Abstract:
BACKGROUND : Severe unbearable pain leads to maternal exhaustion, prolonged labour and foetal distress and needs to
be managed. The management of pain during the first stage of labour is affected by workplace culture. It was observed
that pain is not relieved during labour, and it was not clear when and how labour pain was assessed, and pain relief
implemented. There is value in understanding workplace culture in an organization as change is often necessary.
AIM : This paper aims to understand the workplace culture of midwives regarding pain management during the first
stage of labour by observing current practices.
METHODS : A qualitative structured participant observation was used to observe the labour pain management practice of
midwives and doctors in 18 structured sessions lasting over 19 hours in a central hospital in Gauteng province, South
Africa. Structured participant observation involved midwives working permanently in the labour ward as co-observers
using a creative hermeneutic data analysis.
RESULTS : Two main themes emerged from the data collected: pain assessment and isolation. Midwives and doctors
assessed labour pain poorly or not at all and did not implement pharmacological or non-pharmacological methods of
pain relief. Women in labour were left alone for periods exceeding 30 minutes without a partner or other support
person.
LINKING EVIDENCE TO ACTION : This study suggests that the current workplace culture in the labour ward includes not
assessing or treating (pharmacological and non-pharmacological) women’s pain during the first stage of labour. Pain
management strategies should be collaboratively planned with midwives to improve the management of pain during
labour and the attitude towards support persons.
