Obstetric anaesthesia in low-resource settings

Dyer, Robert A.; Reed, Anthony; James, Michael F.

doi:10.1016/j.bpobgyn.2009.11.005

Cited by 32 publications

(17 citation statements)

References 63 publications

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“…In other studies, Indian obstetricians report a lack of education and training on epidural as a pharmacological pain management option in their training programmes [35, 36]. These challenges were similar to those reported in our study, where healthcare providers were not in a position to implement this service due to financial constraints [37] and a limited number of appropriately trained healthcare providers and/or anaesthetists (0.05 anaesthetists for every 100,000 people) [38]. …”

Section: Discussionsupporting

confidence: 87%

“We know it’s labour pain, so we don’t do anything”: healthcare provider’s knowledge and attitudes regarding the provision of pain relief during labour and after childbirth

McCauley

Danna

Mrema

et al. 2018

BMC Pregnancy Childbirth

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BackgroundMost women experience pain during labour and after childbirth. There are various options, both pharmacological and non-pharmacological, available to help women cope with and relieve pain during labour and after childbirth. In low resource settings, women often do not have access to effective pain relief. Healthcare providers have a duty of care to support women and improve quality of care. We investigated the knowledge and attitudes of healthcare providers regarding the provision of pain relief options in a hospital in Moshi, Tanzania.MethodsSemi-structured key informant interviews (n = 24) and two focus group discussions (n = 10) were conducted with healthcare providers (n = 34) in Tanzania. Transcribed interviews were coded and codes grouped into categories. Thematic framework analysis was undertaken to identify emerging themes.ResultsMost healthcare providers are aware of various approaches to pain management including both pharmacological and non-pharmacological options. Enabling factors included a desire to help, the common use of non-pharmacological methods during labour and the availability of pharmacological pain relief for women who have had a Caesarean section. Challenges included shortage of staff, lack of equipment, no access to nitrous oxide or epidural medication, and fears regarding the effect of opiates on the woman and/or baby. Half of all healthcare providers consider labour pain as ‘natural’ and necessary for birth and therefore do not routinely provide pharmacological pain relief. Suggested solutions to increase evidence-based pain management included: creating an enabling environment, providing education, improving the use of available methods (both pharmacological and non-pharmacological), emphasising the use of context-specific protocols and future research to understand how best to provide care that meets women’s needs.ConclusionsMany healthcare providers do not routinely offer pharmacological pain relief during labour and after childbirth, despite availability of some resources. Most healthcare providers are open to helping women and improving quality of pain management using an approach that respects women’s culture and beliefs. Women are increasingly accessing care during labour and there is now a window of opportunity to adapt and amend available maternity care packages to include comprehensive provision for pain relief (both pharmacological and non-pharmacological) as an integral component of quality of care.

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Section: Discussionsupporting

confidence: 87%

“We know it’s labour pain, so we don’t do anything”: healthcare provider’s knowledge and attitudes regarding the provision of pain relief during labour and after childbirth

McCauley

Danna

Mrema

et al. 2018

BMC Pregnancy Childbirth

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“…Although epidural analgesia is the standard of care in the developed world, spinal analgesia can be an appropriate substitute in low-resource settings. 1,7 Ghana, the site of this research project, is defined as a developing country. 24,25 Spinal analgesia is a relatively safe, easy and cost-effective procedure, when administered by an appropriate health practitioner, such as an anaesthetist.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 With limited resources for epidural analgesia, spinal analgesia may be a useful alternative for relief from labour pain. 7 It has been suggested that spinal opioids provide effective analgesia during labour, with no adverse impact on the incidence of neonatal complications. 8 A diverse body of literature exists on the potential advantages and disadvantages of spinal analgesia on patient ambulation.…”

Section: Introductionmentioning

confidence: 99%

Low-dose spinal anaesthesia provides effective labour analgesia and does not limit ambulation

Anabah

Olufolabi

Boyd

et al. 2015

Southern African Journal of Anaesthesia and Analgesia

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Background: While epidural analgesia for labour pain is standard in high-resource countries, minimal to no analgesia is usually provided in low-resource countries. Intrathecal local anaesthetics provide good pain relief, but the potential impact on ambulation is of concern. Our objective was to determine if a low-dose local anaesthetic combined with an opioid would provide reasonable pain relief, while allowing ambulation in a low-resource setting. Method: This prospective, observational study was conducted at the Tamale Teaching Hospital in Tamale, Ghana. Spinal analgesia was administered to healthy women in labour using a pencil-point 25-G spinal needle at the L3-L4 or L4-L5 interspace, with patients in the sitting position. The intrathecal mixture contained 25 μg of fentanyl, 2.5 mg of bupivacaine and 0.2 mg of morphine. The patient's ability to ambulate following the administration of a low-dose spinal injection was the primary outcome measured. Pain ratings, blood pressure, nausea, vomiting, pruritus, headaches and foetal bradycardia were also recorded. Results: Three hundred and thirty-two parturients consented to participate. Following spinal injection, 328 women (98.8%) experienced mild to no pain, and 4 (1.2%) moderate pain. The administration of spinal analgesia had no effect on ambulation in 291 (87.7%) patients, and a mild effect in 41 (12.3%) patients. Intrathecal analgesia did not severely limit ambulation in any of the patients. Conclusion: Low-dose intrathecal analgesia can provide effective analgesia for labouring patients in low-resource settings without limiting ambulation.

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“…4 The World Federation of Societies of Anesthesiologists (WFSA) recommends the international standards for safe practice of anesthesia for anesthesia professionals throughout the world. They are intended to provide guidance and assistance to anesthesia professionals, their professional societies, hospital and facility administrators, and governments for improving and maintaining the quality and safety of anesthesia care.…”

mentioning

confidence: 99%

Challenges of Anesthesia in Low- and Middle-Income Countries: A Cross-Sectional Survey of Access to Safe Obstetric Anesthesia in East Africa

Epiu

Tindimwebwa

Mijumbi

et al. 2017

Anesthesia &Amp; Analgesia

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BACKGROUND The United Nations 2015 Millennium Development Goals targeted a 75% reduction in maternal mortality. However, in spite of this goal, the number of maternal deaths per 100,000 live births remains unacceptably high across Sub-Saharan Africa. Because many of these deaths could likely be averted with access to safe surgery, including cesarean delivery, we set out to assess the capacity to provide safe anesthetic care for mothers in the main referral hospitals in East Africa. METHODS A cross-sectional survey was conducted at 5 main referral hospitals in East Africa: Uganda, Kenya, Tanzania, Rwanda, and Burundi. Using a questionnaire based on the World Federation of the Societies of Anesthesiologists (WFSA) international guidelines for safe anesthesia, we interviewed anesthetists in these hospitals, key informants from the Ministry of Health and National Anesthesia Society of each country (Supplemental Digital Content, http://links.lww.com/AA/B561). RESULTS Using the WFSA checklist as a guide, none of respondents had all the necessary requirements available to provide safe obstetric anesthesia, and only 7% reported adequate anesthesia staffing. Availability of monitors was limited, and those that were available were often nonfunctional. The paucity of local protocols, and lack of intensive care unit services, also contributed significantly to poor maternal outcomes. For a population of 142.9 million in the East African community, there were only 237 anesthesiologists, with a workforce density of 0.08 in Uganda, 0.39 in Kenya, 0.05 in Tanzania, 0.13 in Rwanda, and 0.02 anesthesiologists in Burundi per 100,000 population in each country. CONCLUSIONS We identified significant shortages of both the personnel and equipment needed to provide safe anesthetic care for obstetric surgical cases across East Africa. There is a need to increase the number of physician anesthetists, to improve the training of non-physician anesthesia providers, and to develop management protocols for obstetric patients requiring anesthesia. This will strengthen health systems and improve surgical outcomes in developing countries. More funding is required for training physician anesthetists if developing countries are to reach the targeted specialist workforce density of the Lancet Commission on Global Surgery of 20 surgical, anesthetic, and obstetric physicians per 100,000 population by 2030.

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Obstetric anaesthesia in low-resource settings

Cited by 32 publications

References 63 publications

“We know it’s labour pain, so we don’t do anything”: healthcare provider’s knowledge and attitudes regarding the provision of pain relief during labour and after childbirth

“We know it’s labour pain, so we don’t do anything”: healthcare provider’s knowledge and attitudes regarding the provision of pain relief during labour and after childbirth

Low-dose spinal anaesthesia provides effective labour analgesia and does not limit ambulation

Challenges of Anesthesia in Low- and Middle-Income Countries: A Cross-Sectional Survey of Access to Safe Obstetric Anesthesia in East Africa

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