“We know it’s labour pain, so we don’t do anything”: Healthcare providers’ knowledge and attitudes regarding the provision of pain relief during labour and after childbirth

News article 15 Nov 2018

Most women experience pain during labour and after childbirth. Healthcare providers have a duty of care to support women and improve quality of care during this time, and there are various options to help women cope with and relieve pain. However, in low resource settings, women often do not have access to effective pain relief.

A Masters student at LSTM and academics from the Centre for Maternal and Newborn Health (CMNH) have conducted a study to investigate the knowledge and attitudes of healthcare providers regarding the provision of pain relief options in a hospital in Moshi, Tanzania. They held 24 semi-structured interviews and 2 focus group discussions with healthcare providers including doctors, anaesthetists, midwives and nurse-midwives. The research has been published in BMC Pregnancy and Childbirth: “We know it’s labour pain, so we don’t do anything”: healthcare provider’s knowledge and attitudes regarding the provision of pain relief during labour and after childbirth

Most healthcare providers in the study reported that they are aware of various approaches to pain management and are open to helping women and improving quality of pain management, using an approach that respects women’s culture and beliefs. Enabling factors to the provision of pain relief included a desire to help and the availability of pharmacological pain relief for women who have had a Caesarean section. For example, one interviewee commented: “If there are pain relief drugs to give the mothers, let it come and be provided to the mothers so that they deliver peacefully. I could see that it's better and good, and it will be helpful to the mother.”

However, half of all healthcare providers interviewed considered labour pain as ‘natural’ and necessary for birth and therefore do not routinely provide pain relief. Additional challenges to women receiving pain relief included shortage of staff, lack of equipment, no access to nitrous oxide or epidural medication, and fears regarding the effect of opiates on the woman and/or baby. For example, one of the interviewees commented: “There is a belief that this pain, we need to know how much pain this patient is experiencing at least at the beginning of the labour to be able to assess and evaluate the progress of labour.”

The interviewees suggested a number of solutions to increase evidence-based pain management. These included creating an enabling environment, providing education, improving the use of available methods (both pharmacological and non-pharmacological), emphasising the use of context-specific protocols and future research to understand how best to provide care that meets women’s needs.

Miss Valentina Actis Danna, co-author and MSc graduate from CMNH:
“By undertaking a MSc in International Public Health/Sexual and Reproductive Stream at LSTM, I had the opportunity to conduct this research in Tanzania. In conducting the interviews, I was touched by the humbleness of healthcare providers who do try to help women to suffer less, but who are concerned that there are not the available resources, and sometime fear that medication can harm the women and/or the baby.

As young researcher, I appreciated the opportunity to collaborate with the academics at the CMNH, being at the frontline in promoting better health for women and newborn in low resource settings and I greatly valued the interdisciplinary knowledge sharing occurred during the Masters programme and in developing this publication."

Dr Mary McCauley, Academic Clinical Lecturer at CMNH: “I am delighted that Valentina’s research project has been published, highlighting that women need access to effective pain relief for better quality of care and to ensure a more positive experience for women in low resource settings during labour and after childbirth.”

Find out more about the Sexual and Reproductive Health stream of the Masters in Public Health here.