Comparing the Experiences of Parturient Women with Remifentanil Analgesia and Elective Cesarean Section and Providing Improver Strategies: A sequential explanatory mixed method study

Abstract

Abstract Introduction: The experiences that women gain from their childbirth process are considered as one of the important consequences of childbirth and these experiences always remain with them throughout their lives. Labor pain is one of the most severe pain a woman experiences, and despite the use of various sedatives, controlling it is still one of the health problems in most countries. One of the most important reasons for women to prefer cesarean delivery without medical indication is fear and intolerance of labor pains. Various types of pain relief techniques have been introduced throughout labor, including epidural anesthesia and injectable drugs. Recently, the use of remifentaline to reduce labor pain has become more common due to its lower side effects than narcotics; Therefore, the research team decided to compare the experiences of postpartum women with remifentanil analgesia and elective cesarean section and provide delivery improvement strategies and examine the effect of the intervention designed based on the instructions on the delivery experience. Methods: This study is a mixed method study with sequential explanatory approach. The quantitative stage of the study was longitudinal. The target population was women giving birth by elective cesarean section and vaginal delivery using remifentanil analgesia in private hospitals in Tabriz. Sampling method was available in quantitative phase and 140 women giving birth were selected in two groups of elective cesarean section (n = 70) and women giving birth by receiving remifentanil (n = 70). For data collection, demographic-social questionnaires, pregnancy depression questionnaire, delivery experience questionnaire and midwifery and neonatal outcomes checklist were used. The results of t-test and multivariate linear regression analysis were reported with 95% confidence interval. In the qualitative phase, women's perceptions of the aspects and determinants of labor experiences were explained painlessly from the perspective of 17 postpartum women. Data were collected through in-depth individual interviews and note-taking using purposive sampling and analyzed using contractual content analysis. Then, based on the data obtained in the quantitative and qualitative part of the study, and by collecting the review results on the texts and opinions of the specialized panel, guidelines for improving delivery experiences were developed.

Results: The results of the quantitative section showed that in the vaginal delivery group with remifentanil analgesia, the income variable was one of the predictors of delivery experience, but in the cesarean section group, none of the demographic variables played a role in explaining the delivery experience score. Also, after adjusting for the effect of income confounder, the postpartum depression score was significantly higher in the elective cesarean section group than the vaginal delivery group with remifentanil analgesia. Analysis of qualitative data related to women's experiences of labor with analgesia leads to the formation of 9 main categories including interaction with infants, human dignity, analgesia, delivery environment, knowledge of analgesic techniques, satisfaction with childbirth, supportive role, concerns and Childbirth concerns and unpleasant childbirth experiences and 23 subclasses including the beginning of transplantation, comfort and relief, maintaining mother's independence, maintaining mother's dignity, analgesic technique, analgesic satisfaction, human elements, stressful environment, physical elements, gaining awareness, gaining Experience from others, misconceptions about painless childbirth, mother's personal attitude, postpartum comfort, effective accompanying presence, supportive role, deprivation of sponsorship, barriers to attendance, fear of childbirth, fear of harm, harm to The baby felt lonely, had a difficult and painful delivery, and was helpless. Finally, the results of the third phase led to the presentation of 70 suggestions for improving the experience of labor with analgesia. Conclusion: Considering the high prevalence of analgesic delivery, it is suggested that the developed strategies be made available to policy makers and planners to design programs with the approach of promoting natural childbirth and women's satisfaction. It is also recommended that obstetricians receive training on ways to improve pain-free delivery experiences.