Parkies L E, Murray D, Okafor U B
Department of Nursing Science, University of Fort Hare, 50 Church Street, 5201, East London, South Africa.
Department of Public Health, University of Fort Hare, 5 Oxford Street, 5201, East London, South Africa.
BMC Nurs. 2024 Mar 14;23(1):176. doi: 10.1186/s12912-024-01844-w.
Women of childbearing age feel great about giving birth, but the pain could be excruciating depending on their pain tolerances. Midwives requires obstetrical knowledge and skills such as pain management during labour and safety. We explored midwives' perspectives on the utilisation of pharmacological pain alleviation interventions during labour in selected hospitals in Matjhabeng Municipality, Free State province, South Africa. A qualitative study was undertaken, involving a sample of ten midwives, using a semi-structured interview guide. The interviews were audio-recorded and transcribed verbatim. Tesch's open coding data analysis method was applied to analyse the data. The midwives were restricted to use Pethidine and Phenergan prescribed by doctors for labour pain relief, which disrupted labour pain management and obliged them either to wait for a physician or follow telephone instructions. According to the midwives, women taking Pethidine and Phenergan encountered adverse effects and discomfort. Midwives identified high workload, inadequate personnel, lack of skill and knowledge, lack of medication availability, and lack of infrastructure as the primary challenges of administering pharmacological methods to women in labour. The lack of standing orders, which delays the administration of medications pending a physician's prescription, constituted an additional difficulty. In the instance that Pethidine and Phenergan were unavailable or ineffective for some women, the midwives recommended that women be administered alternative pharmacological pain relievers. They also advocated for institutionalization of pharmacological guidelines allowing them to use their discretion when treating labour pain. Midwives can only utilise a few standardised and regulated pharmacological medications for labour pain management. The midwives' ability to administer pharmacological pain relief during labour was hampered by a high workload burden, insufficient staff, lack of skill and understanding, drug unavailability, and inadequate infrastructure. Midwives advocated for supported guidelines that would allow them to treat labour pain at their discretion. Intersectoral stakeholders are required to improve midwife skills and attitudes. Health facilities need to train and supply analgesics to midwives. Midwives ought to be familiar with pharmacological pain relievers.
育龄妇女对分娩感觉良好，但根据她们的疼痛耐受力，疼痛可能极其剧烈。助产士需要产科知识和技能，如分娩期间的疼痛管理和安全知识。我们探讨了南非自由州省马奇哈本格市选定医院助产士对分娩期间使用药物性疼痛缓解干预措施的看法。我们进行了一项定性研究，采用半结构化访谈指南，抽取了10名助产士作为样本。访谈进行了录音并逐字转录。采用泰施的开放编码数据分析方法对数据进行分析。助产士只能使用医生开的哌替啶和非那根来缓解分娩疼痛，这扰乱了分娩疼痛管理，使她们要么等待医生，要么遵循电话指示。据助产士称，服用哌替啶和非那根的妇女会出现不良反应和不适。助产士认为工作量大、人员不足、缺乏技能和知识、药物供应不足以及基础设施缺乏是对分娩妇女实施药物方法的主要挑战。缺乏长期医嘱，即在等待医生开处方期间延迟给药，构成了另一个困难。在某些妇女无法获得哌替啶和非那根或其无效的情况下，助产士建议给妇女使用替代药物性止痛剂。他们还主张将药物指南制度化，以便在治疗分娩疼痛时能够自行决定。助产士在分娩疼痛管理中只能使用少数标准化和规范化的药物。助产士在分娩期间实施药物性疼痛缓解的能力受到高工作量负担、工作人员不足、缺乏技能和理解、药物无法获得以及基础设施不足的阻碍。助产士主张制定支持性指南，使她们能够自行决定治疗分娩疼痛。跨部门利益相关者需要提高助产士的技能和态度。卫生机构需要培训并向助产士提供镇痛药。助产士应该熟悉药物性止痛剂。
