Article
The use of pain relief in childbirth and its association with the attendance and workload of midwives ‒ a secondary analysis
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Published: | February 13, 2018 |
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Background: Persistently high rates of birth interventions worldwide as well as in Germany raise multiple discussions about the reasons for this state of obstetric and midwifery care [1]. Beside other interventions, also rates for pain relief in labour are a reason of concern in Germany. Beyond dispute, pain relievers are effective for abnormal birth to prevent caesarean because of decreasing tension and pain. However, there is no doubt that they have several side effects [2]. The reasons for usage of pain relief might depend on cultural, technical, sociological and economic causes. One cause might be the working environment in a labour ward. Less staffing and an increasing workload might lead to insufficient quality of care. An increasing workload might reduce the attendance of midwives in the delivery room. A lack of supportive care during labour might lead to more fear, tension and pain. Dick-Read already described this mechanism in the 30th´s of the last century [3]. A consequence of this vicious circle can be an increasing demand for pain relief. Supportive care during labour might be a factor to reduce the need for pain relief and therefore reduce the risk of side effects or cascades of interventions [4].
Aim: With this secondary analysis, the association between the workload and attendance of midwives with the use of pain relief was investigated. Moreover, the effect of other variables, which also might affect the usage of pain relief were considered.
Methods: Secondary analyses were based on a prospective controlled trial. Four German hospitals with a convenient sample of 999 low-risk women were included (2007–2009). Backward logistic regression was applied. The outcome variable was usage of pain relief. Key predictors were workload and attendance of midwives.
Results: Bivariate analyses revealed a significant effect regarding the association between workload of midwives (p<0.001), attendance of midwives (OR 0.073; 95% CI 0.97-0.98) and use of pain relief. Nevertheless, in multivariate analysis, these predictors did not remain in the model. Instead, the variance of the model was significantly explained by the number of shift changes (OR 1.56; 95% CI 1.24-1.96), dissatisfaction of women with attendance of midwives (OR 1.81; 95% CI 1.12-2.94), time period of staying in the labour ward until birth (OR 2.98; 95% CI 1.85-4.83), induction (OR 2.05; 95% CI 1.16-3.63) and augmentation of labour (OR 2.99; 95% CI 2.05-4.35).
Relevance: The results are important for discussing the impact of workload and attendance of midwives regarding quality of maternity care.
Conclusion: An association between structural aspects of care is evident. Nevertheless, individual aspects of care on different labour wards and womens length of stay in the delivery room seems to be more crucial for the use of pain relief than attendance or workload of midwives. Furthermore, the subjective valuation of women´s view on attendance explained the variance significantly as well as interruption of continuity of care because of shift changes.
Ethical criteria and conflict of interests: The research was not submitted to an ethics committee as it is a secondary analysis. The primary data analysis was submitted to three ethics committees and was given approval. The study is funded by the Federal Ministry of Education and Research (BMBF). There is no conflict of interest.
References
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- Dick-Read G. Mutterwerden ohne Schmerz: Die natürliche Geburt. Hamburg: Hoffmann und Campe; 1953.
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