21 Daughter Sample, Faith Diorgu & Halima Musa Abdul

This is Dr. Daughter. Today Dr. Midwifery, doctor in It's a midwife and a doctor. So, that's amazing to have you here, daughter. I don't know, maybe you want to introduce yourself, daughter. I think it's such a great pleasure just to go and don't be humble. Just tell us all about you. >> Thank you very much, Susan. Good evening, everybody. I want to specially greet my boss is here with me. Dr. Margaret Ezey. She's also in the house. Good evening, ma. Good evening, everybody. >> Thank you. Thank you very much, ma. >> Yes, ma. My name is Dr. Sample. I'm a registered nurse, a midwife, a public health nurse. I had a bachelor of degree in nursing, masters in maternal child health, and PhD in midwifery. I work with the Nursing and Midwifery Council of Nigeria as a nurse there. So, that is the brief description of myself, Susan. >> Fabulous, and we're so honored to have you here, and congratulations again on the big achievement. So, the floor is all yours. You can go ahead and then let us know about all your work. >> Thank you, ma. I am presenting on mother's perception on non-pharmacological interventions for labor pain relief in selected federal hospitals in Nigeria. And I have my co-authors, Professor Faith Diago and Dr. Alima Musa Abdul. Please, next. Hello, Susan. Thank you. Introduction. Labor pain, as we all know, is widely acknowledged as one of the most intense form of pain experienced by women and represents a significant aspect of child birth process. It is a very complex, subjective, and multi-dimensional phenomenon influenced by physiological, psychological, environmental, and social-cultural factors. Smith et al. 2020 and Oza et al. 2020. Next. Susan. Thank you. Inadequate pain relief has been associated with increased maternal anxiety, stress, dis- dissatisfaction with care, and negative birth experiences, which may have long-term psychological implications on the mother. Consequently, the provision of appropriate pain relief during labor is recognized globally as a fundamental component of quality maternal health care. The World Health Organization emphasizes that labor pain relief should be safe, it should be respectful, and also responsive to women's need and preferences. Next. Mother's perception of non-pharmacological labor pain relief is a critical determinant of its acceptance and utilization. Perception shapes expectations, influences their decision-making, and affects the effectiveness of care interventions. Negative perception may lead to underutilization of these methods we are talking about, while positive perception can enhance engagement and satisfaction with care. Therefore, understanding how mothers perceive these interventions is very critical and very essential for improving maternal centered care during labor pain management. Next. Despite the increasing advocacy for these methods, there is limited empirical evidence is on mothers' perception of these methods within Nigerian federal health care settings. Most existing studies have focused on clinical effectiveness or midwives' perspectives, with less attention given to mothers' uh viewpoints. This gap in knowledge highlights the need for studies that explore maternal perception in order to inform policies, practice, and education. Next. So, these are non-pharmacological labor pain methods, as we all know, refers to techniques that alleviate pain without the use of pharmacological methods. These methods include breathing exercises, massage, maternal positioning, relaxation technique, hydrotherapy, emotional support, aromatherapy, warm compresses, movement, walking as we all know. These approaches are non-invasive. They are cost-effective and easy to implement, making them particularly suitable for low source settings such as Nigeria. In addition to addressing physical discomfort, non-pharmacological methods also target the emotional and psychological aspects of the mothers, thereby promoting a more holistic approach. Next. Thank you. So, the objective of this um of this presentation is to examine the perception of mothers on the use of non-pharmacological labor pain relief methods in selected federal hospitals in Nigeria. So, by providing insights into mothers' experiences and viewpoints, the study aimed to contribute to the improvement of labor pain management practices and enhance the quality of maternal health care um services. Next. The research design The overall study adopted a sequential exploratory mixed method research design to comprehensively explore the experiences of mothers and midwives regarding the use of these um methods we are talking about. So, design The design is that of the sequential exploratory mixed method design. The quantitative component is that of the cross-sectional descriptive approach. So, for the purpose of this description uh for the purpose of this presentation, the quantitative aspect of the study using a cross-sectional descriptive approach will be presented. Next. The study area. Six federal hospitals from each of the geopolitical zones were um used for this study. As you can see, we have uh six geopolitical zones in in Nigeria, in our country. The Northwest Zone, where a teaching hospital um Ahmadu Bello University Teaching Hospital was used. The Northeast Zone, North Central, uh Southwest, Southeast, and that of South-South. Next. The sample size and sampling technique. For the quantitative aspect of this study, 160 models were used using uh the random sampling. Then the method of data analysis, for the quantitative aspect of this uh study, we adopted a descriptive cross-sectional design. Then data were collected using structured questionnaire, analyzed using descriptive statistics such as frequencies, percentages, and measures of central tendency. The quantitative The instrument used is that of structured questionnaire. Next. Hello. Okay, yes, sir. Then for data management, the validity was done by three-man expert panel. Um data entry SPSS uh 25 was used, and the descriptive statistics, mean standard deviation, was also used. Next. The results. Next table. Yes. For this first um the this uh table shows the social demographic statistics of the 104 for the mothers. As you can see the variables the age, the educational status, parity, gestational age of the mothers. The table shows that majority of the mothers were in their 20s, late 30s, late in their 20s to late 30s and had a secondary school education. And also with one to four children and most of them delivered vaginally. Next. Then for the perception of mothers on the use of these methods as you can see the findings indicate that sorry the table is not too clear but the findings indicate that mothers express negative perception towards the use of non-pharmacological methods of labor pain relief. With a grand mean of 1.00. Mothers actually agree that yes, these methods are cost-effective, they can reduce anxiety, they can reduce fear but they cannot completely relieve their pain. So they still believe in the pharmacological labor pain relief. That is the most significant of these study. Thank you. Discussion of findings. Mothers perception on these methods as I have earlier said reveals that mothers had overall negative perception of these methods. Although they agree that it is safe, natural and capable of reducing their anxiety but they still believe that it cannot completely eliminate their pain. So they serve they they need pharmacological methods. Then the discussion of findings, they are um The perception of mothers on these methods, this aligned with Botel et al. 2019 who reported that women often perceive these methods as supportive but insufficient for managing severe pain during labor. And also SN et al. 2023 observed that many women still prefer the pharmacological labor pain relief. In contrast, Bajo et al. 2022 observed more positive perception when multiple non-pharmacological methods are being used. When you combine them, suggesting that they may influence um satisfaction. The findings therefore suggest that education and expectation management during antenatal care may influence their overall perception. Conclusion. These methods are widely recognized as valuable supportive interventions. However, their utilization and acceptance are influenced by maternal perception, the health care system factors, cultural beliefs, and availability of resources. Next. And strengthening antenatal education, improving communication between mothers and midwives, and providing supportive labor environment may also enhance the effectiveness and acceptance of these interventions. Mothers view non-pharmacological as less effective than midwives did, highlighting the need for better training resources, education, and cultural awareness for effective use in these uh hospitals that we use. Next. Antenatal classes offer mothers the opportunity to learn about uh more about these uh non-pharmacological labor pain relief before delivery. It will also help. Then, the findings from this study show that mothers who understood these techniques, such as breathing exercises, massage, maternal positioning, warm compresses, were better able to cope with labor discomfort. Next. Breathing techniques emerge as a valuable coping mechanism in the study, helping mothers remain calm and focused during contraction. However, their effectiveness depends on prior familiarity and practice. If they had had uh um information about this technique, it would really play a very good um uh role um for them to accept it and uh really use it during labor. Then, pregnant women can also use online videos, group discussion in order to enhance these uh skills. Midwives and antenatal educators should encourage daily practice as part of uh routine uh pregnancy wellness. Recommendations. By discussing options early with the mothers, earlier during uh antenatal visits or during antenatal classes, midwives can tailor interventions to suit the mother's comfort, cultural background, and uh physical condition. Support also from family members also play a very important role. Uh birth partners, husbands, uh family members can also be allowed to be uh around during uh labor. It will also um go a long way in uh in helping. Next, please. They should also be involved to choose uh birth partners. It can be their spouses, can be friends or relatives. Uh in antenatal training section that covers massage therapy, warm compress uh application, assisting them with movement or uh positioning during labor. When partners actual uh actively involved, they provide both physical and uh physical relief and emotional reassurance by reducing their anxiety and sense of uh isolation. Next. Then healthcare administrators also have a very uh big role to play. Also the policy makers, they should prioritize uh these matters and integrate them into the hospital guidelines. Hospitals should also ensure that essential resources are available for nurses and also for the mothers during labor. For further studies and also further studies should be conducted to explore the effectiveness of specific non-pharmacological labor pain technique in reducing uh uh pain. Next. So these are some of my references. And uh next. Thank you very much. >> Thank you so much daughter and I think this is a very interesting finding and we have some time for questions and answers and thank you so much for being so thoughtful about time so we can start the conversation. Um, I feel that I have there's already some questions here in the chat box but any of you who want to ask questions please raise your hand and we can give you the uh the chance to ask these questions orally. Carol, do you feel that you want to talk or you're okay with me reading your question because I think coming from a doula I think this is a very interesting question to ask. >> Okay, I think you can we can can do this. >> Okay, perfect. So, Carol Carol asked Hi Carol, nice to see you. Pain mitigation is an important role that doulas play in the labor and delivery process. Are midwives traditionally making space for this work to happen as part of their practice? Let's ask this question in the context of your work for example in Nigeria daughter. >> Pain mitigation? >> Mhm. >> Let me get that straight. Pain mitigation. >> Yeah, what is the space of doulas for example in Nigeria to kind of strengthen this option of pain mitigation with through non-pharmacological pain relief? >> Okay. Doulas doulas Mhm. Uh midwives traditionally making space for this work to happen as part of their practice. I think so. Um, doulas doulas sorry. Can you hear me? >> Yes, I can hear you. >> Sorry. >> Yeah, and maybe our doulas part of the our part of the health system not part of the health system, but to your experience daughter, have you seen doulas maybe in Nigeria working? >> doulas is not a popular >> Mhm. >> thing in Nigeria. >> Mhm. >> So, yes. I've not really done anything on that, so I will not be able to >> Yeah. >> on that. Yes, sir. >> Yeah, I think that's a >> I think I will Yes. >> Yeah. I think that's >> something to to really look at. >> Yeah. >> It's something to really >> Thank you for asking the question, Carl, because I think that's where the in conversation starts. Um, I think maybe for those of you who are not familiar with doulas, and I could be wrong and I may Carl, you can add into the chat as well. Doulas are an excellent support system that help particularly in those situations where non-pharmacological pain relief are needed or could be things, right? Through a specific um, focusing on giving massages or training training families into how to reduce the pain perception >> Okay. >> during labor and birth. So, I think that's how the question was coming in. And it's interesting though to see that maybe the term doula or maybe as we do understand as doulas are maybe not necessarily well recognized on or or identified in in Nigeria. So, that is a very maybe that would be an interesting research question daughter. >> Definitely yes. >> To see where doulas are or what are the roles or maybe there's another name that we have for doulas in Nigeria. >> Yes, that would be very interesting. >> Maybe they are already they are there. And and Carol has already offered she can come and help. There you go. We have found I think that's a very very good question. >> It's a very researchable topic yes. >> Yes, and you have you have your teacher and your supervisor here so that will be an excellent research topic. >> We can work together to look at it. >> Yes, we have one person who's raised their hand. I'm just going to ask you to unmute. And then you can go ahead. >> Okay, Abdul Wahab. >> Yes, good evening my doctor. Congratulations. Congratulations for the latest achievement. >> Zainab yes. >> Good evening, how are you? Yeah. Thank you very much and congratulations on the wonderful presentation. Yes, I think from the explanation of your facilitator concerning the doulas. Yeah, I think it's something that we do in Nigeria though it is not institutionalized. It's not institutionalized because from the meaning it's somebody that is not medically trained that stays with a woman in labor. >> That is not medically trained. Like TBA's, are we talking about TBA's? >> Something like that. >> Traditional birth attendants. >> Okay. >> That they will provide all other care to the woman in labor and immediately after delivery. In fact, it can be a relative that will be taking care of like this omugwo of a thing that they do in the east. Something like that. >> No, but the person the person has has delivered. >> This one that doulas also >> trained labor? With what Susanna is saying >> Yes, it extends beyond labor. >> I think that it's already sparkling so many questions and I feel Carol, I think this is a great example of when >> you >> Yes. >> midwifery and doula world and then birth world in fact and can interact and then start the conversation. It's I have to say though that to my knowledge it's not the same as traditional birth attendants, so it's not the same as TBA. TBAs are have been perceived as traditional or indigenous midwives in some parts of the world. Um but doulas, they do have to my understanding Carol and this also differs around the world. They have some training. They some of them hold certificates and they actually have a very strong um body uh that recognizes their work. There's some parts of the world that their their work has been recognized as a way to not only decrease uh pain but actually to enhance the quality of care and to um uh to support to the experience of birth and or the course of pregnancy and postpartum as well. There are postpartum doulas too. There are pregnancy and labor and deliver birth doulas as well. So I think that is a very good especially because there is seems to be some um uh different definitions about are there doulas in Nigeria? I think that would be a >> Yes. >> great question to ask first. And then, what >> Yes. >> is the definition of doula, and how this definition actually maybe overlaps with something that's already happening in Nigeria. Um, I have to tell, for example, I'm coming from Peru, and then doulas are becoming more and more known from that term, uh, because it's also a I don't know where that name doula came, but in in Latin and Hispanic word, it didn't exist as as it. So, it took a lot of advocacy or so for people to be recognized as doulas. But, I think So, Carlow has already said here like she had to go through training and get certified, um, and is considered a traditional health worker in the US. So, I think that would be an excellent >> uh It's like it means uh different things in different country. >> Of course. >> it's what you're saying in your country, in some country they are trained. While in some countries they are not trained. For Nigeria, we we we I I don't think we have this set of people that like uh what uh Zenat was saying, >> Mhm. >> she was referring to them as uh maybe uh people that will come and look after um a woman that delivered or stayed with her during and after delivery. And so, it means different things to different person. So, we will look at her We will look at it. >> And maybe just exchange your email addresses. >> Yes. Yes. I have >> would be >> Yes. >> Yeah. And maybe after you find that, >> Yes. >> run your research again, and then see if um having doulas might change the perception of non-pharmacological pain management. I think that would be so. And then, you come and then present it to the IDM. >> Yes, the next year. Yes. >> Yes. >> Is Is it Is there something that we need to work on? Abdul Wahab, you are here. We will have to put heads together. My boss is here, Dr. Margaret We will do something and you will hear about doulas in the next uh In the next uh yeah. >> This is the idea of the IDM. >> Yes, the ID. >> This is the idea of the IDM to create the questions. >> Yes. I don't know I don't know whether my boss had heard something about doulas doulas before. >> Mhm. >> Ma, have you heard about doulas? >> Yes, I know there is that um uh something called doula. But um because they are trained trained but not medical professionals who assist women um during child birth and even after child birth. >> After birth. >> But they are not They are not medical professionals. But we don't have doulas in the Nigerian health care system. >> Yes, ma'am. >> Yes. Yes. >> Yes, we don't. What What is I can liken to doulas are what we call traditional birth attendants. >> Birth attendants. >> They are people who take care of women in labor and child birth. In the in the remote areas, those who don't have the key Some of them are trained. Some of them are trained. >> formally. Formal training. >> go They don't go through formal education but you know, they can learn through other wives old wives and there is a skill they develop over time and they assist women give birth in remote areas where there is no medical facility and things. It's not what dweller. Dwellers are not recognized in Nigeria. It's not in the health part of the health care system just as we see in other countries because I know in the US maternity women are you know assigned there are dwellers assigned to them who monitor them through pregnancy when it is reaching childbirth. They help them refer them to the hospital where they will give birth but such such thing does not occur in Nigeria for now. >> For now you said the word for now. That's amazing. Thank you so much for this insightful discussion. We're going to give the mic to Kioma. I asked Kioma to unmute and then maybe she has she or he sorry has another question and then we also have an comment here from midwife Shanae from Pakistan. They do not they do not know the concept of doulas. So I think Carol you are already making people question what's going on with the maternity centers that we don't know about doulas around the world. Okay, Kioma I think you can talk now. You have the mic on. You can go ahead and then ask your question. We cannot hear you Kioma. I don't know if you're asking something or you're using the mic. >> Yeah, I thank you for having me now. Yeah. So, I said I just wanted to respond to the issue of doula. First of all, I would thank the presenter daughter um Dr. for this wonderful presentation. Um but what I want to say concerning the doula in in some institutions here like in Aminu Kano Teaching Hospital here, what we have is what we call we call them birth companions. They equally act like those doulas. So, doulas are not actually trained. They are women or specifically that a mother or a relative that have experience as regards to child birth. So, any woman that have experience as regards to child birth can stand in as as a doula. So, in Aminu Kano Teaching Hospital here, what we uh use is a birth companions. They allow the birth companions to come in in form of doula to assist my give a kind of massage at the back and to relieve pain and then give some psychological support to the woman while she's in labor. So, we don't actually call them doulas >> Call them doulas, yes. >> We call them birth companions. So, that's what I wanted to thank you. >> There you go. I think we have a started our qualitative project here like asking >> Yeah. >> Do you know about doula and then we have them birth birth companions. So, probably that's a name that we we're giving them in other parts of the world and I agree with Carl. Carl has mentioned doulas work side by side with midwives in the US. Yeah, I I'm located in Canada and I know that doulas also work with us in delivery and delivery Um, and there are some of our clients that they also want to have more support during their birth and then while the midwife focuses on the clinical aspect and support of the client, the doula offers full support to the emotional, the spiritual, and holistic care. So, and they they are the ones actually that support the non-pharmacological. Maybe that's why maybe daughter, I'm just creating a hypothesis here. Maybe that's why some of the clients didn't have a good perception about non-pharmacological pain relief because that piece of who uses or who um applies the non-pharmacological pain relief, that is the piece missing maybe. I don't know. I'm just creating a hypothesis here. >> Yes. >> Anyways, you have the connection from Carlin and then she said that she is willing to travel wherever you are and then to work on this uh in this big question. >> Yes, it's it's something that we need to look at. >> Yes, totally. >> yes, we need to look at it. >> Exactly. Okay, so >> my first time of hearing that word, doula. I tell you. >> learning, don't don't don't we, right? We always learn something every time.