Provision of labour analgesia and its related barriers among maternal healthcare providers in Kenya: an institutional-based descriptive survey.

Abstract

Background: Although pain relief is a key component of modern obstetric care, it remains a poorly established service in sub-Saharan countries such as Kenya. Maternal health care providers have an extensive role to play in meeting the analgesic needs of women during childbirth. The study sought to examine the practice of labour pain relief and its deterrents among Kenyan maternal health care providers. Methods: This was an institutional based, cross-sectional descriptive survey. The study population included midwives, obstetricians and anaesthesiologists working at the second largest referral hospital in Kenya. A structured, self-admininisterd questionnaire was used. The pattern of provision of labour analgesics, knowledge, attitude and perceived barriers to labour pain management was described. Results: One hundred and seventeen respondents participated in the study with a response rate of 97.5%. The prevalence of routine labor analgesia provision was 61.5%. The commonest pharmacological method prescribed was nonopioids (13.4 %). Regional analgesia was provided by 4(3.6%) of the respondents. Majority of maternal healthcare providers (53.0%) had poor knowledge of labour pain management. Almost all (93.9%) of the respondents had a positive attitude towards the provision of labour analgesia. Non-availability of drugs and equipment (58.1%), lack of clear protocols and guidelines (56.4%) and absence of adequate skilled personnel (55.6%) were reported as the health system factors that hinder the provision of labour analgesia. Conclusions: More than half of maternal health care providers routinely relieve labour pain; gender, cadre, and years of experience are significantly associated with routine provision of labour analgesia. Epidural analgesia is still quite underutilized. There is a need for development of institutional labour pain management protocols to meet the analgesic needs of women during childbirth.