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      A survey of healthcare providers’ knowledge and attitudes regarding pain relief in labor for women in Ethiopia

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          Abstract

          Background

          To explore healthcare providers’ knowledge and attitudes to the need for pain relief for women in labor.

          Methods

          A structured questionnaire ( n = 200) distributed to healthcare providers working in the obstetric departments, including theatres, of three public hospitals in different settings (rural, peri-urban and urban) in Ethiopia. Descriptive analysis was performed using Excel 2013 and SPSS version 22 for associations.

          Results

          The response rate was 81.5% with 164 questionnaires completed. The majority, 79% of respondents, understood that women can feel moderate to severe pain in labor and 77% were of the opinion that labor pain should be relieved. However, common practices included only supportive measures such as breathing and relaxation exercises, back massage and support from family. The general attitude of healthcare providers is that labor is a natural process, women should be able to cope and that pain relief is not a priority for women in labor. More than half, 52% of healthcare providers had safety concerns with using pharmacological methods to relieve pain in labor.

          Conclusion

          The majority of healthcare providers understand that women suffer significant pain during labor. However, providing effective pain relief is currently not provided as part of routine intra-partum care in Ethiopia.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12884-017-1237-4) contains supplementary material, which is available to authorized users.

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          Most cited references13

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          Pain and women's satisfaction with the experience of childbirth: a systematic review.

          To summarize what is known about satisfaction with childbirth, with particular attention to the roles of pain and pain relief. A systematic review of 137 reports of factors influencing women's evaluations of their childbirth experiences. The reports included descriptive studies, randomized controlled trials, and systematic reviews of intrapartum interventions. Results were summarized qualitatively. Four factors-personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making-appear to be so important that they override the influences of age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care, when women evaluate their childbirth experiences. The influences of pain, pain relief, and intrapartum medical interventions on subsequent satisfaction are neither as obvious, as direct, nor as powerful as the influences of the attitudes and behaviors of the caregivers.
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            Why do women not deliver in health facilities: a qualitative study of the community perspectives in south central Ethiopia?

            Background In Ethiopia most childbirth occurs at home and is not assisted by skilled birth attendants. On the other hand having a birth attendant with midwifery skills during child birth is one of the most important interventions in reducing maternal morbidity and mortality. The objective of this study was to make an in-depth assessment of reasons why mothers do not use health facilities for child delivery. Methods Focus Group Discussions were used to gather information on use of health facilities for delivery in Butajira districts of South Central Ethiopia. The study was conducted from January to February 2012. Information was collected from four groups of women who had delivered in the past two years and four groups of men whose wives/partners have delivered in the same period. Data was coded and categorized using open code, qualitative data management software and analyzed based on thematic analysis. Results A total of eight FGD sessions, four with women and four with men groups were conducted involving 81 residents of the Butajira district. FGD participants answered that a large majority of women in the district gave birth at home. Two major themes, client related factors and facility/staff factors, emerged. Factors that emerged within major themes of client factors were decision making on place of delivery, reliance on Traditional Birth Attendants (TBAs), misconception about services provided at health facility, inability of family members to be present at time of labor and delivery, lack of privacy, traditional and/or spiritual factors, economic factors and accessibility to health care facilities. Within major themes of facility/staff factors subthemes that emerged were poor reception, refusal of admission, lack of privacy, information gap, poor competence and shortage of staff and materials at health facilities. Conclusion Women in the study areas do not deliver in health facilities because of reasons that can be attributed to health care system and client related factors. These need to be addressed by considering the specific factors related to the health system and community perspectives.
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              World Health Statistics 2015

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                Author and article information

                Contributors
                Mary.McCauley@lstmed.ac.uk
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                1471-2393
                7 February 2017
                7 February 2017
                2017
                : 17
                : 56
                Affiliations
                [1 ]ISNI 0000 0004 1936 9764, GRID grid.48004.38, , Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, ; Pembroke Place, Liverpool, L3 5QA UK
                [2 ]Department of Anaesthetics, Yekatit 12 Hospital, Addis Ababa, Ethiopia
                [3 ]Department of Obstetrics, Yekatit 12 Hospital, Addis Ababa, Ethiopia
                Article
                1237
                10.1186/s12884-017-1237-4
                5295213
                28173771
                52a0e821-9bf4-4d17-9bf0-218b7e031cef
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 September 2015
                : 27 January 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Obstetrics & Gynecology
                pain relief,labor,healthcare providers,awareness,ethiopia
                Obstetrics & Gynecology
                pain relief, labor, healthcare providers, awareness, ethiopia

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