CLINICAL ARTICLE Denial of pain relief during labor to parturients in southeast Nigeria Chibuike O. Chigbu a, ⁎, Tonia C. Onyeka b a Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria b Department of Anesthesia, University of Nigeria Teaching Hospital, Enugu, Nigeria abstract article info Article history: Received 8 March 2011 Received in revised form 31 March 2011 Accepted 13 June 2011 Keywords: Analgesia Human rights Labor Nigeria Objective: To evaluate the experiences of parturients with regard to pain relief during labor in Enugu, Nigeria. Methods: Women attending the prenatal clinics of 3 maternity care centers were interviewed via pre-tested interviewer-administered questionnaires between August 2010 and January 2011. Both open and closed questions were asked to evaluate the opinions and experiences of the respondents with regard to labor analgesia in previous pregnancies. Results: Overall, 34.1% of respondents were aware of their right to labor pain relief. Only 33.5% of maternal requests for labor pain relief were granted. Women who did not request labor analgesia indicated ignorance and fear of labor caregivers as their major reasons. Conclusion: Most women in southeast Nigeria are unaware of their right to pain relief in labor. Ignorance and fear of unfavorable reactions from labor caregivers are hindering women from requesting labor analgesia. There is a need to address the issue of refusal of maternal requests for labor pain relief because it constitutes a violation of the fundamental right of the parturient and an unnecessary breach of medical ethics. © 2011 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. 1. Introduction Various means of pain relief in labor have been used worldwide for decades. The need for pain relief in labor derives from the fact that the pains of labor are not known to be beneficial to the labor process. Rather, labor pains have been documented to contribute to maternal distress and dissatisfaction [1,2]. Pain relief in labor can be achieved through pharmacologic and non-pharmacologic methods. Non-pharmacologic methods include breathing exercises, low-back massage, and acupuncture, whereas pharmacologic methods—which appear to be the mainstay of pain relief during labor in modern obstetrics—include parenteral opioids, inhalational agents, and epidural analgesia. Available evidence indicates that Nigerian women perceive labor as a very painful process [3], and the pains may not be desirable [2]. Nigerian women have also been reported to be desirous of pain relief in labor [3–6]. Even the more invasive epidural analgesia has been shown to receive widespread acceptability among Nigerian parturients [2]. In the face of increasing evidence of acceptability and desire for labor analgesia among Nigerian parturients, many studies have reported poor practice/provision of pain relief during labor in Nigeria [3,4]. Earlier reports indicate that between 22.1% and 38.9% of parturients receive labor analgesia [3,4]. The question is: why has the provision of labor analgesia in Nigeria remained very low, despite high awareness, desirability, and acceptance among Nigerian parturients? Anecdotal evidence points to the possibility of denial of parturients’ right to labor analgesia and the paternalistic attitude of caregivers. A MEDLINE search did not yield any previous studies exploring the issue of parturients’ right to labor analgesia. Pain relief is a fundamental human right and an ethical issue [7–10]. There is a global advocacy for “a paradigm shift of the medical profession's perspective of pain management from simply good practice to an imperative founded on patients’ rights” [7]. The aim of the present study was to evaluate the experiences of parturients in southeast Nigeria with regard to the relief of the pain of uterine contractions in labor within the context of the parturients’ right to such pain relief. 2. Materials and methods The present study was conducted at the University of Nigeria Teaching Hospital, Mother of Christ Specialist Hospital, and Aghaeze Hospital, Enugu, Nigeria, between August 1, 2010, and January 30, 2011. The University of Nigeria Teaching Hospital is a tertiary public health institution that serves as a referral center for the southeastern states of Enugu, Anambra, Imo, Ebonyi, and Abia; Mother of Christ Specialist Hospital is a mission hospital; and Aghaeze Hospital is a private hospital. In 2010, the University of Nigeria Teaching Hospital recorded 529 deliveries, with 4 vacuum deliveries and 2 cases of epidural anesthesia. Mother of Christ Specialist Hospital recorded 1180 deliveries, with no vacuum deliveries and no cases of epidural anesthesia. Aghaeze Hospital recorded 75 deliveries, with no vacuum International Journal of Gynecology and Obstetrics 114 (2011) 226–228 ⁎ Corresponding author at: Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, PMB 01129, Enugu 400001, Nigeria. Tel.: + 234 8037027137. E-mail address: chchigbu@yahoo.com (C.O. Chigbu). 0020-7292/$ – see front matter © 2011 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. doi:10.1016/j.ijgo.2011.04.006 Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo