title: Pain relief in labour: a qualitative study to determine how to support women to make decisions about pain relief in labour.
abstract: BACKGROUND
  Engagement in decision making is a key priority of modern healthcare. Women are encouraged to make decisions about pain relief in labour in the ante-natal period based upon their expectations of what labour pain will be like. Many women find this planning difficult. The aim of this qualitative study was to explore how women can be better supported in preparing for, and making, decisions during pregnancy and labour regarding pain management.
  
  
  METHODS
  Semi-structured interviews were conducted with 13 primiparous and 10 multiparous women at 36 weeks of pregnancy and again within six weeks postnatally. Data collection and analysis occurred concurrently to identify key themes.
  
  
  RESULTS
  Three main themes emerged from the data. Firstly, during pregnancy women expressed a degree of uncertainty about the level of pain they would experience in labour and the effect of different methods of pain relief. Secondly, women reflected on how decisions had been made regarding pain management in labour and the degree to which they had felt comfortable making these decisions. Finally, women discussed their perceived levels of control, both desired and experienced, over both their bodies and the decisions they were making.
  
  
  CONCLUSIONS
  This study suggests that the current approach of antenatal preparation in the NHS, of asking women to make decisions antenatally for pain relief in labour, needs reviewing. It would be more beneficial to concentrate efforts on better informing women and on engaging them in discussions around their values, expectations and preferences and how these affect each specific choice rather than expecting them to make to make firm decisions in advance of such an unpredictable event as labour.
authors.affiliation: Institute of Health and Society, Baddiley Clark Building, Newcastle University, Baddiley-Clark Building Richardson Road, Newcastle upon Tyne NE2 4AX, United Kingdom. Joanne.Lally@ncl.ac.uk.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Lally
authors.forename: Richard G
authors.initials: RG
authors.lastname: Thomson
authors.forename: Sheila
authors.initials: S
authors.lastname: MacPhail
authors.forename: Catherine
authors.initials: C
authors.lastname: Exley
mesh_terms: D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D048949:Labor Pain / Q000628:therapy*; D007743:Labor, Obstetric; D059408:Pain Management / Q000379:methods; D010298:Parity; D010353:Patient Education as Topic; D010358:Patient Participation; D057240:Patient Preference; D011247:Pregnancy; D011295:Prenatal Care; D036301:Qualitative Research