Patient Satisfaction with Non-Pharmacological Pain Management during Labour at a Midwife Obstetric Unit in a Peri-Urban South Africa - A Descriptive Cross-Sectional Study

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DOI: 10.21522/TIJAR.2014.SE.22.02.Art015

Authors : John Mukuka Musonda, Makafane Cyril Mabathoana


Patient’s satisfaction with pain management is vital for quality care. Therefore, pharmacological and non-pharmacological interventions do contribute significantly to pain control. The aim was to determine patients’ satisfaction with non-pharmacological pain management in labour. A descriptive, cross-sectional design was conducted from June 2017 to March 2019. Participants were conveniently sampled to include 311 women three days after normal delivery. The research tools were Pain Satisfaction and American Pain Society Outcome Questionnaires were used to collect data. Univariate logistic regression was used to test for associations between variables. Findings of the study revealed a mean age of the women was 26.9 years, and 90.4% were Black, IsiZulu speakers, having two children and had secondary education. Moderate pain was experienced in 49.2%, and herbs or prayer were used by 55.3%. To relieve pain, participants reported deep breathing (26.2%), walking (22%), massage (21%) and prayer (14%). Effective pain relief was in 53.1%, while satisfaction was by 56.3%. The only statistically significant predictor of dissatisfaction was the number of live births (p=0.003). One live birth compared to four live births was more likely to be dissatisfied (OR=11.5; 95% CI 1.4-97.2). Findings suggest that non-pharmacological interventions are effective. The moderate pain experienced by a significant proportion may signify the need for pharmacological treatments. The association between low parity and dissatisfaction warrants further research.


[1] City of Ekurhuleni. Ekurhuleni Annual Report 2012-2013. South African Local Government; Available: [Accessed 14.08.2019].

[2] Jones, L. Othman, M., Dowswell, T. Alfirevic, Z. Gates, S. Newburn, M. et al. 2012. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. CD009234. Doi: 10.1002/14651858.CD009234.pub2.

[3] Closs, SJ. Barr, B. Briggs, M. Cash, K. & Seers, K. 2004. A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment. J Pain Symptom Manage 27(3):196–205. Doi: 10.1016/j.jpainsymman.2003.12.010.

[4] Mendoza, T. Mayne, T. Rublee, D. & Cleeland, C. 2006. Reliability and validity of a modified brief pain inventory short form in patients with osteoarthritis. Eur J Pain 10(4):353–61. Doi: 10.1016/j.ejpain.2005.06.002.

[5] Jensen, MP. Gammaitoni, AR. Olaleye, DO. Oleka, N. Nalamachu, SR. & Galer, BS. 2006. The pain quality assessment scale: assessment of pain quality in carpal tunnel syndrome. J Pain 7(11):823–32. Doi: 10.1016/j.jpain.2006.04.003.

[6] Melzack, R. 1975. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1(3):277–99. Doi: 10.1016/0304-3959(75)90044-5.

[7] Sawyer, A. Ayers, S. Abbott, J. Gyte, G. Rabe, H. & Duley, L. 2013. Measures of satisfaction with care during labour and birth: a comparative review. BMC Pregnancy Childbirth 13:108. Doi: 10.1186/1471-2393-13-108.

[8] Hollingshead, NA. Ashburn-Nardo, L. Stewart, J. C. & Hirsh, A. T. 2016. The Pain Experience of Hispanic Americans: A Critical Literature Review and Conceptual Model. J Pain 17(5):513–528.

[9] Olayemi, O. Morhason-Bello, IO. Adedokun, BO. & Ojengbede, OA. 2009. The role of ethnicity on pain perception in labor among parturients at the University College Hospital Ibadan. J Obstet Gynaecol Res 35(2):277–81. Doi: 10.1111/j.1447-0756.2008.00937. x.

[10]  Raosoft, Inc. 2004. Sample size calculator. Available: [Accessed 14.12.2020].

[11]  Dugashvili, G. Kotchlashvili, T. Menabde, G. Janelidze, M. & Marks, L. 2019. Use of the universal pain assessment tool for evaluating pain associated with temporomandibular disorders in youngsters. Eur J Paediatr Dent 20(4):315–9. doi: 10.23804/ejpd.2019.20.04.11.

[12]  Jones, L. Othman, M. Dowswell, T. Alfirevic, Z Gates, S. Newburn, M. et al. 2012. Pain management for women in labour: an overview of systematic reviews. Cochrane Pregnancy and Childbirth Group, editor. Cochrane Database Syst Rev [cited 2020 Dec 4]; Available from:

[13]  Siyoum, M. Mekonnen, S. 2019. Labor pain control and associated factors among women who gave birth at Leku primary hospital, southern Ethiopia. BMC Res Notes 12(1):619. doi: 10.1186/s13104-019-4645-x.

[14]  Kigenyi, O. Tefera, GB., Nabiwemba, E. & Orach, CG. 2013. Quality of intrapartum care at Mulago national referral hospital, Uganda: clients’ perspective. BMC Pregnancy Childbirth 13:162. doi: 10.1186/1471-2393-13-162.

[15]  Aziato, L. Ohene, L.A. Dedey, F. & Clegg-Lamptey, JN. 2016. ‘I was in real pain’: Surgical nurses’ personal pain experiences in Ghana. International Journal Caring Sciences 9(1):90. Available: [Accessed 10.11.2020].

[16]  Aduloju, OP. 2013. Pain perception among parturients at a University Teaching Hospital, South-Western Nigeria. Niger Med J 54(4):211–6. doi: 10.4103/0300-1652.119597.

[17]  Obuna, JA. & Umeora, OU. 2014. Perception of labor pain and utilization of obstetric analgesia by Igbo women of Southeast Nigeria. J Obstet Anaesth Crit Care 4(1):18-22. doi: 10.4103/2249-4472.132815.

[18]  Emelonye, AU. Pitkäaho, T. Aregbesola, A. & Vehviläinen-Julkunen, K. 2016. Spouses’ perspective of their participation and role in childbirth pain relief. Ann Med Health Sci Res 6(6):367–74. doi: 10.4103/amhsr.amhsr_12_16.

[19]  Steel, A. Adams, J. Sibbritt, D. Broom, A. Gallois, C. & Frawley, J. 2015. Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women. Health Expect 18(5):1633–44. Doi: 10.1111/hex.12155.

[20]  Shaban, I. Mohammad, K. & Homer, C. 2016. Development and validation of women’s satisfaction with hospital-based intrapartum care scale in Jordan. J Transcult Nurs 27(3):256–61. Doi: 10.1177/1043659614550486.

[21]  Akadri, AA. & Odelola, OI. 2018. Labour pain perception: experiences of Nigerian mothers. Pan Afr Med J 30:288. Doi: 10.11604/pamj.2018.30.288.16672.

[22]  Henderson, J. & Redshaw, M. 2017. Sociodemographic differences in women’s experience of early labour care: a mixed methods study. BMJ Open 7(7): e016351. Doi: 10.1136/bmjopen-2017-016351.

[23]  Ullman R, Smith LA, Burns E, Mori R, Dowswell T. 2010. Parenteral opioids for maternal pain management in labour. Cochrane Pregnancy and Childbirth Group, editor. Cochrane Database [6.pub2].

[24]  Aziato, L. Odai, PN. & Omenyo, CN. 2016. Religious beliefs and practices in pregnancy and labour: an inductive qualitative study among post-partum women in Ghana. BMC Pregnancy Childbirth. 16(1):138. Doi: 10.1186/s12884-016-0920-1.

[25]  Kulesza-Brończyk, B. Dobrzycka, B. Glinska, K. & Terlikowski, SJ. 2013. Strategies for coping with labour pain. Prog Health Sci 3(2):82-7 Available: [Accessed 13.12.2020].

[26]  Yuksel, H. Cayir, Y. Kosan, Z. Tastan, K. 2017. Effectiveness of breathing exercises during the second stage of labor-on-labor pain and duration: a randomized controlled trial. J Integr Med 15(6):456–61.

[27]  Nattah, FM. & Abbas, WA. 2015. Assessment of level of pain and its relationship with breathing exercise in the first stage of labour among primi mothers at Hilla Teaching Hospital. Eur J Sci Res 135(2):121-8. Available: [Accessed 05.11.2020].

[28]  Melzack, R. Bélanger, E. & Lacroix, R. 1991. Labor pain: effect of maternal position on front and back pain. J Pain Symptom Manage 6(8):476–80. Doi:10.1016/0885-3924(91)90003-m.

[29]  Ondeck, M. 2014. Healthy birth practice #2: walk, move around, and change positions throughout labor. J Perinat Educ 23(4):188–93. Doi: 10.1891/1058-1243.28.2.81.

[30]  Lawrence, A. Lewis, L. Hofmeyr, GJ. & Styles, C. 2013. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. CD003934. Doi: 10.1002/14651858.CD003934.pub4. [Accessed 09.122.2020].

[31]  Levett, KM. Smith, CA. Bensoussan, A. & Dahlen, HG. 2016. Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour. BMJ Open 6(7): e010691. Doi: 10.1136/bmjopen-2015-010691.

[32]  Taavoni, S. Abdolahian, S. & Haghani, H. 2013. Effect of sacrum-perineum heat therapy on active phase labour pain and client satisfaction: a randomized, controlled trial study. Pain Med 14(9):1301–6. Doi: 10.1111/pme.12161.

[33]  Lee, SL. Liu, CY. Lu, YY. Gau, ML. 2013. Efficacy of Warm Showers on Labor Pain and Birth Experiences During the First Labor Stage. J Obstet Gynecol Neonatal Nurs 42(1):19–28.

[34]  Ganji, Z. Shirvani, M. Rezaei-Abhari, F. Danesh, M. 2013. The effect of intermittent local heat and cold on labor pain and childbirth outcome. Iran J Nurs Midwifery Res 18:298–303.

[35]  National Maternity Guidelines Committee. Guidelines for maternity care in South Africa. National Department of Health; 2016. Available
from: [Accessed 01.12.2020].