Non-pharmacological labor pain relive methods: utilization and associated factors among midwives and maternity nurses in Najran, Saudi Arabia

BACKGROUND

Traditionally, pharmacological pain relief methods have been the most acceptable option for controlling labor pain, accompanied by numerous adverse consequences. Non-pharmacological labor pain relive methods can reduce labor pain while maintaining an effective and satisfying delivery experience and delaying the use of pharmacological methods. This study explores the utilization of non-pharmacological labor pain relive methods and its associated factors among midwives and maternity nurses.

METHODS

A cross-sectional research was conducted in Maternal and Children Hospital/Najran, Saudi Arabia, from April to May 2023 and incorporated a convenience sample of 164 midwives and maternity nurses. The data was collected using a self-reported questionnaire composed of five sections; basic data, facility-related factors, non-pharmacological labor pain relive utilization and attitude scales, and knowledge quiz. A logistic regression was used to determine the associated factors with non-pharmacological labor pain relive utilization.

RESULTS

The results revealed that 68.3% of participants utilized non-pharmacological labor pain relive methods. The midwives and maternity nurses helped the parturient to tolerate labor pain by applying the non-pharmacological labor pain relive methods, including; positioning (55.5%), breathing exercises (53.7%), comfortable and relaxing environment (52.4%), therapeutic communication (47%), positive reinforcement (40.9%), relaxation (40.2%), and therapeutic touch (31%). In addition, working unit, providers-patient ratio, working hours, non-pharmacological labor pain relive training, years of experience, and non-pharmacological labor pain relive attitude were significant determinants of non-pharmacological labor pain relive utilization (P < 0.05).

CONCLUSIONS

High non-pharmacological labor pain relive utilization was significantly associated with nurses' older age and higher education, working in the delivery room, lower nurse-patient ratio, lower working hours, in-services training, increased years of experience, and positive attitude. The study sheds light on the importance of handling the pre-mentioned factors to enhance non-pharmacological labor pain relive utilization.

Determining the effect of inhalation and lavender essential oil massage therapy on the severity of perceived labor pain in primiparous women: A randomized controlled trial

BACKGROUND

This research aimed to reveal the effect of lavender essence inhalation and the massage therapy applied with lavender oil on the severity of labor pain of primiparous women.

METHODS

This randomized controlled trial was conducted with three groups. Pregnant women participating in the study were randomly divided into control group (n=40), lavender essence inhalation group (n=44) and lavender essence massage (n=37) groups. The applications were divided in three for each phase in the first stage of labor (early, active and transition). Thereafter sacral compression and circular massage were applied for 15 minutes on the lower back (waist) region of the participants by using 2 drops of lavender oil in each phase of labor; 2 drops of lavender oil were dripped onto the palms of the participants in the inhalation group by the researcher and they were asked to inhale it for 3 minutes. Research data were collected using Personal Information Form (PIF), Visual Analogue Scale (VAS) and Postpartum Assessment of Women Survey (PAWS).

RESULTS

The results of the research revealed that the labor pain perceived by the women who were applied inhalation and massage therapy using lavender essential oil were milder compared to the control group (p<0.05). Another finding of the research revealed that the lavender oil inhalation gave the best results in the latent phase, however the massage therapy with lavender oil was more effective in the active and transition phases.

CONCLUSION

Inhalation and massage therapy applied using lavender essential oil contributed to the alleviation of perceived labor pain. For this reason, massage therapy and inhalation applications using lavender oil are recommended to be applied by midwives as a complementary method to adapt to labor pain during delivery.

Use of non-pharmacological methods in managing labour pain: experiences of nurse-midwives in two selected district hospitals in eastern Tanzania

Background

Labour pain usually brings with it many concerns for a parturient and her family. The majority of the women in labour pain may require some sort of pain relief method during this period, be it pharmacological or non-pharmacological. In Tanzania, the use of non-pharmacological methods to relief labour pain remains low among nurse-midwives. We analysed the experiences of nurse-midwives in the use of non-pharmacological methods to manage labour pain, in two selected districts of Pwani and Dar es Salaam regions in eastern Tanzania. This paper describes Non-pharmacological Methods (NPMs) currently used by nurse-midwives, the facilitators, myths and fears related to the use of NPMs.

Materials and Methods

An exploratory qualitative study using in-depth interviews was conducted with 18 purposively recruited nurse-midwives working in labour wards in two selected district hospitals in Pwani and Dar es Salaam regions in eastern Tanzania. Qualitative conventional content analysis was used to generate categories describing the experience of using non-pharmacological methods in managing labour pain.

Results

This study revealed that nurse-midwives encouraged women to tolerate labour pain and instructed them to change positions and to do deep breathing exercises as a means to relief labour pain. Nurse-midwives’ inner motives facilitated the use of non-pharmacological strategies for labour pain relief despite the fear of using them and myths that labour pain is necessary for childbirth.

Conclusion

This study generates information about the use of non-pharmacological strategies to relief labour pain. Although nurse-midwives are motivated to apply various non-pharmacological strategies to relief labour pain, fear and misconceptions about the necessity of labour pain during childbirth prohibit the effective use of these strategies. Therefore, together with capacity building the nurse-midwives in the use of non-pharmacological strategies to relief labour pain, efforts should be made to address the misconceptions that may partly be of socio-cultural origin.

Nurses' perceptions of infants' procedural pain assessment and alleviation with non-pharmacological methods in Estonia

PURPOSE

The purpose of this study was to describe nurses perceptions of infants' procedural pain assessment and alleviation with non-pharmacological methods including parental guidance in departments of neonatal and infant medicine and Neonatal Intensive Care (NICUs).

DESIGN AND METHODS

A descriptive cross-sectional survey was carried out among all nurses (n= 149) who were working in neonatal and infant departments or NICUs in Estonian hospitals. Altogether, 128 questionnaires were returned and 111 respondents were eligible (75% response rate). The data were analysed using statistical methods.

RESULTS

More than half of the nurses agreed that systematic documentation of the measurement of pain is necessary for nursing care and that it affects pain alleviation in infants. Half of the respondents (51%) confirmed that pain scales are important in the measurement of infants' pain, but 58% claimed they were able to assess pain in a reliable way without using pain assessment scales. Nurses also reported that they were unfamiliar with most pain scales and they were not routinely used in everyday practice. Nurses said that the most useful non-pharmacological pain alleviation methods were touching (83%) and positioning infants (78%), the most rarely used were skin-to-skin care (12%) and encouraging mothers to breastfeed the infant (34%). The majority of respondents (79%) reported that they do not know or do not have written instructions on pain assessment in their workplace, and only a few (10%) reported that they have participated in pain management courses during the last year.

CONCLUSIONS

There is a need to increase the use of pain assessment scales and pain documentation in everyday practice in those hospitals in Estonia. The use of scales in pain assessment was valued by few nurses. It seems that there is a lack of knowledge on non-pharmacological methods, and nurses reported using only a few non-pharmacological pain alleviation methods and guided parents on using them.

PRACTICE IMPLICATIONS

Nurses need pain management guidelines for everyday work, and in addition to nurses, written guidelines for parents are needed.

Acute postoperative pain following hospital discharge after total knee arthroplasty

OBJECTIVE

The increasingly shorter hospitalization following total knee arthroplasty (TKA) requires patients to assume earlier responsibility to self-manage their pain. Poorly managed acute pain increases the risk of persistent pain, reduces quality of life and increases unnecessary healthcare utilization. This study aims to examine post-discharge pain intensity, pain management behaviors and potential barriers to optimal self-management of pain.

DESIGN

We administered a questionnaire at 2 weeks after discharge to 174 patients undergoing TKA in 10 Australian hospitals. Participants rated pain expectation and severity, use of analgesics and non-pharmacological methods, side-effects, walking and exercise times, perceptions of analgesics, adequacy of pain management information provided and satisfaction with pain relief.

RESULTS

Of 171 (98%) participants who completed the questionnaire, 88 (52%) reported that the worst pain period occurred during the first 2 weeks at home. During the first 2 weeks at home, the average pain was 'severe/extreme' for 40 (23%) participants and 92 (54%) experienced severe pain at least some of the time. Many participants sought further medical help for their pain. Adequate information on analgesics and non-pharmacological methods for pain relief were reported by only 73% and 47%, respectively. Approximately 20% had negative perceptions about analgesic use. Higher pain severity was associated with lower satisfaction and less time spent walking daily.

CONCLUSIONS

Effective pain relief after hospital discharge following TKA is a challenge. Many participants reported significant pain, sought further medical help for pain relief and had inadequate information at discharge to effectively self-manage their postoperative knee pain.