Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

Pain relief in labour: a qualitative study to determine how to support women to make decisions about pain relief in labour

Authors: Joanne E Lally, Richard G Thomson, Sheila MacPhail, Catherine Exley

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

Login to get access

Abstract

Background

Engagement in decision making is a key priority of modern healthcare. Women are encouraged to make decisions about pain relief in labour in the ante-natal period based upon their expectations of what labour pain will be like. Many women find this planning difficult. The aim of this qualitative study was to explore how women can be better supported in preparing for, and making, decisions during pregnancy and labour regarding pain management.

Methods

Semi-structured interviews were conducted with 13 primiparous and 10 multiparous women at 36 weeks of pregnancy and again within six weeks postnatally. Data collection and analysis occurred concurrently to identify key themes.

Results

Three main themes emerged from the data. Firstly, during pregnancy women expressed a degree of uncertainty about the level of pain they would experience in labour and the effect of different methods of pain relief. Secondly, women reflected on how decisions had been made regarding pain management in labour and the degree to which they had felt comfortable making these decisions. Finally, women discussed their perceived levels of control, both desired and experienced, over both their bodies and the decisions they were making.

Conclusion

This study suggests that the current approach of antenatal preparation in the NHS, of asking women to make decisions antenatally for pain relief in labour, needs reviewing. It would be more beneficial to concentrate efforts on better informing women and on engaging them in discussions around their values, expectations and preferences and how these affect each specific choice rather than expecting them to make to make firm decisions in advance of such an unpredictable event as labour.
Literature
1.
2.
3.
Department of Health: NHS Constitution. 2010, London: Department of Health
4.
Janzen JA, Silvius J, Jacobs S, Slaughter S, Dalziel W, Drummond N: What is a health expectation? Developing a pragmatic conceptual model from psychological theory. Health Expectations. 2006, 9: 37-48. 10.1111/j.1369-7625.2006.00363.x.CrossRefPubMed
5.
O'Connor AM: Validation of a decisional conflict scale. Med Decis Making. 1995, 15: 25-30. 10.1177/0272989X9501500105.CrossRefPubMed
6.
Green JM: Expectations and experiences of pain in labour: Findings from a large prospective study. Birth. 1993, 20 (2): 65-72. 10.1111/j.1523-536X.1993.tb00419.x.CrossRefPubMed
7.
Leung KK, Silvius JL, Pimlott N, Dalziel W, Drummond N: Why health expectations and hopes are different: the development of a conceptual model. Health Expectations. 2009, 12: 347-360. 10.1111/j.1369-7625.2009.00570.x.CrossRefPubMed
8.
Kravitz RL, Callahan EJ, Paterniti D, Antonius D, Dunham M, Lewis CE: Prevalence and sources of patients’ unmet expectations for care. Annals of Internal Medicine. 1996, 125 (9): 730-737. 10.7326/0003-4819-125-9-199611010-00004.CrossRefPubMed
9.
Thompson AGH, Sunol R: Expectations as determinants of patient satisfaction: Concepts, Theory and Evidence. International Journal of Quality in HealthCare. 1994, 7 (2): 127-141.CrossRef
10.
Lally JE, Murtagh MJ, Macphail S, Thomson RG: More in hope than expectation: a systematic review of women's expectations and experience of pain relief in labour. BMC Medicine. 2008, 6 (7):
11.
Roberts C, Raynes-Greenow C, Nassar N, Trevena L, McCaffery K: Protocol for a randomised controlled trial of a decision aid for the management of pain in labour and childbirth [ISRCTN52287533]. BMC Pregnancy and Childbirth. 2004, 4 (1): 24-10.1186/1471-2393-4-24.CrossRefPubMedPubMedCentral
12.
13.
Gupton A, Beaton J, Sloan J, Bramadat I: The development of a scale to measure childbirth expectations. The Canadian Journal of Nursing Research. 1991, 23: 35-47.PubMed
14.
Waldenstrom U, Borg IM, Olsson B, Skold M: The childbirth experience: a study of 295 new mothers. Birth: Issues in Perinatal Care. 1996, 23 (3): 144-153. 10.1111/j.1523-536X.1996.tb00475.x.CrossRef
15.
Kitzinger S: Birth your way: Choosing birth at home or in a birth centre. 2011, Chester le Street: Fresh Heart Publishing
16.
Lundgren I, Dahlberg K: Women's experience of pain during childbirth. Midwifery. 1998, 14 (2): 105-110. 10.1016/S0266-6138(98)90007-9.CrossRefPubMed
17.
Leap N: Being with women in pain: do midwives need to rethink their role. British Journal of Midwifery. 1997, 5 (5): 263-CrossRef
18.
Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S: The nature and management of labor pain: part I. Non-pharmacologic pain relief.[erratum appears in American Family Physician. 2003 Dec 15;68(12):2330]. Am Fam Physician. 2003, 68 (6): 1109-1112.PubMed
19.
Peach MJ: The King Edward Memorial Hospital 1000 mother survey of methods of pain relief in labour. Anaesthesia & Intensive Care. 1991, 19 (3): 393-399.
20.
Sadler LC, Davison T, McCowan LME: Maternal satisfaction with active management of labor: a randomized controlled trial. Birth: Issues in Perinatal Care. 2001, 28 (4): 225-235. 10.1046/j.1523-536X.2001.00225.x.CrossRef
21.
Maclean J: Pain Psychology. Health Psychology in Context. Edited by: Gilmartin J. 2009, Chichester: Wiley
22.
Rooks JP: Labor Pain Management Other Than Neuraxial: what do we know and where do we go next?. Birth. 2012, 39 (4): 318-322. 10.1111/birt.12009.CrossRefPubMed
23.
Baum F: Researching public health: behind the qualitative-quantitative methodological debate. Social Science and Medicine. 1995, 40 (4): 459-468. 10.1016/0277-9536(94)E0103-Y.CrossRefPubMed
24.
Ritchie J, Lewis J, Elan G: Designing and selecting samples. Qualitative Research Practice. Edited by: Ritchie J, Lewis J. 2003, London: Sage Publications, 78-81.
25.
Green JM, Coupland VA, Kitzinger JV: Expectations, experiences, and psychological outcomes of childbirth: a prospective study of 825 women. Birth. 1990, 17 (1): 15-24. 10.1111/j.1523-536X.1990.tb00004.x.CrossRefPubMed
26.
Green JM, Coupland VA, Kitzinger JV: Great Expectations: A prospective study of womens expectations and experiences of childbirth. 1998, Cheshire: Books for Midwives Press
27.
Escott D, Spiby H, Slade P, Fraser RB: The range of coping strategies women use to manage pain and anxiety prior to and during first experience of labour. Midwifery. 2004, 20 (2): 144-156. 10.1016/j.midw.2003.11.001.CrossRefPubMed
28.
Gibbins J, Thomson AM: Women’s expectations and experiences of childbirth. Midwifery. 2001, 17 (4): 302-313. 10.1054/midw.2001.0263.CrossRefPubMed
29.
Yearby M: Pain in childbearing: Key issues in management. 2000, Bailliere Tindall: Edinburgh
30.
VandeVusse A, VandeVusse L: Reality Television as a Source of information about birth: the messages and their implications. Journal of Midwifery & Women’s Health. 2008, 53 (5): 482-CrossRef
31.
Simkin PT: Birth Plans: After 25 Years, Women Still Want To Be Heard. Birth. 2007, 34 (1): 49-51. 10.1111/j.1523-536X.2006.00126.x.CrossRef
32.
Brown SJ, Lumley J: Communication and decision-making in labour: do birth plans make a difference?. Health Expectations. 1998, 1 (2): 106-116. 10.1046/j.1369-6513.1998.00023.x.CrossRefPubMed
33.
Hodnett E: Pain and women's satisfaction with the experience of childbirth: a systematic review. American Journal of Obstetrics & Gynaecology. 2002, 186 (5): S160-S172.
34.
Fox B, Worts D: Revisiting the critique of medicalized childbirth: a contribution to the sociology of birth. Gender and Society. 1999, 13 (3): 234-246.CrossRef
35.
Green JM, Baston HA: Feeling in control during labor: concepts, correlates, and consequences. Birth. 2003, 30 (4): 235-247. 10.1046/j.1523-536X.2003.00253.x.CrossRefPubMed
36.
Mander R: The control of pain in labour. Journal of Clinical Nursing. 1992, 1 (4): 219-223. 10.1111/j.1365-2702.1992.tb00102.x.CrossRef
37.
Niven C, Gijsbers K: Obstetric and non-obstetric factors related to labour pain. Journal of Reproductive and Infant Psychology. 1984, 2 (2): 61-78. 10.1080/02646838408403451.CrossRef
38.
National Institute for Clinical Excellence: Guideline 62: Antenatal Care In. 2008, London: NICE
39.
Leap N, Anderson T: The role of pain in normal birth and the empowerment of women. 2004, London: Churchill Livingstone
40.
Ross-Davie M, Munro J, Jokinen M: Supporting women in labour. Evidence Based Guidelines for Midwifery-Led Care in Labour. 2012, London: Royal College of Midwives
41.
Royal College of Obstetricians and G: Antenatal Care: Routine care for healthy pregnant women. 2008, London: Commissioned by NICE
42.
Jacoby A: Mothers’ views about information and advice in pregnancy and childbirth: findings from a national study. Midwifery. 1988, 4 (3): 103-110. 10.1016/S0266-6138(88)80022-6.CrossRefPubMed
43.
Soltani H: Exploring women’s views on information provided during pregnancy. British Journal of Midwifery. 2005, 13 (10): 633-636.CrossRef
44.
Elwyn G, Frosch D, Volandes AE, Edwards A, Montori VM: Investing in deliberation: a definition and classification of decision support interventions for people facing difficult health decisions. Medical Decision Making. 2010, 30 (6): 701-711. 10.1177/0272989X10386231.CrossRefPubMed
45.
Coulter A: Partnerships with patients: the pros and cons of shared clinical decision-making. Journal of Health Services Research Policy. 1997, 2 (2): 112-121.PubMed
46.
Right Care SDM Programme: Measuring shared decision making: a review of the research evidence. 2012, Cambridge: Department of Health
47.
Stapleton H, Thomas G: Informed choice and decision making. Informed choice in maternity care. Edited by: Kirkham M. 2001, Basingstoke: Palgrave: Macmillan
48.
Raynes-Greenow CH, Nassar N, Torvaldsen S, Trevena L, Roberts CL: Assisting informed decision making for labour analgesia: a randomised controlled trial of a decision aid for labour analgesia versus a pamphlet. BMC Pregnancy Childbirth. 2010, 10 (15):
49.
Bekker HL, Legare F, Stacey D, O’Connor A, Lemyre L: Is anxiety a suitable measure of decision aid effectiveness: a systematic review?. Patient Education and Counseling. 2003, 50 (3): 255-262. 10.1016/S0738-3991(03)00045-4.CrossRefPubMed
50.
Mander R: Choosing the choices in the USA: examples in the maternity area. Journal of Advanced Nursing. 1997, 25: 1192-1197. 10.1046/j.1365-2648.1997.19970251192.x.CrossRefPubMed
51.
Sandall J, Soltani H, Gates S, Shennan A, Devane D: Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, Volume 8. 2013, John Wiley & Sons, Ltd
52.
53.
Hallowell N, Lawton J, Gregory S: Reflections on Research: The realities of doing research in the social sciences. 2005, Maidenhead, England: Open Univiersity Press
Metadata
Title
Pain relief in labour: a qualitative study to determine how to support women to make decisions about pain relief in labour
Authors
Joanne E Lally
Richard G Thomson
Sheila MacPhail
Catherine Exley
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-14-6

Other articles of this Issue 1/2014

BMC Pregnancy and Childbirth 1/2014 Go to the issue

Research article

Impact of mode of delivery on the birth experience in first-time mothers: a qualitative study

Research article

Is postpartum depression a homogenous disorder: time of onset, severity, symptoms and hopelessness in relation to the course of depression

Research article

Screening models using multiple markers for early detection of late-onset preeclampsia in low-risk pregnancy

Research article

Appropriateness of elective caesarean deliveries in a perinatal network: a cross-sectional study

Research article

Women’s empowerment and male involvement in antenatal care: analyses of Demographic and Health Surveys (DHS) in selected African countries

Research article

Adherence to evidence based care practices for childbirth before and after a quality improvement intervention in health facilities of Rajasthan, India