Workplace culture of midwives regarding pain management during the first stage of labour

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.