Pain perception among parturients in Enugu, South-eastern Nigeria

In order to evaluate pain perception among parturients in Enugu, South-east Nigeria, a cross-sectional questionnaire study of parturients who delivered vaginally in four health institutions in Enugu from 2 December 2005 to 21 January 2006 was administered. Data analysis was by means of percentages, means +/- SD, correlation coefficients, t-tests, chi2-tests, one-way ANOVA and other inferential statistics using the statistical package SPSS for MS Windows at the 95% confidence level. A total of 250 questionnaires were distributed, out of which 181 were correctly filled and returned for a response rate of 72.4%. On a scale of 0 to 10, with 0 representing no pain and 10 representing maximal pain, the mean intensity of pain recorded by the respondents was 7.7 +/- 2.8. A total of 40 (22.1%) parturients received some pain relieving drug during their labour while 141 (77.9%) did not. Of the 40 women who received intra-partum analgesia, three women received pethidine, 17 (42.5%) received pentazocine, while 20 (50%) did not know the analgesic they received. Of the 141 respondents who did not receive intra-partum analgesia, 79 (56.0%) would have liked to have receive analgesia, while 62 (44.0%) would not. Of the 92 women who had their backs rubbed by companions during labour, 67 (72.8%) reported that this practice was helpful in relieving their labour pains, while 25 (27.2%) did not find it helpful. Of the 141 women who had a companion, 103 (73.0%) reported that this was helpful in relieving labour pains, while 38 (27.0%) reported no benefit. Antenatal care, place of residence, ethnicity, religion, marital status, occupational level, receiving intra-partum analgesia, type of analgesia received, having a companion during labour or receiving lectures on labour pains during the antenatal period had no significant impact on pain perception by the respondents (p > 0.05 for each of these variables). There was no significant correlation between pain scores and the respondents' ages and gestational age at delivery (p > 0.05). However, there was a significant positive correlation between the parturients' pain scores and their educational levels (r = 0.18, p = 0.018) and a significant negative correlation between pain scores and parity (r = -0.23, p = 0.009), with primigravidae having the highest perceived mean pain score compared with multiparas and grandmultiparas (7.5 +/- 2.3 vs 6.6 +/- 2.5 vs 6.3 +/- 2.1, p = 0.048). Additionally, those parturients who had their backs rubbed by a companion had a significantly higher mean perceived pain score than their counterparts whose backs were not rubbed (8.4 +/- 2.4 vs 6.8 +/- 2.9, p = 0.000). Parturients whose labours were either induced or augmented had a significantly higher perceived mean pain score than those who had spontaneous labour (8.9 +/- 2.5 vs 7.1 +/- 2.8, p = 0.001). It was concluded that parturients in Enugu, Eastern Nigeria, perceive labour as a very painful process with only a minority of them receiving any form of intra-partum analgesia. There is thus a large unmet need for pain relief among the parturients. Obstetric analgesia as is currently practiced in developed countries is long overdue in Nigeria.