Labour analgesia: awareness and barriers among healthcare providers at a tertiary care centre

Kalyani S. D. L. Sangineni; Sushmitha Salian; Anish Waghray; Sandeep Garre; Rama Krishna Prasad Chikkala; Syama Sundar Ayya

doi:10.18203/2320-6012.ijrms20260605

Authors

Kalyani S. D. L. Sangineni Department of Anaesthesiology, AIIMS Bibinagar, Hyderabad, Telangana, India
Sushmitha Salian Department of Anaesthesiology, AIIMS Bibinagar, Hyderabad, Telangana, India https://orcid.org/0009-0000-1323-4074
Anish Waghray Department of Anaesthesiology, Amista Hospital and Clinics, Banjara Hills, Hyderabad, Telangana, India https://orcid.org/0009-0007-9553-1697
Sandeep Garre Department of Anaesthesiology, AIIMS Bibinagar, Hyderabad, Telangana, India https://orcid.org/0009-0006-1481-8075
Rama Krishna Prasad Chikkala Department of Anaesthesiology, AIIMS Bibinagar, Hyderabad, Telangana, India https://orcid.org/0000-0001-9284-0020
Syama Sundar Ayya Department of Anaesthesiology, AIIMS Bibinagar, Hyderabad, Telangana, India https://orcid.org/0000-0002-5181-5993

DOI:

https://doi.org/10.18203/2320-6012.ijrms20260605

Keywords:

Labour analgesia, Tertiary care, Pregnant women, Questionnaire, Antenatal education

Abstract

Background: Labour analgesia has evolved from use of ether to modern regional techniques, significantly improving maternal and neonatal outcomes. Despite advancements and increasing awareness utilization remains limited among parturients in India. The aim of the study was to assess knowledge, perceptions of healthcare providers regarding labour analgesia and to identify barriers to its wider implementation.

Methods: Mixed-method cross-sectional survey was conducted among 303 healthcare providers at our institute using a validated questionnaire. Both qualitative and quantitative data were collected. Internal consistency and face validity were established during pilot testing. Descriptive and inferential analysis were performed.

Results: Of 303 respondents, 60.7% (185) were female and 46.2% (139) were doctors. Although 95% (285) were aware of the term labour analgesia, only 52.8% (161) had witnessed its administration. Approximately one quarter of respondents believed it prolongs the duration of labour. Barriers to utilization of labour analgesia included lack of availability of anaesthesiologist (14.2%, n=42) and not being offered services (17.8%, n=55). A majority (68.3%, n=207) endorsed antenatal education, and 56.1% (n=170) supported its inclusion in government hospitals.

Conclusions: Despite high awareness of labour analgesia, its utilization remains limited due to systemic barriers. Increased training and practice of labour analgesia in teaching institutes may help build trust and enhance its utilization.

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References

Shidhaye RV, Galande MV, Bangal VB, Joshi SS, Shidhaye UR. Awareness and attitude of Indian pregnant women towards labour analgesia. Anaesth Pain Intensive Care. 2012;16(2):131-6.

WHO. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018.

Jain K, Bhatia N, Parikh K, Singla K, Dhir A, Gupta S, et al. A cross-sectional study of labour analgesia practices across India. J Obstet Anaesth Crit Care. 2024;14(2):65-72. DOI: https://doi.org/10.4103/JOACC.JOACC_51_23

Seijmonsbergen-Schermers AE, van den Akker T, Rydahl E, et al. Variations in use of childbirth interventions in 13 high-income countries: a multinational cross-sectional study. PLoS Med 2020;17(5):e1003103. DOI: https://doi.org/10.1371/journal.pmed.1003103

Li Z, Zhou X, Wang H. Epidural ropivacaine versus levobupivacaine for labour: meta-analysis of maternal and fetal outcomes. BMC Anesthesiol 2024;24:45. DOI: https://doi.org/10.1186/s12871-024-02767-4

Chen Y, Liu S, Zhao X, et al. Epidural analgesia and intrapartum caesarean indications: retrospective cohort study. BMC Pregnancy Childbirth 2021;21:512.

Nirmalan PK. The validation of questionnaires. Kerala J Ophthalmol 2021;33(3):260–2. DOI: https://doi.org/10.4103/kjo.kjo_12_21

United Nations Children’s Fund (UNICEF) India. Key data, 2025. Available at: https://www.unicef.org/india/key-data. Accessed on 26 June 2025.

Minhas MR, Kamal R, Afshan G, Raheel H. Knowledge, attitude and practice of parturients regarding epidural analgesia for labour in a university hospital in Karachi. J Pak Med Assoc 2005;55(2):63-6.

American College of Obstetricians and Gynecologists. Analgesia and cesarean delivery rates. Committee Opinion No. 339. Obstet Gynecol. 2006;107:213-5

American College of Obstetricians and Gynecologists. Pain relief during labor. Committee Opinion No. 295. Obstet Gynecol. 2004;104:213-5. DOI: https://doi.org/10.1097/00006250-200407000-00061

National Institute for Health and Care Excellence (NICE). Intrapartum care for healthy women and babies. Clinical Guideline CG190. London: National Institute for Health and Care Excellence; 2014.

Imarengiaye CO, Olagbuji BN, Ezeanochie MC, Akhideme II. Clinical correlates of women requesting labour epidural analgesia in a tertiary hospital in Nigeria. Niger Postgrad Med J. 2013;20(3):181-5. DOI: https://doi.org/10.4103/1117-1936.164833

Melesse AS, Bayable SD, Simegn GD, Ashebir YG, Ayenew NT, Fetene MB. Survey on knowledge, attitude and practice of labour analgesia among health-care providers at Debre Markos Comprehensive Specialized Hospital, Ethiopia 2021: a cross-sectional study. Ann Med Surg (Lond) 2022;81:104525. DOI: https://doi.org/10.1016/j.amsu.2022.103306

Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;(5):CD000331. DOI: https://doi.org/10.1002/14651858.CD000331.pub4

Narayanappa A, Gurulingaswamy S, Prabhakaraiah U, Kempegowda K, Hanumantharayappa NB. Practice of labour analgesia among anaesthesiologists across India: a cross-sectional study. Anesth Essays Res. 2018;12(1):204-9. DOI: https://doi.org/10.4103/aer.AER_74_18

Dalal K, Chakraborty S, Mandal S, Nordenmark M, Landstad BJ. Do occupations affect the experience of prolonged labour pain? A national study of women in India. Discov Soc Sci Health. 2025;2(1):e0012. DOI: https://doi.org/10.1007/s44155-025-00239-9

Parajuli BD, Koirala M, Joshi P. Knowledge and attitude about labour epidural analgesia among pregnant women attending antenatal clinic. J Nepal Health Res Counc. 2024;22(2):188-94.

Govindrao Deogaonkar S, Natekar S. Awareness and acceptance of labour analgesia in rural India. Int J Med Res Rev. 2016;4(12):2255-60. DOI: https://doi.org/10.17511/ijmrr.2016.i12.15

Vijapurkar S, Sandeep G, Kalbande JV, Merin Thomas S, Singha SK. Knowledge, attitude, and practices of labour analgesia among obstetric residents: a cross-sectional survey. Cureus. 2024;16(6):e62326. DOI: https://doi.org/10.7759/cureus.62326

Hussain SS, Maheswari P. Barriers for labour analgesia in South India: knowledge and attitude of relevant stakeholders- a hospital-based cross-sectional study. Indian J Anaesth. 2017;61(2):170-3. DOI: https://doi.org/10.4103/0019-5049.199848

Taneja B, Nath K, Dua CK. Clinical audit on the existing attitudes and knowledge of obstetricians regarding labour analgesia. Indian J Anaesth. 2014;58(2):185-8.