Skip to main content

Advertisement

Labor pain control and associated factors among women who gave birth at Leku primary hospital, southern Ethiopia

Article metrics

  • 126 Accesses

Abstract

Objective

To assess labor pain control and associated factors among women who give birth at Leku primary hospital, southern Ethiopia, 2018/19. A systematic random sampling technique was used to select 404 mothers who gave birth at Leku hospital during the data collection period. Data were collected by two first degree midwives immediately after delivery using Labor Agentry Scale (LAS).

Results

In this study, 404 mothers were participated making the response rate of 100%. Among the participants, 104 (25.7%) of mothers reported Mild control of labor pain. Maternal age of 19 to 24 year AOR = 5.85 (95% CI 2.14, 15.98), being farmer AOR = 2.5 (1.14, 5.57), primi-para AOR = 0.13 (0.06, 0.3), good family support AOR = 2.8 (1.49, 5.3), short duration of labor (< 12 h) AOR = 3.2 (1.65, 6.23) and history of pregnancy loss AOR = 0.06 (0.03, 0.14) were significantly associated with greater control of labor pain. In general, compared to other studies, the level of labor pain control is good in this study area. Enhancing factors of labor pain control have to be strengthened to increase greater control of labor pain. Qualitative research is highly recommended to identify cultural factors related to labor pain control and management.

Introduction

Pain during labor and childbirth is a unique and the most severe pains event in women’s life. The extent to which a woman feels in control of pain during labor is an important indicator of maternal emotional wellbeing in childbirth [1]. More than 90% of the tension and stress during the pregnancy period is related to childbirth [2]. Loss of labor pain control was reported by 54.6% of women in the Netherland [3]. A study conducted in Sweden showed that 41% of participants reported labor pain as the worst experience that they have [4].

Labor pain is thought to have both physiological and psychological origin [5]. The physiological origin of labor pain is uterus contractions or cervical dilation [6] and psychological factors like stress, anxiety, and fear were shown to associated with labor pain [6, 7]. Pain stimulates the sympathetic nervous system, which causes an increase in the heart rate, blood pressure, sweat production, endocrine hyper-function, and delays the patient’s prognosis [8]. Poorly controlled labor pain resulted in negative or traumatic childbirth experiences [3].

Childbirth experiences/feeling control of labor pain/can be affected by internal and external factors of the women. Internal factors like attitude towards staff [9], attitude toward the experience of pain (perceiving), motivation towards childbearing and education about childbirth affects the extent of labor pain and feeling of control [10]. Those women who have learned how to experience safe childbirth showed low levels of stress as compared to their counterparts (control group) (p = 0.002) [11]. Labor pain tolerance is also affected by an individual’s endurance, acceptance of the pain and physical condition [12]. Only few works of the literatures indicated the factors for positive labor pain control. Therefore, this paper was aimed to assess women’s control of labor pain and associated factors among women who gave birth.

Main text

Study area and period

An institution-based cross-sectional study was conducted in Leku primary hospital, southern Ethiopia from December 2018 to March 30/2019. All women who present with singleton pregnancies at full-term (37–42 weeks) were included in the study while laboring women with known obstetric, medical or psychological problems were excluded. Systematic random sampling techniques were applied to select 404 study participants among post-partial mothers. In this study labor pain tolerance (self-control) was measured as “Greater control of pain” if women’s response score is more than a mean value of Labor Agentry Scale (LAS) and “Mild control of pain” if women’s answer score is less than a mean value of Labor Agentry Scale (LAS).

Data collection techniques and tools

After the birth of the baby, each woman’s medical card was used to select participants who satisfy the eligibility criterion. Information about length (duration) of labor, type of labor (spontaneous/induced), mode of delivery, presence of complications, and details of the newborn were obtained from this medical registration. Postpartum women were interviewed in the postnatal unit within 24 h of vaginal delivery or 48 h after cesarean delivery for their feeling of labor pain using Labor Agentry Scale (LAS). Labour Agentry Scale (LAS) is a self-report scale designed to

measure feelings of control during childbirth which has a 10-item tool and each question (item) has a seven-point scale from one “almost always” to seven [7] “never”. The questions tend to measure the extent to which the mother felt she was in “tense, confident, important, lost self-control, fearful, relaxed, helpless, failure, in good behavior and have support from someone”. This tool was initially developed by Hodnett and Simmons Tropea. Factors associated with labor pain control were analyzed using binary and multivariable logistic regressions.

Results

Socio-demographic characteristics

A total of 404 post-partial mothers were participated in this study making a response rate of 100%. The minimum and maximum ages of participants were 15 and 40 years respectively with a mean and standard deviation (± SD) of 24.46 ± 4.75 years. In this study majority of the participants were were married 385 (95.3%), Sidama ethnicity 336 (83.2%), protestant in religion 321 (79.5%), the majority of women were between 19 and 29 years of age (66.6%), only 35.9 of participants attended high school and above, 233 (57.7%) of them were from rural and 141 (34.9%) were farmers (see Table 1). Among the participants 381 (94.3%) has at least one Ante Natal Care visit, 196 (48.5%) were primigravida, 60 (14.9%) have a history of pregnancy loss (abortion or stillbirth), 208 (51.5%) were multi-gravida, 84 (20.8%) of pregnancies were unplanned, 122 (30.2%) have no/poor family support, 37 (9.2%) have history of depression, almost all 389 (96.3%) have no any complication, almost half of them 212 (52.5%) have no alive child, 23 of them gave birth by cesarean section and duration of labor was less than 12 h for 327 (80.9%) of participants (see Table 2).

Table 1 Socio-demographic characteristics of study participants on labor pain control at Leku general hospital, 2019
Table 2 Obstetrics characteristics of study participants on labor pain control at Leku general hospital, 2019

Level of labor pain control

Among the ten (10) questionnaires used to measure labor pain intensity, five of them were reversely recoded, to sum up, and calculate the mean value. Hence, the mean value of this study was 35. Accordingly, 104 (25.7%) of mothers reported that they have mild control of pain during labor and delivery (scored less than mean value to control labor). On Multivariate analysis, compared to age > 30 years only maternal age 19 to 24 year (AOR = 5.85; 95% CI 2.14, 15.98) associated with greater control of labor pain. Being farmer (AOR = 2.5; 95% CI 1.14, 5.57) compared to housewives, good family support (AOR = 2.8; 95% CI 1.49, 5.3), and short duration of labor (< 12 h) (AOR = 3.2; 95% CI 1.65, 6.23) were positively associated with greater control of labor pain. History of pregnancy loss (AOR = 0.06; 95% CI 0.03, 0.14) and primi-para (AOR = 0.13; 95% CI 0.06, 0.3) were negatively associated with greater control of labor pain (see Table 3).

Table 3 Factors associated with labor pain control among mothers who gave birth at Leku general hospital, SNNPR, Ethiopia, 2018/9

Discussion

In this study, 104 (25.7%) mothers reported that they failed to control labor pain during labor and delivery. This is not comparable with a finding from the Netherland and Swedish where 54.6% and 41% of post-partial mothers reported loss of labor pain control respectively [3, 4]. The difference might be due to a difference in culture and setting. Labor pain tolerance and expression of pain intensity is affected by culture, physical and psychological factors [9]. For instance, In Europe and America, women show a wide range of reactions against labor pain. However, in Korean culture, the women need to be quiet during delivery so they will not make their family ashamed [13].

The odds of greater control of pain among mothers who are 19 to 24 years old is almost six times higher than the odds mothers who are older than 30 years. This may be secondary to their physical endurance. Studies have identified that labor pain tolerance is affected by an individual’s endurance, acceptance of the pain and physical condition [12].

The odds of greater control of pain among primi-para mother is 87% less likely compared to multipara mothers. This is supported by previous studies where primi-paras complain about physical pain and discomfort more than multipara mothers [3, 14].

The odds of greater control of pain by women who have family support is almost three times higher than that of mothers who have no/poor family support. This is supported by a study conducted in Nepal where the presence of husband or other family members during childbirth is found to help mothers to cope with labor pain, [15,16,17].

The odds of greater control of pain is 2.5 times higher among farmers compared to the odds of pain control among housewives. This might be due to physical strength as farmers involve in hard work and frequent exercise than housewives.

Similar to study from the Netherland [3], the odds of greater control of pain among mothers who have a short duration of labor (≤ 12 h) were three times higher than their counterparts.

The odds of greater control of labor pain are 94% less likely for mothers who have a history of pregnancy loss compared to their counterparts. Higher intensity of labor pain is correlated with a history of abortion or stillbirth [3, 14] and having abnormal pregnancy increase labor pain [18].

Limitations

The study was conducted only at one hospital, so that it may not representative the whole population.

Availability of data and materials

The dataset analyzed is available from the corresponding author on a reasonable request.

Abbreviations

LAS:

Labor Agentry Scale

References

  1. 1.

    Hodnett ED, Simmons-Tropea DA. The Labour Agentry Scale: psychometric properties of an instrument measuring control during childbirth. Res Nurs Health. 1987;10(5):301–10.

  2. 2.

    Hosseininasab S, Taghavi S, Ahmadian S. The effectiveness of prenatal education in decreasing the childbirth pain and anxiety. 2010.

  3. 3.

    Hollander M, van Hastenberg E, van Dillen J, van Pampus M, de Miranda E, Stramrood C. Preventing traumatic childbirth experiences: 2192 women’s perceptions and views. Arch Women’s Ment Health. 2017;20(4):515–23.

  4. 4.

    Yerby M. Pain in childbearing: key issues in management. Elsevier Health Sciences. 2000. p. 5 (Epub 6).

  5. 5.

    Lee Lai Yin I. The experience of pain in the context of childbirth for Hong Kong Chinese women: a longitudinal cohort interview study. University of Central Lancashire; 2017.

  6. 6.

    Abushaikha L, Oweis A. Labour pain experience and intensity: a Jordanian perspective. Int J Nurs Pract. 2005;11(1):33–8.

  7. 7.

    Lang AJ, Sorrell JT, Rodgers CS, Lebeck MM. Anxiety sensitivity as a predictor of labor pain. Eur J Pain. 2006;10(3):263.

  8. 8.

    Fortescue C, Wee MY. Analgesia in labor: non-regional techniques. Contin Educ Anaesth Crit Care Pain. 2005;5(1):9–13.

  9. 9.

    Beigi NMA, Broumandfar K, Bahadoran P, Abedi HA. Women’s experience of pain during childbirth. Iran J Nurs Midwifery Res. 2010;15(2):77.

  10. 10.

    Havelka Meštrović A, Bilić M, Buhin Lončar L, Mičković V, Lončar Z. Psychological factors in experience of pain during childbirth. Coll Anthropol. 2015;39(3):557–65.

  11. 11.

    Firouzbakht M, Nikpour M, Salmalian H, Ledari FM, Khafri S. The effect of perinatal education on Iranian mothers’ stress and labor pain. Glob J Health Sci. 2014;6(1):61.

  12. 12.

    Du Gas BW. Introduction to patient care: a comprehensive approach to nursing. Philadelphia: W.B Saunders; 1983.

  13. 13.

    Olds SB, London ML, Ladewig PA, Davidson MR. Maternal newborn nursing and women’s health care 7ed. New Jersey: Prentice-Hall; 2003.

  14. 14.

    Gerd F, Kopare T, Gaston-Johansson F, Norvell KT. Factors associated with more intense labor pain. Hoboken: Wiley Online Library; 1988.

  15. 15.

    Sapkota S, Kobayashi T, Kakehashi M, Baral G, Yoshida I. In the Nepalese context, can a husband’s attendance during childbirth help his wife feel more in control of labor? BMC Pregnancy Childbirth. 2012;12(1):49.

  16. 16.

    Najafi TF, Roudsari RL, Ebrahimipour H. The best encouraging persons in labor: a content analysis of Iranian mothers’ experiences of labor support. PLoS ONE. 2017;12(7):e0179702.

  17. 17.

    Nilsson L, Thorsell T, Heartfelt Wahn E, Ekström A. Factors influencing positive birth experiences of first-time mothers. Nurs Res Pract. 2013;2013:349124. https://doi.org/10.1155/2013/349124.

  18. 18.

    Potter PA, Perry AG. Basic nursing: a critical thinking approach. 4th edn. Philadelphia: Mosby; 1999. p. 1.

Download references

Acknowledgements

We would like to express our gratitude to Hawassa University, Leku primary hospital, data collectors and study participants.

Funding

This study was supported by Hawassa University, Ethiopia. The University has no role throughout the research process.

Author information

MS conceived and designed the study, collected, analyzed and interpreted the data, and drafted the manuscript. SM write the project proposal, supervised the overall process of the research. Both authors critically reviewed the manuscript. Both authors read and approved the final manuscript.

Correspondence to Melese Siyoum.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the IRB of the College of Medicine and Health Sciences, Hawassa University. Data were collected after taking written consent from the mothers.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This 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.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Keywords

  • Labor analgesia
  • Labor pain
  • Labor pain control
  • Southern Ethiopia
  • Leku