Labour analgesia and the perceived barriers to its provision amongst maternal healthcare providers at Moi Teaching and Referral Hospital.

Abstract

Background: A majority of women experience moderate to severe pain during labour that eventually affects the parturient, and fetus. Maternal health care providers have an extensive role to play in meeting the analgesic needs of women during childbirth. Although pain relief is a key component of modern obstetric care, it remains a poorly established service in sub-Saharan countries such as Kenya. Objectives:To assess the practice of labour pain management and its related barriers among maternal health care providers working at Moi Teaching and Referral Hospital (MTRH). Methods and materials: This was an institution-based, cross-sectional descriptive survey conducted from 1st January to 31st March 2021. A structured, self-administered, questionnaire was completed by 117 maternal health care providers (obstetricians, anesthesiologists, and midwives) within MTRH. The outcome of interest was the self-reported past practice of provision of any analgesia to a woman in labour. Data were analyzed using IBM SPSS software package version 23.0. Qualitative data were described using numbers and percentages. Descriptive analysis was done, and logistic regression analyses were applied to identify the association between dependent (provision of labour analgesia) and independent variables (healthcare provider factors and health system factors). The odds ratio and 95% confidence interval were computed to determine the strength of association. Results: One hundred and seventeen (117/120) maternal healthcare providers participated in the study representing a response rate of 97.5%.Of the respondents, 61.5% reported providing labour analgesia routinely. Among those reporting routine provision of labour analgesia, 12.5% reported providing opioids, 20.8% reported providing non-opioids, 5.6% reported providing regional methods, and 88.9% reported providing non-pharmacological methods respectively. More than half of the respondents (53%) had poor knowledge of labour analgesia. Almost all (94%) of the respondents reported 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. Other reasons for reported non-provision of labour analgesia included providers‟ concerns about foetal distress (55%) and adverse maternal effects (49%). On multivariate logistic regression analysis, practitioners with more than 10 years of practice (AOR: 9.85, 95% CI 1.52, 1.96) were almost ten times (9.82) more likely to report routine provision of labour analgesia. Conclusions: The proportion of maternal health care providers at MTRH reporting routine provision of labour analgesia was above average at 61.5%. Generally, the maternal healthcare providers had poor knowledge of labour analgesia. Practitioners with more than 10 years of practice were 10 times more likely to report routine provision of labour analgesia. Non-availability of drugs and equipment and lack of clear protocols and guidelines were the main health system factors hindering the provision of labour analgesia at MTRH. Recommendations: There is a need for continuous professional training of maternal healthcare providers on labour analgesia. National and institutional labour pain management protocols should be developed and interdisciplinary collaboration and mentorship encouraged to meet the analgesia needs of women during childbirth.