DISCUSSION
Main findings
This study aimed to test the hypothesis that fear, misconceptions and
lack of awareness lead to refusal of epidural for labour analgesia. The
following principal observations emerged; parturient who reported at the
maternity unit of the Tamale Teaching Hospital showed awareness of
epidural labour analgesia services, however, many refused to receive an
epidural for labour analgesia on our labour and delivery service. The
educational background, age, cultural or religious beliefs and attitude
of some midwives were observed to be factors that influenced the refusal
of epidural for labour analgesia.
Strengths and limitations
In brief, the results from this study and related literature reviewed
consistently showed that there is generally very low patronage of
epidural labour analgesia among parturients in developing countries with
age, educational background, cultural or religious beliefs, cost of
service and attitude of some midwives arguably being the most predictive
of acceptance or refusal of the epidural for labour analgesia. Language
barrier and failure to explore some effects of socio-economic background
on the awareness and acceptance of labour analgesia services were the
limitations encountered during this study. There is a need for
healthcare providers to initiate education on the epidural for labour
analgesia to reduce fear and misconceptions to increase patronage.
Interpretation
Studies have demonstrated that
parturients who accept to receive
an epidural for labour analgesia are more likely to have attended
ante-natal care or read some reference books [13]. Also, factors
within parturients may influence whether they receive an epidural for
labour analgesia. Other reasons such as anaesthesia care providers not
accessible in a timely fashion, friends and family members discouraging
the parturient, and previous experiences may impact future choices
[14]. Policies guiding practice at the various hospitals may also
prevent a parturient from receiving an epidural for labour analgesia.
Childbirth experience in Ghana ranges from agony to ecstasy. It is
described as a multidimensional experience that includes intense
physical, emotional, psychological, developmental, social, cultural and
spiritual components. It differs in meaning and quality for each
labouring woman and changes as labour progresses. Labour pain is ranked
among the most intense pains recorded [1]. Many women in Ghana rate
labour pain as severe, while a few reports little or no pain [2].
Each woman’s labour pain is unique to her. The amount of labour pain one
woman may feel will differ from that felt by another woman. It depends
on factors such as level of pain tolerance, the size, and position of
the baby, the strength of uterine contractions and prior birth
experiences [3]. The findings of this study suggested that many
parturients experience severe or excruciating pain in Ghana during
childbirth and may need pain relief (Table 3) . Satisfaction
with childbirth experience is closely related to less pain during
labour. Numerous strategies, both pharmacologic and non-pharmacologic,
have been used as a treatment for labour pain relief [4]. Shidhaye
et al reported that many pregnant women in developing countries are
mostly not aware of labour analgesia services in their hospital. Lack of
awareness or the availability of labour analgesia services in many
hospitals of poor resource countries may be the prime cause of low
patronage [15]. Olayemi et al [11] attributed low
awareness of epidural for labour analgesia to the fact that healthcare
providers themselves are either ignorant of pain relief in labour or
consider it a less priority in educating women. Conversely, the present
study showed awareness of epidural for labour analgesia among
parturients at the maternity unit of the Tamale Teaching Hospital. A
survey demonstrated that out of 76 % of pregnant women who showed some
awareness of epidural labour analgesia service, only 19 % of them
patronized it during childbirth, while the majority refused to accept it
due to fears and misconceptions [16]. Another literature showed a
disparity of epidural use that existed along ethnic and racial lines,
with Africa American less likely than whites to receive an epidural for
labour analgesia. Fear, naturalism and family influence were some
reasons that led to the refusal of epidural for labour analgesia by the
Africa Americans [17, 18]. Similarly, the findings of this study
showed that despite the high awareness of epidural labour analgesia
service among parturients at the delivery unit, many still refused for
it to be administered to them. Age, educational background, cultural or
religious beliefs, cost of service, and some attitudes of midwives among
others were factors that led to the refusal of the epidural for labour
analgesia at the delivery unit of the Tamale Teaching Hospital. Hanem et
al. and Minhas et al. [19, 15] reported a correlation between
educational background and knowledge on labour analgesia acceptance.
Although our current study did not evaluate the socioeconomic background
of respondents, we observed that women with non-formal education were
less likely to accept epidural for labour analgesia. They have bound to
the cultural or religious beliefs that labour is a natural process and
does not need any intervention in the form of pain management and that
husbands are the heads of the family and therefore should give their
consent before they accept labour analgesia. These findings were not out
of place, more so in a setting where traditional and religious practices
are prevalent. This may have a great influence on the decision to refuse
epidural labour analgesia. An in-depth understanding of these factors
observed may better enable healthcare providers to assist parturients in
the decision-making process at the delivery unit regarding epidural for
labour analgesia.