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Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands.

Christiaens W, Verhaeghe M, Bracke P - BMC Health Serv Res (2010)

Bottom Line: Apart from this general result, we also find large country differences.Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts.In the Netherlands, on the contrary, pain medication use is already low.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Sociology, Ghent University, Ghent, Belgium. wendy.christiaens@UGent.be

ABSTRACT

Background: A cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in 2 maternity care models. Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process.

Methods: Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Two questionnaires were filled out by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. However, only women having a hospital birth without obstetric intervention (N = 327) were included in this analysis. A logistic regression analysis has been performed.

Results: Labour pain acceptance and personal control in pain relief render pain medication use during labour less likely, especially if they occur together. Apart from this general result, we also find large country differences. Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts. This country difference cannot be explained by labour pain acceptance, since - in contrast to our working hypothesis - Dutch and Belgian women giving birth in a hospital setting are characterised by a similar labour pain acceptance. Our findings suggest that personal control in pain relief can partially explain the country differences in coping with labour pain. For Dutch women we find that the use of pain medication is lowest if women experience control over the reception of pain medication and have a positive attitude towards labour pain. In Belgium however, not personal control over the use of pain relief predicts the use of pain medication, but negative attitudes towards labour.

Conclusions: Apart from individual level determinants, such as length of labour or pain acceptance, our findings suggest that the maternity care context is of major importance in the study of the management of labour pain. The pain medication use in Belgian hospital maternity care is high and is very sensitive to negative attitudes towards labour pain. In the Netherlands, on the contrary, pain medication use is already low. This can partially be explained by a low degree of personal control in pain relief, especially when co-occurring with positive pain attitudes.

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Causal diagram. RQ: Research Question. T0: Time zero, 30 weeks of pregnancy. T1: Time 1, within 2 weeks after birth
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Figure 1: Causal diagram. RQ: Research Question. T0: Time zero, 30 weeks of pregnancy. T1: Time 1, within 2 weeks after birth

Mentions: The second and third research questions concern the role of the care context. While it is important to recognise individual characteristics (e.g., pain acceptance and personal control) when explaining the use of pain medication, it is equally important to consider the interplay of these factors with the social contexts in which pain medication is used [43]. As our second research question (RQ2) we want to assess the contribution of the Belgian and Dutch care context to 1) the pain acceptance and personal control in pain relief and 2) the medication use during labour. In a third step (RQ3), a cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in two maternity care models. The three research questions and variables included in this investigation are represented in figure 1.


Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands.

Christiaens W, Verhaeghe M, Bracke P - BMC Health Serv Res (2010)

Causal diagram. RQ: Research Question. T0: Time zero, 30 weeks of pregnancy. T1: Time 1, within 2 weeks after birth
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2944275&req=5

Figure 1: Causal diagram. RQ: Research Question. T0: Time zero, 30 weeks of pregnancy. T1: Time 1, within 2 weeks after birth
Mentions: The second and third research questions concern the role of the care context. While it is important to recognise individual characteristics (e.g., pain acceptance and personal control) when explaining the use of pain medication, it is equally important to consider the interplay of these factors with the social contexts in which pain medication is used [43]. As our second research question (RQ2) we want to assess the contribution of the Belgian and Dutch care context to 1) the pain acceptance and personal control in pain relief and 2) the medication use during labour. In a third step (RQ3), a cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in two maternity care models. The three research questions and variables included in this investigation are represented in figure 1.

Bottom Line: Apart from this general result, we also find large country differences.Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts.In the Netherlands, on the contrary, pain medication use is already low.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Sociology, Ghent University, Ghent, Belgium. wendy.christiaens@UGent.be

ABSTRACT

Background: A cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in 2 maternity care models. Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process.

Methods: Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Two questionnaires were filled out by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. However, only women having a hospital birth without obstetric intervention (N = 327) were included in this analysis. A logistic regression analysis has been performed.

Results: Labour pain acceptance and personal control in pain relief render pain medication use during labour less likely, especially if they occur together. Apart from this general result, we also find large country differences. Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts. This country difference cannot be explained by labour pain acceptance, since - in contrast to our working hypothesis - Dutch and Belgian women giving birth in a hospital setting are characterised by a similar labour pain acceptance. Our findings suggest that personal control in pain relief can partially explain the country differences in coping with labour pain. For Dutch women we find that the use of pain medication is lowest if women experience control over the reception of pain medication and have a positive attitude towards labour pain. In Belgium however, not personal control over the use of pain relief predicts the use of pain medication, but negative attitudes towards labour.

Conclusions: Apart from individual level determinants, such as length of labour or pain acceptance, our findings suggest that the maternity care context is of major importance in the study of the management of labour pain. The pain medication use in Belgian hospital maternity care is high and is very sensitive to negative attitudes towards labour pain. In the Netherlands, on the contrary, pain medication use is already low. This can partially be explained by a low degree of personal control in pain relief, especially when co-occurring with positive pain attitudes.

Show MeSH
Related in: MedlinePlus