Parturients experience labour pain of varying degrees, ranging from moderate to severe pain during the first and second stages of labor. The progression, intensity, characteristics, as well as the cause of first and second stage of labour pain varies greatly among women (1–5). When pain during labor is severe it may adversely affect parturient and fetus. Particularly those parturient with cardiac co-morbidity are at high risk. Therefore, effective pain relief in labour is not only humane, but has vast physiological and psychological benefits for both the mother and the baby (4–7).
Currently, the practice of pain relief during labour is become a growing area. Several controversies have existed since its evolution from the biblical myths to date. However, apart from medical indication, maternal request signifies sufficient justification for labour pain analgesia. In many developed countries, labour analgesia is considered an important part of ante-natal and intra/post-partum care. During ante-natal care for women with fixed cardiac output, planning the method of labour analgesia is becoming a routine practice(7–9).
Nowadays, there are many methods of pain relief in labour including pharmacological and non-pharmacological. The essentials of obstetric pain relief methods must be safe, simple, effective, not interfering with labour progression, and ideally should preserve fetal homeostasis(3, 7, 10). There is a wide spectrum of non-pharmacological options available for pain relief in labour include psychological therapies(7, 11, 12), continuous social support(7, 11, 12), mind-body intervention(7, 11, 12), the use of transcutaneous electrical nerve stimulator (TENS)(13, 14), acupuncture(15, 16). The pharmacological analgesia for labour include non-opioids (ketamine)(7), opioids (pethidine, morphine, and fentanyl)(3, 7, 17, 18), inhalational analgesia (a 50:50 mix of oxygen/nitrous oxide, and volatile agents)(3, 7), and regional analgesia for labour [epidural analgesia(19, 20), combined spinal-epidural, and peripheral nerve blocks](3, 7). The effectiveness and adverse events of these methods of pain relief in labour varies. Overall, the available evidence suggests that epidural labour analgesia remains the gold standard, and currently it is the method used widely.
Studies have shown that various barriers contributing to optimal treatment of labour pain and utilization of labour analgesia include health professional related barriers, system related barriers, and patient-related barriers. Among those, health care provider related barriers are the main barriers, the easiest to be assessed and measured, and to be corrected in many low and middle-income countries such as Ethiopia. A lack of knowledge, poor attitudes, and unavailability of labour analgesia options are considered to be the main barriers that influences utilization of labour analgesia in low resource settings(2, 21–23).
An increasing body of evidences showed that many health care professionals lack adequate knowledge and attitude for effectively managing labour pain, leaving many women and their baby to endure a reduced functional and psychological quality of life(22, 23). This poor knowledge and attitudes begins in basic educational programs (24–26). Studies on students’ knowledge and attitude about pain relief in labour are limited. However, there are studies regarding graduate students’ (nursing, midwifery, pharmacy, and medical students) about pain management in general, and inadequate knowledge of pain management has been reported (26–28).
Ethiopia is a low-income country and working hard to achieve Sustainable Development Goals 4, and Ministry of Health is focusing on a very important part of pregnancy. However, the issue of obstetric analgesia as part of maternal care is not a common practice and often neglected in Ethiopia. This may have been influenced by several factors such as awareness and experience of health care providers, acceptability and availability, restricted training and teaching about labour analgesia. Midwives are the health care professionals that pregnant women come in close contact with commonly in Ethiopia. To date there is no published data on new graduate midwives’ awareness and attitudes of pain relief in labour and the options or methods of labour analgesia in Ethiopia. In addition, newly graduate midwives can have an effective role in establishing labour analgesia service and in raising of awareness of mothers. For this purpose, therefore, we conducted a cross-sectional study to assess final year midwifery students’ knowledge and attitude towards pain relief in labour.