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| BRIEF COMMUNICATION |
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| Year : 2012 | Volume
: 56
| Issue : 2 | Page : 195-198 |
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Awareness and attitudes towards labour pain and labour pain relief of urban women attending a private antenatal clinic in Chennai, India
Joyce Nilima James, Kunder Samuel Prakash, Manickam Ponniah
Department of Anaesthesiology, CMC Velore, Tamil Nadu, India
| Date of Web Publication | 17-May-2012 |
Correspondence Address:
Joyce Nilima James
Department of Anaesthesiology, CMC Vellore - 632 004, Tamil Nadu
India
DOI: 10.4103/0019-5049.96331
How to cite this article:
James JN, Prakash KS, Ponniah M. Awareness and attitudes towards labour pain and labour pain relief of urban women attending a private antenatal clinic in Chennai, India. Indian J Anaesth 2012;56:195-8 |
How to cite this URL:
James JN, Prakash KS, Ponniah M. Awareness and attitudes towards labour pain and labour pain relief of urban women attending a private antenatal clinic in Chennai, India. Indian J Anaesth [serial online] 2012 [cited 2013 May 22];56:195-8. Available from: http://www.ijaweb.org/text.asp?2012/56/2/195/96331 |
 Introduction | |  |
The awareness and attitudes towards labour pain and labour pain relief in antenatal women are not clearly known, particularly in developing countries. Childbirth, however fulfilling, is a painful experience for the majority of women. [1],[2] Various pharmacological and non-pharmacological methods of labour analgesia are available. This survey was carried out to assess the women's awareness and attitudes towards labor pain and labor pain relief.
| Methods | | |
The survey was conducted in the antenatal clinic of a 30-bedded private hospital in Chennai, India. After institutional approval and informed consent, the prepared questionnaire was handed to the women to be filled up while waiting for the antenatal check-up. Two hundred questionnaires were handed out, 109 were returned and 100 had answered most of the questions.
| Results | | |
The demographic data are presented in [Table 1]. The median age was 27.39 years. Almost all of the women (98/100) were educated (completed a minimum of study up to class 10 or more). Half of the women were home makers (56/100, 56%). Most of the women were primiparous (63/100, 63%).
The primiparous women were assessed for their expectations about labour pain. Forty-one (41/63, 65.08%) expected to experience some degree of pain during labour [Table 2]. | Table 2: Awareness of nature of labour pain and attitude
towards labour pain
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Fifty-one women (51/100, 51%) felt that labour pain should be relieved [Table 2]. Reasons to opt for pain relief were: To relieve pain (n=7), to relieve stress (n=5), to feel confident (n=2), to enjoy the experience (n=3) and better assessment of the baby (n=1).
Some (24/100, 24%) felt that labour pain should not be relieved and a few of them gave the following reasons: It is a natural process (n=7), to be able to push the baby (n=2), no pain no gain (n=3) and it may lead to some other problem (n=1). The rest (25/100, 25%) had no opinion on whether labour pain should be relieved.
Only 23% of the women (23/100) planned to ask for pain relief during the forthcoming delivery. Thirty-six percent of the women (36/100) did not intend to use any labour pain relief and 10% (10/100) wanted to have more information before they made a decision.
Most of the women (78/100, 78%) had heard about methods to relieve labour pain mainly through the media and through their doctor [Table 3], but the majority (65/78, 83.33%) had no idea which method is useful. The rest (13/78, 16.67%) chose epidural injection, breathing exercises, injections, entonox and music therapy as useful methods.
Thirty-six women (36/78, 46.15%) had concerns relating to the relief of labour pain. Their concerns were baby related (20/36, 55.56%) (baby may be affected, mother-baby bonding may be affected), labour related (n=14/36, 38.89%) (contractions may be unnatural, inability to push or use lower body parts, may lead to caesarean section or instrument use, labour may be unnatural) and/or pain relief method related (n=23/36,63.89%) (method may not work, back ache).
| Discussion | | |
Two-thirds of the primiparas were aware that labour is painful. Uterine contractions, cervical dilatation and stretching of the lower uterine segment are responsible for pain during the first stage of labour. Visceral afferent C-type fibres accompanying the sympathetic nerves carry the pain impulses and enter the spinal cord at the T 10 -L 1 levels. In the second stage of labour, somatic afferent fibres from the vagina and perineum convey pain impulses in the pudendal nerves to the S 2 -S 4 spinal nerve roots. [1],[2]
Half the participants were in favour of labour pain being relieved but very few (18/51, 35.29%) could guess the beneficial effects of relieving pain and stress. This lack of knowledge is further confirmed by the poor response for plans to use labour analgesia (23/100, 23%). Labour pain results in the stimulation of the sympathetic nervous system leading to maternal hypertension and reduced uteroplacental blood flow. During labour, the woman may also hyperventilate, leading to leftward shift of the maternal oxygen-haemoglobin dissociation curve and a consequential reduction in the foetal arterial oxygen tension. Relief of pain and anxiety during labour may benefit the mother and foetus by decreasing maternal hyperventilation and catecholamine secretion. [2]
The women in our survey are better informed than antenatal women in Nairobi, South Africa and Nigeria that labour pain can be relieved. However, their level of knowledge is similarly low. [3],[4],[5],[6] There are many methods to relieve labour pain. The pharmacological methods known are parenteral opioids, epidural analgesia, nitrous oxide and paracervical block. [1],[7] Some of the non-pharmacological methods are breathing exercises, transcutaneous electrical nerve stimulation, sterile water injections, acupressure, acupuncture, hydrotherapy, immersion bath, audio-analgesia, aromatherapy, hypnosis, labour support, massage and relaxation. [8],[9] The ideal labour pain relief method must be safe and effective, and should not interfere with labour or the mobility of the parturient. [1]
Only 36 women had any such concerns.
Our survey had only 100 participants and did not study the effect of religion, age, parity or education on the awareness and attitudes to labour pain and labour pain relief.
There are no Indian studies to determine these issues. Further studies are necessary to ascertain and compare awareness and attitudes towards labour pain and labour pain relief in rural areas as opposed to urban areas, as also among men and non-pregnant women. The timing, best method and benefits of educating the antenatal woman also need to be determined in the Indian context. [4],[10],[11] Clinical studies may also be required to determine the most cost-effective method. Based on the information gained, necessary changes may be made in patient care and health policy.
| Conclusion | | |
This descriptive study revealed that there is sufficient awareness that labour is painful and that there are ways to relieve labour pain. However, there is a lack of knowledge regarding the need for pain relief during labour, the various types of labour pain relief methods and their advantages and disadvantages.
Antenatal women should be educated about the need for labour pain relief and the available options. This may be done at an appropriate time during the antenatal visits by the obstetrician or Anaesthetist. The pregnant women's knowledge may also be improved by the provision of information leaflets, labour pain websites and childbirth preparation classes.
| References | | |
| 1. | Findley I, Chamberlain G. ABC of labor care. Relief of pain. BMJ 1999;318:927-30. 
[PUBMED] [FULLTEXT] |
| 2. | Ferne RB, Barbara MS, Cynthia AW, Alan CS. Obstetrical Anesthesia. In: Paul GB (editor). Clinical Anesthesia, 6 th ed. New Delhi: Wolters Kluwer (India) Pvt. Ltd; 2009. p. 1142-5.
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| 3. | Mung'ayi V, Nekyon D, Karuga R. Knowledge, attitude and use of labour pain relief methods among women attending antenatal clinic in Nairobi. East Afr Med J 2008;85:438-41.
[PUBMED] |
| 4. | Mugambe JM, Nel M, Hiemstra LA, Steinberg WJ. Knowledge and attitude toward pain relief during labour of women attending the antenatal clinic of Cecilia Makiwane Hospital, South Africa. SA Fam Pract 2007;49:16-24.
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| 5. | Ibach F, Dyer RA, Fawcus S, Dyer SJ. Knowledge and expectations of labour among primigravid women in the public health sector. S Afr Med J 2007;97:461-4.
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| 6. | Olayemi O, Aimakhu CO, Udoh ES. Attitudes of patients to obstetric analgesia at the University College Hospital, Ibadan, Nigeria. J Obstet Gynaecol 2003;23:38-40.
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| 7. | Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: Part II. Pharmacologic pain relief. Am Fam Physician 2003;68:1115-20.
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| 8. | Brown ST, Douglas C, Flood LP. Women's evaluation of intrapartum nonpharmacological pain relief methods used during labor. J Perinat Educ 2001;10:1-8.
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| 9. | Tournaire M, Theau-Yonneau A. Complementary and Alternative Approaches to Pain Relief During Labor. Evid Based Complement Alternat Med 2007;4:409-17.
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| 10. | Raynes-Greenow CH, Roberts CL, McCaffery K, Clarke J. Knowledge and decision-making for labour analgesia of Australian primiparous women. Midwifery 2007;23:139-45.
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| 11. | Stewart A, Sodhi V, Harper N, Yentis SM. Assessment of the effect upon maternal knowledge of an information leaflet about pain relief in labour. Anaesthesia 2003;58:1015-19.
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[Table 1], [Table 2], [Table 3]
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