

A systematic review and meta-analysis of women's satisfaction with skilled delivery care and the associated factors in Ethiopia.

Evidence of variation in maternity health service practices has increased the government’s interest in quantifying and advancing the quality of institutional delivery care in the developing world, including Ethiopia. Therefore, we conducted a systematic review and meta-analysis to update and provide more representative data on women’s satisfaction with skilled delivery care and the associated factors in Ethiopia. This systematic review and meta-analysis followed the Preferred Reporting Items 2015 guideline. We searched PubMed/Medline, SCOPUS, Embase, Web of Science, and Google Scholar electronic databases for all 36 included studies. The pooled prevalence of women’s satisfaction with skilled delivery care and the associated factors were estimated using a random-effects model. Subgroup analysis and meta-regression were performed to identify the source of heterogeneity. Furthermore, publication bias was checked using eggers and funnel plots. All statistical analyses were performed using STATA version 14.0 software. The pooled prevalence of women’s satisfaction with skilled delivery care was 67.31 with 95% confidence interval (60.18–74.44). Wanted pregnancy (adjusted odds ratio = 2.86, 95% confidence interval: (2.24–3.64)), having a plan to deliver at a health facility (adjusted odds ratio = 2.09, 95% confidence interval: (1.42–3.09)), access to ambulance service (adjusted odds ratio = 1.52, 95% confidence interval: (1.00–2.31)), waiting time < 15 min (adjusted odds ratio = 3.66, 95% confidence interval: (2.51–5.33)), privacy assured (adjusted odds ratio = 3.94, 95% confidence interval: (2.23–6.94)), short duration of labour < 12 hr (adjusted odds ratio = 2.55, 95% confidence interval: (1.58–4.12)), proper labour pain management (adjusted odds ratio = 3.01, 95% confidence interval: (1.46–6.22)), and normal newborn outcome (adjusted odds ratio = 3.94, 95% confidence interval: (2.17–7.15)) were associated with women’s satisfaction. Almost two-thirds of women were satisfied with skilled delivery care. In comparison, the remaining one-third were not satisfied with the care. The quality of intrapartum care, unwanted pregnancy, lack of ambulance services, prolonged duration of labour, poor labour pain management, and complicated newborn outcome were factors affecting women’s satisfaction with skilled delivery care in Ethiopia. Therefore, strategies need to be developed to increase the satisfaction level by considering the abovementioned factors during routine delivery care.

Outcomes to measure the effects of pharmacological interventions for pain management for women during labour and birth: a review of systematic reviews and randomised trials.

Pharmacological pain management options can relieve women's pain during labour and birth. Trials of these interventions have used a wide variety of outcomes, complicating meaningful comparisons of their effects. To facilitate better assessment of the effectiveness of labour pain management in trials and meta-analyses, consensus about key outcomes and the development of a core outcome set is essential. To identify all outcomes used in studies of pharmacological pain management interventions during labour and birth. A review of systematic reviews and their included randomised controlled trials was undertaken. Cochrane CENTRAL was searched to identify all Cochrane systematic reviews describing pharmacological pain management options for labour and birth. Search terms included 'pain management', 'labour' and variants, with no limits on year of publication or language. Cochrane reviews and randomised controlled trials contained within these reviews were included, provided they compared a pharmacological intervention with other pain management options, placebo or no treatment. All outcomes reported by reviews or trials were extracted and tabulated, with frequencies of individual outcomes reported. Nine Cochrane reviews and 227 unique trials were included. In total, 146 unique outcomes were identified and categorised into maternal, fetal, neonatal, child, health service, provider's perspective or economic outcome domains. Outcomes of pharmacological pain management interventions during labour and birth vary widely between trials. The standardisation of trial outcomes would permit the assessment of meta-analyses for best clinical practice. Outcomes to measure pharmacological pain management options during labour are highly variable and require standardisation.

The factor structure of the childbirth self-efficacy inventory in a sample of Turkish pregnant women

ABSTRACT&#x0D; Aim: Childbirth self-efficacy is very important for the type and management of birth. Women with high self-efficacy prefer vaginal delivery, manage labor pain more easily, need fewer analgesic interventions, and experience fewer complications at birth. This study aimed to examine the factor structure of the Childbirth Self-Efficacy Inventory Short-Version (CBSEI-32) in Turkish pregnant women.&#x0D; Material and Method: This study was conducted in a methodological design. The sample of the study consisted of the pregnant women admitted to the obstetrics and gynecology outpatient clinic of Karaman State Hospital. The data were collected using the descriptive information form for the pregnant and the CBSEI. Numbers, percentages, arithmetic mean, factor analysis, and Cronbach’s alpha coefficient were used in the data analyses. &#x0D; Results: As a result of the exploratory factor analysis (EFA), items 6, 12, 13 and 16 in the OE sub-dimension were excluded because their factor load values were below 0.32. And the two-factor structure consisting of 28 items was obtained as the outcome expectancy (OE) and the self-efficacy expectancy (EE). Confirmatory factor analysis (CFA) was performed to obtain additional evidence of construct validity in line with the scores of the scale. It was determined that the fit indices calculated as a result of CFA without any modification were p=0.00, 2/SD; 2.43, GFI=0.90, AGFI=0.90, CFI=0.90, and RMSEA=0.06. The total Cronbach’s alpha reliability coefficient was 0.82. &#x0D; Conclusion: The study demonstrated that the Turkish version of the “Childbirth Self-Efficacy Inventory” is a valid and reliable tool to measure the childbirth self-efficacy of women during pregnancy.