Socio-demographic characteristics of participants
The puerperal women (11.8%) were under the ages of 20 years as the majority of the women were unemployed (52.9%) as depicted in Table 1. On the level of education, the majority (52.9%) had attained secondary school level while 58.8% of the women were married. The puerperal women (88.2%) were Christians and Ewe ((94.1%) by ethnicity. The women (64.71%) had two pregnancies and five pregnancies (5.9%). All the women had their deliveries in the hospital.
Table 1
Socio-demographic and birth history of puerperal women
Variables
|
Responses
|
Frequency
|
Percentages
|
Age
|
Less than 20
|
2
|
11.8
|
20–29
|
12
|
70.6
|
30–39
|
3
|
17.6
|
Employment status
|
Unemployed
|
9
|
52.9
|
Civil/government work
|
1
|
5.9
|
Self/privately employed
|
7
|
41.2
|
Level of education
|
Uneducated
|
1
|
5.9
|
Basic
|
6
|
35.3
|
Secondary
|
9
|
52.9
|
Tertiary
|
1
|
5.9
|
Marital Status
|
Single
|
10
|
58.8
|
Married
|
7
|
41.9
|
Number of Pregnancies
|
One
|
3
|
17.7
|
Two
|
11
|
64.7
|
Three
|
2
|
11.8
|
Five
|
1
|
5.9
|
Puerperal women’s perception of severity of labour pains
The researchers ask participants to rate the severity of labour pains they experience in the last delivery. The majority (41.2%) of the women expressed their labour pain as very severe pain. This was followed by women (35.3%) who expressed their labour pain as severe pain and 23.5% expressed moderate pain. The very severe labour pain was rated to be unbearable, severe was too painful, but bearable while moderate pain was compared to the pain the participant had experienced.
“It is one of the most severe forms of pain one can ever experience. This pain was actually unbearable. I think it is the worst type of pain ever to be experienced by anybody. There is no amount of pain that can be used to compare to the severity of this type of pain during labour. It is so piercing” (Participant C)
“The pain was so severe and unbearable; I did not know what to but to only bear...” (Participant E)
“...good thing about the pain is that it comes and goes, so you will find some relief, but when the pain is on, there is nothing to be compared to. It is so severe and generally can only be said to be unbearable and the severest form of pain.” (Participant N)
The study also revealed that the majority (58.8%) of the women indicated their labour pain lasted less than 12 hours. The actual period that the pain commenced till labour was complete varied from each woman.
“The pain became severe in the morning and by the evening I had given birth. But in the peak of the pain, nothing could be comparable” (Participant M)
“For the pain it lasts the entire duration of the labour, because the pain goes and comes. But I can say that the pain lasted the whole day” (Participant A)
“For me, contrary to what other women say and experience, I had the labour start like 1 pm and by 10 pm I had put to birth. But for the pain it was so so so severe” (Participant F)
Means puerperal women expressed labour pains
Labouring women used various strategies in managing severe labour pains. This strategy ranges from making noise to adopting comfortable body positioning and snapping of figures. The women expressed their labour pain by shouting and walking around (47.1%), crying and screaming (35.3%) and staying calm and snapping their fingers (17.6%). This way of expressing the pain was described by the women as self-comforting.
“I can’t remember, but I am told I was shouting and calling my husband, I think doing this actually helped me to endure the pain. Honestly, it was really a painful experience” (Participant D)
“I was so restless and had to walk from one place to another. I just walked around the labour wards, especially when the pain became severe. I think the walking around the facility actually helped me to adjust better. It made me feel the labour less compared to my previous labours. (Participant H)
“There is nothing to be done to alleviate the pain. I walked and sometimes I scout by the labour bed. I was just restless. I went to the washroom many times hoping for relief. In fact, I think I did everything as long as the pain was that much severe” (Participant G)
Perception of midwives’ attitude towards pain management during labour
The puerperal women had varied ratings for the attitude of the midwives during labour and their general predilection towards effective pain management. Furthermore, on the aspect of the women’s perception of the midwife's attitude, most of the women indicated they were satisfied (52.9%), very satisfied (23.5%) of the midwives' attitude towards pain management. Others indicated the attitude of the midwives were poor (5.9%) and very poor (11.8%). Women gave praise to the positive attitude of midwives during their labouring process. The attitude of the midwife generally related to her empathy and desire to institute measures that can alleviate labour pain. Midwives that remained focused on this curse were described as having a satisfactory attitude and those who did not express a desire to help were described as having a poor attitude or low satisfaction.
“I must say, contrary to my prejudice about midwives’ attitude in the labour ward, the one who attend to me was so caring, sometimes when I remember some of the questions, I asked her, yet she had the patience to respond, I must say that she was a God sent” (Participant B)
“The midwife that attended to me in this last pregnancy was an angel. She explained to me so well what to expect, she supported me when I needed it most and also allowed my husband to stay with me in the larger part of the labour period, I honestly feel very cared for” (Participant K)
However, some of the women had a contrary view of the attitude of the midwives that attended to them during their last labour process. As they indicate they were not satisfied with the attending midwives’ attitude, participants tried to ascribe reasons for such behaviours.
“The least talked of the midwife the better. I think that day she was so overwhelmed with the number of women in labour. We were four women under her care and she was ‘kind of confused’. Even If you called her, she spent so much time before she came to one’s attention. I don’t hope to have such an experience again. For me this last labouring experience was actually a nightmare” (Participant Q)
“I almost gave birth in the washroom, when I said the baby was coming, they wouldn't listen, they were just there watching television and talking. A midwife even asked me if I was the first person to go into labour” (Participant L)
Labour pain-relieving techniques adopted by women in labour
The participants use various techniques to reduce pain during the last labour. The mothers revealed that they employed the technique of breathing through their mouths (29.4%), other people that engaged them in a conversation (23.5%), engaged in diversionary therapy & reassurance (11.8%). These techniques that are adopted by women in labour were taught them during the antenatal clinic (ANC) period.
“The midwives in the ANC had taught me that since this was my first experience, when the labour set in I should inhale through my nose and breathe out through pursed lips slowly. True this this advice, it was reiterated to me during labour and honestly, it was actually very helpful” (Participant E)
“I was told when labour set in, I should have someone I care for and love to stay with me during the ANC visits. When I was in labour because it was a private facility, my husband was allowed into the ward because we were the only people. My husband was so supportive, sometimes I feel sorry for his experiences that day” (Participant O)
This notwithstanding, some women said nothing was done to manage their pain (35.3%). The study also looked at other methods that were used to relieve the labour pains of the women. The majority of the women said they received supportive care from their relatives and the midwives (82.3%). Some women described the labour process as a natural process that is expected to be painful and in light of this, they could not phantom any non-pharmacologic method that could be instituted to alleviate the pain of labour. Such women had little or no expectation of pain management during labour.
“I cannot remember what was done specifically because I was in pain. I do not know however what they could have done about it anyway. I just endured the pain because I understood it as a normal process that will help bring forth a life” (Participant B)
“For me labour is a natural process that ought to be painful. I do not think I expected anyone to help me bear the pain, I had already made up my mind that it’s a painful process and true to my thought it was actually that painful. I could only bear it. The pain is enshrined by God (Participant F)
The change in body position and the nursing interventions instituted by midwives also aided in improving pain relieve among parturient women. Some indicated they received other pain-relieving methods such as intravenous fluid, bathing and laying on sideways (5.9%). Key to the interventions were the fact that some support only was instituted too late when the services were not needed or no more anticipated. Also, others identified some pharmacologic interventions that were instituted to support the management of the pain.
“For me the labour lasted two long and was so painful. So, when the doctor came on rounds, I complained and was given some medications and intravenous infusions” (Participant M)
“I was given an injection only at the point I could not bear the pain any longer. For me that injection was of no use because shortly after that I was put to birth” (Participant J)
“Was not given any specific medicine” (Participant G)
The provision of information regarding labour pains
Indicating if the midwives provided enough information regarding labour pains, the women had varied opinions. Some of the women indicate that the information provided by midwives regarding pain management during the labour was insufficient. Others indicated that they were not given information at the point of labour, but were given education during the ANC about the labour process and cervical dilations, contractions and bearing down. During labour information given specifically of the expectations throughout the process and how long it will last influence positively the woman’s ability to bear labour pains.
“I think that the midwives need to always tell the labouring women what to expect, compared to my first labour experience, in the last one the midwife told me I will give birth in about seven hours’ time, right at the time of arrival, so I could predict the progress of the pain.” (Participant C)
“I was told to take deep breaths when the pain comes, I think that was so supportive in alleviating the pain to some extent” (Participant O)
“The midwives did next to nothing about alleviating the pain. They just watched me go through all the experience myself.” (Participant Q)
Table 2
Labour pain pattern and management
Variables
|
Frequency
|
Percentage
|
Intensity of pain
|
Moderate
|
4
|
23.5
|
Severe
|
6
|
35.3
|
Very Severe
|
7
|
41.2
|
Expression of pain
|
Calm & snapping fingers
|
3
|
17.6
|
Crying & Screaming
|
6
|
35.3
|
Shouting & walking
|
8
|
47.1
|
Feeling about the attitude of Midwives
|
Very Poor
|
2
|
11.8
|
Poor
|
1
|
5.9
|
Satisfactory
|
9
|
52.9
|
Very Satisfactory
|
4
|
23.5
|
Labour pain management
|
Breathing through the mouth
|
5
|
29.4
|
Engaging patient in a chat
|
4
|
23.5
|
Diversional therapy & reassurance
|
2
|
11.8
|
None
|
6
|
35.3
|
Other methods used
|
Giving IV fluid
|
1
|
5.9
|
Washing down
|
1
|
5.9
|
Laying sideways
|
1
|
5.9
|
Nothing
|
14
|
82.4
|
Parturient women’s involvement in pain management
The study revealed that most (58.8%) of the women were not involved in decision making about labour pain management and that only 41.2% were involved as indicated in Table 2. The nature of the involvement included education, information giving and expressing of empathy, allowing the presence of family members like the husband in the labour room and listening to the concerns expressed by the women by the midwife
“I received some education on what to do when labour pain becomes severe during ANC services. Actually, the midwife was also very empathetic and seems to understand the pain I was experiencing” (Participant I)
“The midwife told my husband to massage my back when the pain is severe and he did, so it made me feel better. I think the presence of my husband in the labour room was supportive. However, I do not think that if it was a government owned facility I would have benefited from this” (Participant O)
Some of the women, however, had different experiences when it came to their involvement in pain management during labour. They contend the care that was given was appalling and did meet their basic expectations as some could not identify anything that was done specifically to alleviate pain during labour.
“No one asked me about how I felt. From the behaviour of the midwife, I wondered at a point if she is aware that it was painful. Her behaviour was very appalling” (Participant A)
“I cannot immediately identify anything they did for me because I was in pain. I think I only did things to alleviate the pain by myself” (Participant J)
Satisfaction of parturient women regarding labour pain management
On the aspect of satisfaction with labour pain management by midwives, the majority (58.8%) of the women said they were satisfied with the pain management they received from midwives. Others (11.8%) also indicated they were very satisfied while 29.4% indicated they were not satisfied with the labour pain management they received from midwives.
“My experience in the labour ward was one I do not wish any woman in labour to go through. How could I have been satisfied when I was treated like a machine that is just supposed to bear the pain because labour is a natural phenomenon?” (Participant Q)
“For me labour was my worst nightmare and the midwife even made it worse for me. It’s like the midwives are trained to care about nothing. Irrespective of the amount of pain one is bearing they just look on unconcerned” (Participant M)
“I can say compared to my previous experiences; this one was fairly welcoming. The midwives in the labour ward have now changed. They were caring and supportive” (Participant D)
“Having to give birth in a private hospital was a good experience for me. I had the luxury to do anything and more so I was the only woman in labour at the time. I received the maximum support from the midwives and all the care professionals” (Participant O)
Furthermore, 52.9% of the women said the midwives did their best in managing their labour pains, 35.3% showed the midwives could do better in their labour pain management while 11.8% were neutral. Finally, the majority (70.6%) of the women alleged the care given them by the midwives was good, 11.8% showed it was bad and 17.7% believed the midwives could do better.
Relationship of number of labour and pain characteristics
For those who were first timers, the majority (57.1%) expressed their pain as very severe, experienced severe pains (28.6%) while 14.3% reported moderate pain.
“Contrary to what I have always heard and thought, I think the pain was manageable, indeed I was still expecting the worst when the midwife asked me to move to the delivery room because I was due” (Participant B)
“I have very severe pains only about three hours of the birth. Yes, labour is painful, but it’s not that the pain persists throughout the period one is labouring. The intensity, frequency and duration of the pain only increases as the labour itself progresses. I think the worst case is in the last hours preceding the birth itself” (Participant K)
For those who had attended labour two times, the majority (42.9%) reported severe pain while equal numbers (28.6%) reported moderate and very severe pains respectively. Also, the majority (42.9%) of those attending labour for the first time were satisfied with the midwives’ attitude during labour pain care. Finally, those who attended labour once or twice gave a good general comment about the care given them (71.4%) for each respectively.