Provision of labour analgesia and its related barriers among maternal health care providers in Kenya: An institution-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. This study sought to examine the practice of labour pain relief and its deterrents among Kenyan maternal health care providers. Methods: This was an institution based, cross-sectional, descriptive survey. The study population included midwives, obstetricians, and anaesthesiologists working at the second largest tertiary facility in Kenya. A structured, self- administered questionnaire was used. The patterns of analgesic provision during labour, knowledge, attitude, and perceived barriers to labour pain management were described. Results: One hundred and seventeen respondents participated in the study, with a response rate of 97.5%. The prevalence of routine labour analgesia provision was 61.5%. The most common pharmacological method prescribed was non-opioids (13.4 %). Regional analgesia was provided by 4 (3.6%) of the respondents. Sex, cadre, and years of experience were significantly associated with the routine provision of labour analgesia. The 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. The 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 hindered the provision of labour analgesia. Conclusions: More than half of maternal health care providers routinely relieved labour pain. Epidural analgesia is still relatively underutilized. There is a need for the development of institutional labour pain management protocols, to meet the analgesic needs of women during childbirth.