Table 2 Healthcare provider quotes regarding barriers
THEME 2: Barrier to providing pain relief | ||
|---|---|---|
Sub-theme | Quote | |
Shortage of staff | Q 14 | “Let’s say we have four patients to monitor labour and all of them are in pain so you, you are the only one who is there in room 3 [pre-labour room], this is your location, you are the only healthcare provider, so how could you manage to help everyone; go and massage everyone who is in such pain, who is experiencing more pain?” (Midwife, KII) |
Q 15 | “[…] I mean the shortage of nurses, or staff become a major challenge because you may find, maybe you’re allocated to a certain room, five or ten mothers are in labour, you are, you’re there by yourself …it becomes difficult.” (Nurse-midwife, FGD) | |
Privacy | Q 16 | “We need to keep the privacy, and if you have a lot of relatives around and only a small curtain, there is no privacy to patients, no secret for them…we need more space.” (Nurse-midwife, KII) |
Limited education and opportunity | Q 17 | “I think maybe there a lack of trained personnel for [epidural], because it is not used here and no-one is experienced to teach us.” (Specialist registrar in Anaesthetics, KII) |
Q 18 | “I think shortage of resources, especially we don’t have the catheters and monitors, you know for every patient you need a continuous tocographic machine for every patient, we don’t have these resources.” (Specialist registrar in O&G, KII) | |
Q 19 | “Teaching about pain management is not part of formal classes in medical school, because even when we learnt about labour, the slides on pain management was just one so, no, not much emphasis on pain management.” (Specialist registrar in O&G, KII) | |
Q 20 | “I’ve read about epidural, but I’ve no experience with epidural.” (Specialist registrar in O&G, KII) | |
Q 21 | “I know there are different methods of labour analgesia and epidural is one of them; but you can also give nitrous oxide but I’ve not much experience because I’ve just observed in some few centres abroad but I’ve not been trained on that.” (Consultant Obstetrician and Gynaecologist, KII) | |
Negative beliefs, fears, malpractices | Q 22 | “There is a belief that this pain, we need to know how much pain this patient is experiencing at least at the beginning of the labour to be able to assess and evaluate the progress of labour.” (Junior doctor, KII) |
Q 23 | “Once you give someone pethidine (she) may be dizzy, may feel like sleeping, so once someone is dizzy, and feel like sleeping all the time, how does she push?” (Midwife, KII) | |
Q 24 | “…the other thing is pain relief can cause harm to babies, they can sedate them, you’ll have an inactive baby, you can’t use it…” (Consultant Obstetrician and Gynaecologist, KII) | |
Q 25 | “…Whatever is available, like the opioids analgesics, they are not really recommended before a woman gives birth because that will also give respiratory depression to the babies, so before they deliver there is very little you can do…” (Specialist registrar in O&G, KII) | |
Q 26 | “They will go through labour and pain must be there so to deliver a baby, if there is no pain that means, there can’t be a baby without pain.” (Nurse midwife, KII) | |
Q 27 | “I’ve not practiced pain relief during labour because we assume that it should be there, and we take it as a normal, [but] of course it’s not normal but we take it as if every woman should experience this.” (Specialist registrar in O&G, KII) | |
Q 28 | “It happens sometimes the woman may get a tear; we normally give infiltration before starting repairing but some healthcare providers, they just stitch it without giving it, even if the mother is screaming, they just say “shut up her”, and just proceed, so it happens.” (Specialist registrar in Anaesthesia, KII) | |
Q 29 | “During episiotomy, sometimes they do not actually provide the lignocaine, local anaesthesia during the cutting but it is written in the book, it is written there.” (Nurse-midwife, FGD) | |
Limited availability of protocols | Q 30 | “We don’t have a proper, pain management protocol for women who are delivering normally; we don’t give them analgesia.” (Specialist registrar in O&G, KII) |
Q 31 | “For those of who had vaginal deliveries once they complain of severe pain we just give them diclofenac injection, maybe a start dose and observe; if the pain continues we give paracetamol.” (Junior doctor, KII) | |
Q 32 | “I have not seen a protocol anywhere, but we’ve just learned it from our senior that this is how we do things, this is how we manage this.” (Junior doctor, KII) | |