Awareness, barriers and facilitators of labor analgesia among stakeholders in Kawempe National Referral Hospital

Abstract

Introduction: Many women who deliver children by vaginal route have severe labor pains yet they would benefit from pain relief. The severe labor pains are also unacceptable to women yet safe interventions under a health care provider are available. A study conducted in Uganda revealed a high unmet need for labor analgesia. Despite this high unmet need for labor analgesia, its practice remains low. In addition, facilitators and barriers to its utilization among obstetric health care providers in Uganda, particularly at the Kawempe NRH remain poorly documented. Objectives: This study sought to assess the awareness, explore barriers and facilitators to using labour analgesia by stakeholders at KNRH. Methods: This was a mixed methods cross sectional study that collected qualitative and quantitative data concurrently between October and November 2022 at Kawempe National Referral Hospital. The study was carried out on the mothers that delivered vaginally in the postnatal ward and among obstetric healthcare providers in the hospital. Consecutive sampling method was used. Descriptive analysis was used for demographic while the awareness was got as a proportion of women who were aware of labour analgesia out of the total number of participants. Qualitative data was analysed NVIVO by framework analysis. Results: In our study, awareness of labor analgesia was 15% among postnatal mothers delivered vaginally at KNRH. Inadequate knowledge, unavailability of analgesia drugs, cultural and religious beliefs were the main barriers to utilization of labor analgesia. Among the HCPs, the barriers included low staffing levels, lack of knowledge and training of HCPs on labor analgesia, lack of supplies and equipment and lack of privacy of male companion to be with their partners. The facilitators included equipping the HCPs and pregnant women with knowledge and making analgesics readily available by increasing supply in the hospitals, training and capacity building of health workers through trainings, and CMEs, awareness creation and mindset change among communities towards use of analgesia were the proposed/possible facilitators of utilization of labor analgesia. Conclusion: Awareness of labor analgesia at KNRH was very low. The barriers to labor analgesia mainly include inadequate resources and infrastructure. Recommendations: There is need for labor analgesia awareness campaigns and mind-set change for pregnant mothers which should be delivered to them during ANC visits, mass media and social media. The providers should be equipped with the knowledge and skills about use of analgesia through trainings, seminars and CMEs. The Ministry of health and health care providers need to implement labor analgesia protocols to provide a good experience of child birth among mothers in Uganda. The Ministry of health should ensure a constant supply of the analgesics in the facilities