Practice of Non-Pharmacological Labor Pain Management and Associated Factors among Skilled Birth Attendants at Hospitals Found In Gondar Province, Northwest Ethiopia (2024 G.C): Mixed Study

Practice of Non-Pharmacological Labor Pain Management and Associated Factors among Skilled Birth Attendants at Hospitals Found In Gondar Province, Northwest Ethiopia (2024 G.C): Mixed Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Practice of Non-Pharmacological Labor Pain Management and Associated Factors among Skilled Birth Attendants at Hospitals Found In Gondar Province, Northwest Ethiopia (2024 G.C): Mixed Study Mahlet Adem, MIHERETU MOLLA, BIRHANU WUBIE, KINDU YINGES, Ayalew Wassie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7958863/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Labor pain management involves both pharmacological and non-pharmacological approaches. The main goal of non-pharmacological therapies is to assist laboring women in managing their discomfort. Although managing labor through non - pharmacological methods facilitates labor progression and promotes early initiation of breastfeeding, its practical application is not acknowledged in Ethiopia. Objective To assess practice of non-pharmacological labor pain management and associated factors among skilled birth attendants at hospitals in Gondar Province, Northwest Ethiopia, 2024. Method A mixed methods study was conducted from December 15, 2023, to February 5, 2024. Four hundred sixteen skilled birth attendants from 18 public hospitals were selected using the census-sampling method and purposive in quantitative and qualitative respectively. Data was collected with a structured self-administered questionnaire, observation checklist, and in-depth interviews. Epi Info version 7.3 and SPSS version 25 were used for quantitative data entry and analysis respectively. Bi-variable and multivariable logistic regression analysis was done for quantitative data. A P-value of < 0.05 was used as the criterion for statistical significance. Thematic analysis of qualitative data was done with NVivo version 14. Results The practice of non-pharmacological labor pain management is 50.5% (45.5–55.5). Profession knowledge (AOR = 2, 95% CI = 1.246–3.319) and attitude (AOR = 7.3, 95% CI = 4.583–11.821) were found to be significantly associated with the practice of non-pharmacological labor pain management. Resource and time constraints and infrastructural and training gaps were reported as reasons for the poor practice of non-pharmacological labor pain management. Conclusion and Recommendation: The practice of non-pharmacological labor pain management is not comprehensive. Professional knowledge and attitudes of the professionals are significantly associated with their practice of non-pharmacological labor pain Management. Health facilities need for comprehensive education, training programs, should be equipped with necessary resources, and should be developed to optimize workflow and prioritize comprehensive pain management support for laboring women. Non-Pharmacological Labor Pain Management Skill Birth Attendant Gondar Ethiopia Figures Figure 1 Introduction Labor pain is defined as "an unpleasant emotional and sensory experience that results in a complex, subjective, and multifaceted reaction that may or may not cause tissue damage"(1, 2). During the first stage of labor, uterine contractions restrict blood flow, leading to discomfort, the second stage is characterized by pain arising from compression of the pelvic tissues and the stretching of the vagina and perineum(3). The degree of labor pain varies significantly between individuals. While some women experience minimal pain and deliver unexpectedly (4). Labor pain is the worst pain a woman would ever feel in her lifetime. So Effective pain management is a crucial factor influencing maternal satisfaction during labor(5). Labor pain management involves pharmacological and non-pharmacological approaches (6). The main goal of non-pharmacological therapies is to assist laboring women in managing their discomfort (4). Non-pharmacologic pain management methods involve providing physical comfort measures like warmth or cold applications, massage, and reassurance, emotional support, continuous companionship, and anticipatory guidance for the woman(7). Non-pharmacological pain treatment techniques during labor are non-invasive, affordable, and straightforward (8). Non-pharmacological labor pain treatment has various benefits, including shortening the length of labor, reducing the need for oxytocin and anesthesia, increasing the depth of the relationship between the patient and the maternity care providers, reducing instrumental deliveries, and reducing cesarean sections. A low newborn Apgar score, prolonged infant hospitalization, anxiety, postpartum depression, postpartum bleeding, fever, and postpartum bleeding can all be reduced(9). Lack of labor pain management techniques is one sign of poor treatment, a contributing reason to the low rate of institutional deliveries, increased cesarean section desire, and an indirect cause of maternal morbidity and mortality(10). A caesarian section was wanted by about 36.4% of laboring mothers to prevent labor pain (11). Additionally, inadequate pain management throughout labor and vaginal delivery was linked to women's low satisfaction with intrapartum care (12, 13). This influences a woman's decision on where to give birth in Ethiopia(14). Because of this, just 48% of births from women who received prenatal care take place in a medical facility (15). Approximately 73% of women utilize at least one non-pharmacologic technique to relieve pain during childbirth globally(16, 17). More than 70% of women in high-income nations receive obstetric analgesia, and pain treatment is a regular aspect of labor management (18). Pain-free labor programs are very new in several low-income nations, such as Ethiopia, and their extent of use has not yet been thoroughly investigated(19). The provision of physical and psychological support and the use of non-pharmacological comfort measures during labor and delivery were listed as basic competencies under Practice Standard III created by the Ethiopian Federal Ministry of Health in 2013. However, its practical application is not acknowledged(20). Therefore, this study practices non-pharmacological labor pain management and associated factors among skilled birth attendant at Hospitals Found in Gondar province, Northwest Ethiopia Method Study design and period A mixed-methods study (institutional cross-sectional and descriptive qualitative) design was conducted from December 15, 2023 to February 5, 2024. Study area The research carried out in the public hospitals situated in the Gondar province (central, western, and northern Gondar zones) within the Amhara National Region of Ethiopia. These zones encompass 18 hospitals, consisting of 14 primary public hospitals, 03 General Hospital and 01 specialized public hospital. These healthcare facilities provide to a population of over 7 million individuals residing in the area. These hospitals offer labor and delivery services as part of their healthcare provisions (21). Source of population All skilled birth Attendants working at hospitals found in the Gondar Province Study population All Skill birth Attendants who were working in the labor ward and following the laboring mother during the study period Sampling procedure and sample size calculation Sample size determination for the proportion Sample size for quantitative : The sample size was calculate by using the single population proportion formula, n= (Z α/2 ) 2 (p (1-p))/e 2 where; n = number of sample size, at 95%CI = 1.96, e = margin of error = 5% p = proportion of labor pain management practice = 43.3% (28). n = 1.96² (0.433 (1-0.433))/ 0.05² =378. Therefore, the largest sample size for this study was 378. Finally, 10% of the calculated sample size is added for the non-response rate giving a total sample size, N of 416. Sampling procedure For quantitative Four hundred sixteen skilled birth attendants from 18 public hospitals were selected using the census-sampling method (Fig. 1 ). Sample size and sampling procedure for qualitative five In-Depth Interviews (5) were selected purposively after analysis of the quantitative data, and until information, saturation was obtained. Inclusion and exclusion criteria Inclusion criteria All skilled birth attendants who were working at labor and delivery wards on the hospitals during the study period. Exclusion criteria Skill birth attendant who was not available (i.e., who was on annual leave, maternity leave, or seriously ill) during the time of data collection Variables of the study Dependent variable Skilled birth attendants on Practice non-pharmacological Labor pain management Independent variable Socio-demographic variables: Age, sex, profession, year of experience and level of education Knowledge of skilled birth attendants towards non-pharmacological labor pain management Attitude of skilled birth attendants towards non-pharmacological labor pain management 3.8 Operational definition Skilled birth attendant a qualified health professional such as a midwife, doctor, health officer, or nurse who has been educated and trained to proficiency in the skill needed to manage normal pregnancies, childbirth, and the immediate postnatal period, and in identification, management, and referral of complications in women and newborns (23). Non-pharmacological labor pain management refers to the use of non-medical techniques and interventions to alleviate the pain and discomfort experienced during labor and delivery. These techniques include relaxation techniques, breathing exercises, massage, hydrotherapy, acupuncture, aromatherapy, and the use of birth balls, among others(24). Good Practice of non-pharmacological labor pain management: skilled birth attendant who was practice above the mean value of non-pharmacological labor pain management(25). Poor Practice of non-pharmacological labor pain management: skilled birth attendant who was practice below the mean value of non-pharmacological labor pain management(25). Attitude of non-pharmacological labor pain management: was measured from a total of 07 items on the Likert scale Total score ranged from 0 to 35(26). Positive Attitude: study participants who score less than the mean value. Negative Attitude: study participants who score above the mean value. Good knowledge of non-pharmacological labor pain management: skilled birth attendant caregivers who answer mean and above value of knowledge-related questions(27). Data collection tools and procedures For the quantitative part : A structured, self-administered questionnaire with no objective measures (like observation) to evaluate them. Questioners were developed in English, adapting items from existing studies. The instrument was pretested for its reliability. Qualified obstetricians and public health experts reviewed the content validity of the questionnaire. The questionnaire addressed four key areas: socio-demographic characteristics of the providers, knowledge of skilled birth attendants on non-pharmacological labor pain management, Attitude towards skilled birth attendants on non-pharmacological labor pain management, and observational checklist of practices skilled birth attendants on non-pharmacological labor pain management. After obtaining informed consent, the questionnaire was distributed to the healthcare providers. Six diploma midwives under the supervision of one MSc candidate conducted data collection. Data Collection for the qualitative part In-depth interviews were carried out with informants such as facility heads; obstetric care providers, maternal and child health heads, and labor ward case team heads who agreed to be interviewed at different facilities in the study area. An in-depth interview guide, which was developed in English and translated into Amharic after the first phase result of this study quantitative study results were obtained. The advisor checked the developed in-depth interview guide before using it. During the interview, the cell phone was off and placed out of view except the recorder. Arrangement before the date of the interview was done. Equipment failures were checked immediately following each interview. Data analysis and control For the quantitative part After collection, data was recorded into Epi Data 7.1 and exported to SPSS version 22 for additional analysis. The research population was given in tables along with pertinent characteristics using frequency, percentage, and summary statistics. A bivariate analysis was used to evaluate the initial rough relationship between each independent variable and the dependent variable. Then, to control the cofounders, those independent variables with P value < 0.25 were transferred to multivariate logistic regression. The threshold for statistical significance was a P-value of less than 0.05, and the strength of the connection was shown by an AOR with a 95% confidence range. Model fitness was checked, which was (Hosmer and Lemeshow Test) = 0.34, with no multicollinearity (Variance inflation factor (VIF) < 3). For the qualitative part The recorded interviews were played again to extract data from them and translate them into an English text. Coding and sorting were done on the IDI data. Following Nvivo version 14 theme analysis, the concepts were combined in their respective topic domains. To illustrate how respondents feel about the issue, important quotes were included. A narrative summary and presentation of the findings were made. The quantitative study's conclusions and the data were included in the discussion at the end. Data quality control Pretest was conducted with 5% (21 respondents) of skilled birth attendant non-pharmacological labor pain management providers in Debremarkose Hospital, which was outside of the study area before the actual data were collected. Data quality was ensured during collection, coding, entry, and analysis. The rigor of the qualitative studies ensured that emerging themes were probed in subsequent interviews well to understand the themes. The same interview guide was used for all interviewees. Data quality Trustworthiness The Trustworthiness Criteria for the study was established through four key principles: credibility, transferability, dependability, and confirmability. Credibility is to maintain credibility, before the data collection, the investigators evaluated the in-depth interview questions. All members who participated in the study took orientation about the purpose of the study and the responsibility given before the interview took place to avoid unnecessary interruption and keep the rights of the participants. Professionals before data collection were evaluated the interview guide. Transferability is the transferability of the study was achieved by describing the study setting, sample, and data collection procedure clearly and in detail. The interview was conducted with the aid of digital audio records. Dependability is The dependability of the study was obtained through prolonged engagement with the participants to develop trust in the interviewer. This helps to increase the consistency of the study. Conformability is a detailed recording of each activity of the participant ensured the conformability of the study at the time of the interview and every procedure of the study. The principal investigator participated from the start to the end of the study. Result Socio-demographic characteristics of respondents Of the 416 skill birth attendants invited for the study, 400 (96.1%) responded to the questionnaires. The mean age and standard deviation of study participants were 29.3 ± SD 3.58 years old. The half of participants was male 235(58.8%). Among the respondents, 360(90%) were Orthodox and 351(87.8) were midwives. Of the respondents, 326(81.5%) were BSC and 203(70.5%) had clinical experience group (6–10) years of clinical experience as skilled birth attendants (Table 1 ). Table 1 Socio-Demographic characteristics among skill birth attendants at Hospitals Found in Gondar province, Northwest Ethiopia, 2024 (n = 400) Variables Frequency and percentage Age =30 164(41%) Gender Male 235(58.8%) Female 165(41.2%) Religion Protestant 24(6%) Orthodox 360(90%) Muslim 16(4%) Marital status Single 221(55.3%) Married 172(43%) Divorced 7(1.8%) Profession General practitioner 9(2.3%) Midwives 357(89.3%) Emergence Surgery 28(7%) Resident 6(1.5%) Level of Education Diploma 7(1.8%) BSc 346(86.5%) MSc 32(8%) Medical Doctor 15(3.8%) Clinical Experience 10 years 66(16.5%) Knowledge of skilled birth attendant of Non-pharmacological Labor Pain Management Of the 400 respondents, 248 (62%) had adequate knowledge of skilled birth attendant on non-pharmacological labor pain management and 115 (28.7%) had inadequate knowledge of skilled birth attendant on non-pharmacological labor pain management. The most commonly known non-pharmacological labor pain Management methods were Reassurance or psychological support 250(62.5%), Movement and Positioning 232(58%), and Back Massage and Touch 216(54%) (Table 2 ). Table 2 Knowledge of skilled birth attendant on practice on Non-pharmacological Labor Pain Management at Hospitals Found in Gondar province, Northwest Ethiopia, 2024(n = 400) Variable Yes, N (%) No, N (%) Movement and Positioning 232 (58%) 169(42%) Instruction for Breathing 164 (41%) 236(59%) Counter pressure 37 (9.3%) 363(90.8%) Application of Cold or Heat 107 (26.8%) 293(73.3%) Back Massage and Touch 216(54%) 184(46%) Water immersion 71(17.8%) 329(82.3%) Transcutaneous Electrical Nerve Stimulation 24(6%) 376(94%) Acupuncture 30(7.5%) 370(92.5%) Aromatherapy 7(1.8%) 393(98.3%) Spiritual Care 99(25.8%) 301(75.3%) Music therapy 70(17.5%) 330(82.5%) Instruction for relaxation 116(29%) 284(71%) Showing companion 78(19.5%) 322(80.5%) Show the patient how to bear down 93(23.3%) 307(76.8%) Reassurance or psychological support 250(62.5%) 150(37.5) Minimizing noise, adjusting room temperature 62(15.5) 328(84.5%) Attitude of skilled birth attendants on practice of Non-pharmacological Labor Pain Management Among the total respondents, 213 (53.3%) had a positive attitude toward non pharmacological labor pain management, and 46.3% had a negative attitude toward non-pharmacological labor pain management (Table 3 ). Table 3 Attitude of skilled birth attendant on non-pharmacological labor pain relief at Hospitals Found in Gondar province, Northwest Ethiopia, 2024(n = 400) Question Strong agree Agree Neutral Disagree Strong disagree Women does feel pain during labor 298(74.4%) 89(22.4%) 9(2.3%) 0 4(1.0%) Perception of pain is unique and distinct for each woman 129(32.3%) 226(56.5%) 26(6.5%) 13(3.3%) 6(1.5%) Pain during labor should be relieved 78(19.5%) 107(26.8%) 71(17.8%) 99(24.8%) 45(11.3%) You have responsibility to manage labor pain 104(26%) 132(33%) 104(26%) 53(13.3%) 7(1.8%) Non-pharmacologic pain management methods can help the mother to cope with labor pain 76(19%) 178(44.5%) 118(29.5%) 25(6.3%) 3(0.8%) Every laboring mother should be managed with non-pharmacologic labor pain management 56(14%) 106(36.3%) 150(37.5%) 83(20.8%) 4(1%) Non-pharmacologic labor pain management method can be used in combination with pharmacologic methods. 109(27.3%) 145(36.3%) 111(27.8%) 26(6.5%) 8(2%) Practice of skilled birth attendants on non-pharmacological labor pain management Only half (50.5%) CI = (44.5–55.5) of the respondents reported good practicing the NPLPM. Techniques such as laboring women in birthing positions, psychotherapy, and ambulating allowing mothers, were the most commonly used. Conversely, methods such as acupuncture and subcutaneous water injection have rarely used (Table 4 ). Table 4 practice of skilled birth attendant on non-pharmacological labor pain management at Hospitals Found in Gondar province, Northwest Ethiopia, 2024(n = 400) Variables Yes (n, %) No (n, %) Health Care providers show the patient how to bear down during labor and delivery 349(87.3%) 51(12.8%) Health Care provider allow companion of her choice during labor and delivery 317(79.3%) 83(20.8%) Health care provider massage the back to relieve labor pain 248(62%) 152(38%) Health care providers use hot or cold pack compress to relief labor pain 136(34%) 264(66%) Health care provider use psychotherapy to relief labor pain 334(83.5%) 66(16.5%) Health care provider use relaxation/ breathing technique to relieve labor pain 306(76.5%) 94(23.5%) Health care provider allows the mother to ambulate/labor Exercise 330(82.5%) 70(17.5%) Health care provider use Acupuncture to relieve labor pain 0 400(100%) Health care provider use subcutaneous water injection 95(23.8%) 305(76.3%) Factors associated with skilled birth attendant on practice of Non-pharmacological Labor Pain Management In the Bivariable logistic regression participants, age, sex, religion, educational status, years of experience, knowledge, and attitude towards non-pharmacological labor pain management were found significantly associated (Table 5 ). In the multivariable logistic regression analysis, knowledge, and attitude remained significant. Professionals who had adequate knowledge of NPLPM had 2 times increased odds of practicing NPLPM than those with inadequate knowledge (AOR = 2,95%CI=(1.246–3.319)), similarly professionals who had a positive attitude on NPLMPM had 7.36 times increased odds of practice NPLPM compared to professionals with negative attitude (AOR = 7.36, 95% CI=(4.583–11.821)) Table 5 Bi-variable and multi-variable analysis of factors associated with practice of non-pharmacological labor pain management methods among skill birth attendant at Hospitals Found in Gondar province, Northwest Ethiopia, 2024 (n = 400). Variable NPLPM COR AOR p-value Good Poor Age ≤ 30 128 108 1 1 ≥ 31 74 90 14.41(0.966–2.151) 1.443 (0.885–2.352) Gender Male 113 122 1 1 Female 89 76 0.79(0.531–1.179) 1.071 (0.648–1.771) Religion Protestant 11 13 1 1 Orthodox 187 173 0.78(0.342–1.794) 1.064 (0.409–2.764 Muslim 4 12 2.53(0.634 − 0.166) 4.064 (0.814–20.283) Marital status Single 108 113 1 Married 91 81 0.85(0.571–1.268) Divorced 3 4 1.27(0.279–5.827) Profession General practitioner 2 7 1 Midwives 186 171 0.263(0.054–1.282) Emergency surgery 12 16 0.381(0.067–2.172) Resident 2 4 0.0571(0.057–5.775) Education status ≤ First Degree 187 175 1 ≥ Second Degree 15 23 1.638(0.828–3.242) Clinical experience ≤ 5 61 70 1 1 6–10 108 95 0.245(0.050–1.195) 0.427 (0.070–2.592) > 10 33 33 0.381(0.043–3.338) 0.156 (0.010–2.385) Knowledge Poor 105 47 1 1 Good 97 151 3.478(2.266–5.337) 2.034 (1.246–3.319) 0.003 Attitude Positive 58 155 8.94(5.678–14.106) 7.360 (4.583–11.821) 0.001 Negative 144 43 1 1 Qualitative study results Socio-demographic characteristics of the interviewee’s five informants’ including health officers, facility manager, maternity ward coordinator, and labor ward midwives. The respondents were between the age of 26–35 years and they are from one comprehensive Hospital and four primary hospital. Three of them were Orthodox and had work experience of 6–10 years. All of them are BSC in qualification Thematic analysis Utilization and Experience of Techniques: Skilled birth attendants (SBAs) employ a range of non-pharmacological techniques to effectively manage labor pain. These techniques encompass massage, warm compresses, deep breathing techniques, psychotherapy, and postural corrections. SBAs have observed that these strategies have a positive impact on women in labor, resulting in reduced pain levels and enhanced comfort. "As both a mother and a midwife, I employed a range of non-pharmacological techniques to assist during labor. I discovered that practicing deep breathing, providing massages, and adjusting positions significantly alleviated the intensity of contractions. This sense of control over my body and the act of giving birth proved to be incredibly empowering."(A midwifes with 6 year experience) Perceived Benefits and Efficacy: SBAs underscored the numerous benefits of non-pharmacological labor pain management. They stressed their effectiveness in promoting relaxation, reducing stress and anxiety, minimal to zero adverse effects, and enhancing the overall childbirth journey for women. SBAs noted that empowering women with the means to actively participate in their labor and delivery process through these methods contributed to a greater sense of control and agency. “Non-pharmacological approaches provide women with a holistic and natural method to manage pain during labor. Breathing, exercises and massage are effective techniques that can induce relaxation, alleviate stress, and improve the overall birthing process.”( A midwifes with 9 years’ experience) “Non-drug approaches offer minimal to zero adverse reactions in contrast to drug-based treatments, rendering them safe and appropriate for a diverse group of women. These methods enable women to play an active role in their childbirth process and may decrease the necessity for medical interventions.”( A midwife with 8 Years’ experience) Challenges and limitations: Despite the benefits they offer, SBAs encountered challenges when implementing non-pharmacological pain management techniques. These challenges encompass time constraints during busy labor and delivery shifts, as well as limited availability of resources like hydrotherapy facilities or birthing balls. SBAs also encountered instances where women's cultural preferences and restrictions hindered the use of certain strategies. “Nevertheless, accessing or affording specific non-pharmacological alternatives might pose a challenge for certain women, particularly in resource-limited settings. Moreover, women's acceptance and utilization of these methods can be influenced by cultural beliefs and preferences.”(A midwife with 6 year experience) “The efficacy of non-pharmacological techniques may differ among women, potentially failing to offer adequate pain relief. Furthermore, healthcare professionals might need further education to successfully incorporate these methods into obstetric practices.”(A midwife with 8 years’ experience) “Inadequate training and resources in healthcare settings pose major obstacles. Numerous midwives do not receive formal instruction on non-pharmacological methods, and hospitals may lack the essential equipment or facilities to facilitate their use.”(A midwifes with 9 years’ experience) “Time limitations during hectic labor and delivery shifts create an additional obstacle. Due to the large number of patients and insufficient staffing, it can be difficult to allocate enough time to properly implement these methods for every woman in labor. Consequently, there is less time available for individual patient care, leading to a decreased ability to offer thorough pain management assistance.”(A midwifes with 7 years’ experience) “The presence of inadequate infrastructure, such as inconsistent electricity and water supply, may impede the successful execution of specific non-pharmacological approaches like water births or the utilization of medical devices such as Transcutaneous electrical nerve stimulation (TENS) machines.”(A midwifes with 10 years’ experience) Facilitators of Integration: Incorporating non-pharmacological approaches into obstetric treatment becomes more feasible with the utilization of existing community structures and resources, active community involvement and awareness campaigns, policy backing, comprehensive education and training for healthcare professionals. “It is crucial to offer training and capacity building to healthcare providers. Equipping midwives and other obstetric care providers with in-depth education on non-pharmacological methods, along with hands-on skills training, enables them to effectively incorporate these techniques into their professional practice.” (A midwifes with 7 years’ experience) “Investing in infrastructure and equipment holds immense importance. It is essential for healthcare facilities to possess the required resources to facilitate non-pharmacological approaches, including birthing pools, spaces for relaxation, and training materials.” (A midwifes with 10 years’ experience) Discussion In this study, we reported the practice of labor pain management and associated factors among skilled birth attendants. The present study established that the prevalence of skilled attendants who practice non-pharmacologic labor pain management was 50.5%. This study finding is in line with the study done in the Tigray Region and Egypt which was 43.3% and 44.9% respectively(22, 28). Our findings show that these areas are moderately but consistently using non-pharmacological labor pain management in different settings. This study result is higher than the studies performed in the Gedeo zone, Gamo Gofa zone, and India which were 37%, 37.5%, and 37%repectively(20, 29). This may be due to a difference in the study period, level of health institution, and sample size, this study was conducted only in public hospitals. Although this finding is still lower than the findings Harari region, Ethiopia, and Saudi Arabia that was 59.3%,66%, and 68.3% respectively(26, 30). This may be due to a difference in the study period, level of health institution, and sample size, this study was conducted only in public hospitals. The majority of interviewers SBAs successfully manage labor pain by using a variety of non-pharmacological treatments like massage, deep breathing exercises, psychotherapy, and positional modifications. This is similar to what the study conducted in Tanzania and Ghana, which stated most healthcare providers reported that they did routinely offer non-pharmacological options, such as counseling women about the nature and severity of labor pain and trying to provide psychological support and assurance (31, 32). SBA who has adequate knowledge of NPLPM was 2 times more likely to use the NPLPM method than SBA who has inadequate knowledge. (AOR = 2, (95%), CI (1.246–3.319)) Similarly lack of knowledge is one of the barriers to the use of NPLPM in Kenya and Nigeria (33, 34). This finding is opposite to a study done in Kembata which reported skilled birth attendants who had inadequate knowledge were 3.9 times more likely to use NPLPMs than those who had adequate knowledge (AOR: 3.9, 95% CI: 2.27, 6.83)(35). This difference may be in this study SBAs who had a high level of education were more likely to practice NPLPM, and professionals who had a high level of education were more likely to have adequate knowledge, they practice what they knew. Most interviewer's SBAs understood the usefulness and benefits of using non-pharmacological methods in managing labor pain fostering calm, lowering tension and anxiety, and improving the childbirth experience for women were highlighted. Our study revealed, similarly conducted in Tanzania that increasing women's comfort and self-confidence, as well as their ability to cope with pain, were the most reported benefits(31). The attitude of the professionals is significantly and positively associated with obstetric pain relief, where skilled birth attendants who had positive attitudes were 7.3 times more likely to practice obstetric pain relief than those who had negative attitudes (AOR = 7.3, 95% CI = 4.583–11.821). The finding was consistent with the study conducted in Bangladesh, Nigeria, and Ethiopia (26, 34, 36). Healthcare professionals with a positive attitude are more inclined to possess the necessary skills and carry out their duties effectively. Positive attitudes towards NPLPM can lead to more compassionate care and a greater willingness to adopt and advocate for these methods. The qualitative findings factor of non-pharmacological labor pain management are limited access to resources and equipment, time constraints during busy shifts, and cultural barriers affecting the utilization of certain techniques. Further, factors facilitating the integration of non-pharmacological methods into obstetric care were identified, including comprehensive education and training for healthcare providers, community engagement and awareness campaigns, policy support, and investment in infrastructure and equipment. Conclusion The practice of non-pharmacological labor pain management is low. The profession of knowledge and attitude of the professionals are significantly associated factors that affect the practice of non-pharmacological labor pain relief for mothers during childbirth. In the qualitative part of this study limited access to resources and equipment, time constraints during busy shifts, cultural, comprehensive education and training for healthcare providers, policy support, and investment in infrastructure and equipment barriers affecting the utilization of certain techniques. List of abbreviation and acronym AOR Adjusted odds ratio COR Crude odds ratio CI Confidence interval NPLPRMs Non-Pharmacological Labor pain relief methods SBA Skilled birth attendant TENS Transcutaneous electrical nerve stimulation UoGSCH University of Gondar Specialized Comprehensive Hospital Declarations Ethical Approval and consent to participants All method were conducted according the ethical standards of the declaration Helsinki. The study was conducted under the Ethiopian Health Research Ethics Guidelines. Ethical clearance was obtained from the University of Gondar's Ethical Review Committee with Ref-Mid/W.H/03/2016 E.C. A formal letter of administrative and case team manager approval was obtained from the three hospitals. Informed consent was taken from each of the study participants. Consent to publication Not applicable. Availability of data and material The data sets used and analyzed during this study was available from corresponding author. Competing interest No competing interest. Funding Notapplicable. Acknowledgement We would like to thank the study participant and data collectors as well as supervisors for their dedication to data collection in an organized manner. References McDoland R. Current Obstetric & Gynecologic diagnosis. Obstetric analgesia and anesthesia edition Alan H Decherney & Lauren Nathan. 2004. Merskey H. Pain terms: a list with definitions and notes on usage. 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Knowledge, attitude, practice and barriers to educational implementation of nonpharmacological pain management during labor in selected hospitals, Kenya. Central African Journal of Public Health. 2018;4(1):20-6. Ogboli-Nwasor E, Adaji S, Bature S, Shittu O. Pain relief in labor: a survey of awareness, attitude, and practice of health care providers in Zaria, Nigeria. Journal of pain research. 2011:227-32. Geltore TE, Taye A, Kelbore AG. Utilization of obstetric analgesia in labor pain management and associated factors among obstetric caregivers in public health facilities of Kembata Tembaro Zone, Southern Ethiopia. Journal of pain research. 2018:3089-97. Tasnim S. Perception about pain relief during normal labour among health care providers conducting delivery. Medicine today. 2010;22(1):20-3. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 14 May, 2026 Reviews received at journal 17 Dec, 2025 Reviewers agreed at journal 05 Dec, 2025 Reviewers invited by journal 04 Dec, 2025 Editor invited by journal 10 Nov, 2025 Editor assigned by journal 08 Nov, 2025 Submission checks completed at journal 08 Nov, 2025 First submitted to journal 27 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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10:03:46","extension":"html","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93753,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7958863/v1/5881b0e9e606668549719cd3.html"},{"id":97683508,"identity":"09dc6882-6fb2-48cf-9c2c-f977e2167bdd","added_by":"auto","created_at":"2025-12-08 10:03:47","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":103465,"visible":true,"origin":"","legend":"\u003cp\u003eSampling technique of practice of non-pharmacological labor pain management and associated factors among skilled birth attendants at hospitals found in Gondar Province, Northwest Ethiopia, 2023.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7958863/v1/42613aa40e4b26d8c1f6a0e3.jpg"},{"id":97684456,"identity":"e8c0ef8f-9930-4bdc-95c3-c4ff6ab9aa47","added_by":"auto","created_at":"2025-12-08 10:06:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1460896,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7958863/v1/6a408377-8da4-45b5-b4de-24364051e665.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Practice of Non-Pharmacological Labor Pain Management and Associated Factors among Skilled Birth Attendants at Hospitals Found In Gondar Province, Northwest Ethiopia (2024 G.C): Mixed Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLabor pain is defined as \"an unpleasant emotional and sensory experience that results in a complex, subjective, and multifaceted reaction that may or may not cause tissue damage\"(1, 2). During the first stage of labor, uterine contractions restrict blood flow, leading to discomfort, the second stage is characterized by pain arising from compression of the pelvic tissues and the stretching of the vagina and perineum(3). The degree of labor pain varies significantly between individuals. While some women experience minimal pain and deliver unexpectedly (4). Labor pain is the worst pain a woman would ever feel in her lifetime. So Effective pain management is a crucial factor influencing maternal satisfaction during labor(5).\u003c/p\u003e\u003cp\u003eLabor pain management involves pharmacological and non-pharmacological approaches (6). The main goal of non-pharmacological therapies is to assist laboring women in managing their discomfort (4). Non-pharmacologic pain management methods involve providing physical comfort measures like warmth or cold applications, massage, and reassurance, emotional support, continuous companionship, and anticipatory guidance for the woman(7). Non-pharmacological pain treatment techniques during labor are non-invasive, affordable, and straightforward (8). Non-pharmacological labor pain treatment has various benefits, including shortening the length of labor, reducing the need for oxytocin and anesthesia, increasing the depth of the relationship between the patient and the maternity care providers, reducing instrumental deliveries, and reducing cesarean sections. A low newborn Apgar score, prolonged infant hospitalization, anxiety, postpartum depression, postpartum bleeding, fever, and postpartum bleeding can all be reduced(9).\u003c/p\u003e\u003cp\u003eLack of labor pain management techniques is one sign of poor treatment, a contributing reason to the low rate of institutional deliveries, increased cesarean section desire, and an indirect cause of maternal morbidity and mortality(10). A caesarian section was wanted by about 36.4% of laboring mothers to prevent labor pain (11). Additionally, inadequate pain management throughout labor and vaginal delivery was linked to women's low satisfaction with intrapartum care (12, 13). This influences a woman's decision on where to give birth in Ethiopia(14). Because of this, just 48% of births from women who received prenatal care take place in a medical facility (15).\u003c/p\u003e\u003cp\u003eApproximately 73% of women utilize at least one non-pharmacologic technique to relieve pain during childbirth globally(16, 17). More than 70% of women in high-income nations receive obstetric analgesia, and pain treatment is a regular aspect of labor management (18). Pain-free labor programs are very new in several low-income nations, such as Ethiopia, and their extent of use has not yet been thoroughly investigated(19).\u003c/p\u003e\u003cp\u003eThe provision of physical and psychological support and the use of non-pharmacological comfort measures during labor and delivery were listed as basic competencies under Practice Standard III created by the Ethiopian Federal Ministry of Health in 2013. However, its practical application is not acknowledged(20). Therefore, this study practices non-pharmacological labor pain management and associated factors among skilled birth attendant at Hospitals Found in Gondar province, Northwest Ethiopia\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and period\u003c/h2\u003e\u003cp\u003eA mixed-methods study (institutional cross-sectional and descriptive qualitative) design was conducted from December 15, 2023 to February 5, 2024.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy area\u003c/h3\u003e\n\u003cp\u003eThe research carried out in the public hospitals situated in the Gondar province (central, western, and northern Gondar zones) within the Amhara National Region of Ethiopia. These zones encompass 18 hospitals, consisting of 14 primary public hospitals, 03 General Hospital and 01 specialized public hospital. These healthcare facilities provide to a population of over 7\u0026nbsp;million individuals residing in the area. These hospitals offer labor and delivery services as part of their healthcare provisions (21).\u003c/p\u003e\n\u003ch3\u003eSource of population\u003c/h3\u003e\n\u003cp\u003eAll skilled birth Attendants working at hospitals found in the Gondar Province\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eAll Skill birth Attendants who were working in the labor ward and following the laboring mother during the study period\u003c/p\u003e\n\u003ch3\u003eSampling procedure and sample size calculation\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSample size determination for the proportion\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e\u003cb\u003eSample size for quantitative\u003c/b\u003e:\u003c/h2\u003e\u003cp\u003eThe sample size was calculate by using the single population proportion formula,\u003c/p\u003e\u003cp\u003en= (Z\u003csub\u003eα/2\u003c/sub\u003e)\u003csup\u003e2\u003c/sup\u003e(p (1-p))/e\u003csup\u003e2\u003c/sup\u003e where; n = number of sample size, at 95%CI = 1.96, e = margin of error = 5% p = proportion of labor pain management practice = 43.3% (28).\u003c/p\u003e\u003cp\u003en = 1.96² (0.433 (1-0.433))/ 0.05² =378. Therefore, the largest sample size for this study was 378. Finally, 10% of the calculated sample size is added for the non-response rate giving a total sample size, N of 416.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eSampling procedure\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eFor quantitative\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eFour hundred sixteen skilled birth attendants from 18 public hospitals were selected using the census-sampling method (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSample size and sampling procedure for qualitative\u003c/strong\u003e\u003c/p\u003e\u003cp\u003efive In-Depth Interviews (5) were selected purposively after analysis of the quantitative data, and until information, saturation was obtained.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003eInclusion criteria\u003c/h2\u003e\u003cp\u003eAll skilled birth attendants who were working at labor and delivery wards on the hospitals during the study period.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eExclusion criteria\u003c/h2\u003e\u003cp\u003eSkill birth attendant who was not available (i.e., who was on annual leave, maternity leave, or seriously ill) during the time of data collection\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eVariables of the study\u003c/h2\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003eDependent variable\u003c/h2\u003e\u003cp\u003eSkilled birth attendants on Practice non-pharmacological Labor pain management\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eIndependent variable\u003c/h2\u003e\u003cp\u003eSocio-demographic variables: Age, sex, profession, year of experience and level of education\u003c/p\u003e\u003cp\u003eKnowledge of skilled birth attendants towards non-pharmacological labor pain management\u003c/p\u003e\u003cp\u003eAttitude of skilled birth attendants towards non-pharmacological labor pain management\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.8 Operational definition\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSkilled birth attendant\u003c/strong\u003e\u003c/p\u003e\u003cp\u003ea qualified health professional such as a midwife, doctor, health officer, or nurse who has been educated and trained to proficiency in the skill needed to manage normal pregnancies, childbirth, and the immediate postnatal period, and in identification, management, and referral of complications in women and newborns (23).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eNon-pharmacological labor pain management\u003c/b\u003e refers to the use of non-medical techniques and interventions to alleviate the pain and discomfort experienced during labor and delivery. These techniques include relaxation techniques, breathing exercises, massage, hydrotherapy, acupuncture, aromatherapy, and the use of birth balls, among others(24).\u003c/p\u003e\u003cp\u003eGood Practice of non-pharmacological labor pain management: skilled birth attendant who was practice above the mean value of non-pharmacological labor pain management(25).\u003c/p\u003e\u003cp\u003ePoor Practice of non-pharmacological labor pain management: skilled birth attendant who was practice below the mean value of non-pharmacological labor pain management(25).\u003c/p\u003e\u003cp\u003eAttitude of non-pharmacological labor pain management: was measured from a total of 07 items on the Likert scale Total score ranged from 0 to 35(26).\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePositive Attitude: study participants who score less than the mean value.\u003c/p\u003e\u003cp\u003eNegative Attitude: study participants who score above the mean value.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eGood knowledge of non-pharmacological labor pain management: skilled birth attendant caregivers who answer mean and above value of knowledge-related questions(27).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eData collection tools and procedures\u003c/h2\u003e\u003cp\u003e\u003cb\u003eFor the quantitative part\u003c/b\u003e: A structured, self-administered questionnaire with no objective measures (like observation) to evaluate them. Questioners were developed in English, adapting items from existing studies. The instrument was pretested for its reliability. Qualified obstetricians and public health experts reviewed the content validity of the questionnaire. The questionnaire addressed four key areas: socio-demographic characteristics of the providers, knowledge of skilled birth attendants on non-pharmacological labor pain management, Attitude towards skilled birth attendants on non-pharmacological labor pain management, and observational checklist of practices skilled birth attendants on non-pharmacological labor pain management. After obtaining informed consent, the questionnaire was distributed to the healthcare providers. Six diploma midwives under the supervision of one MSc candidate conducted data collection.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eData Collection for the qualitative part\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eIn-depth interviews were carried out with informants such as facility heads; obstetric care providers, maternal and child health heads, and labor ward case team heads who agreed to be interviewed at different facilities in the study area. An in-depth interview guide, which was developed in English and translated into Amharic after the first phase result of this study quantitative study results were obtained. The advisor checked the developed in-depth interview guide before using it. During the interview, the cell phone was off and placed out of view except the recorder. Arrangement before the date of the interview was done. Equipment failures were checked immediately following each interview.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eData analysis and control\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eFor the quantitative part\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eAfter collection, data was recorded into Epi Data 7.1 and exported to SPSS version 22 for additional analysis. The research population was given in tables along with pertinent characteristics using frequency, percentage, and summary statistics. A bivariate analysis was used to evaluate the initial rough relationship between each independent variable and the dependent variable. Then, to control the cofounders, those independent variables with P value \u0026lt; 0.25 were transferred to multivariate logistic regression. The threshold for statistical significance was a P-value of less than 0.05, and the strength of the connection was shown by an AOR with a 95% confidence range. Model fitness was checked, which was (Hosmer and Lemeshow Test) = 0.34, with no multicollinearity (Variance inflation factor (VIF) \u0026lt; 3).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFor the qualitative part\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe recorded interviews were played again to extract data from them and translate them into an English text. Coding and sorting were done on the IDI data. Following Nvivo version 14 theme analysis, the concepts were combined in their respective topic domains. To illustrate how respondents feel about the issue, important quotes were included. A narrative summary and presentation of the findings were made. The quantitative study's conclusions and the data were included in the discussion at the end.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eData quality control\u003c/strong\u003e\u003c/p\u003e\u003cp\u003ePretest was conducted with 5% (21 respondents) of skilled birth attendant non-pharmacological labor pain management providers in Debremarkose Hospital, which was outside of the study area before the actual data were collected. Data quality was ensured during collection, coding, entry, and analysis. The rigor of the qualitative studies ensured that emerging themes were probed in subsequent interviews well to understand the themes. The same interview guide was used for all interviewees.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eData quality Trustworthiness\u003c/h2\u003e\u003cp\u003eThe Trustworthiness Criteria for the study was established through four key principles: credibility, transferability, dependability, and confirmability. Credibility is to maintain credibility, before the data collection, the investigators evaluated the in-depth interview questions. All members who participated in the study took orientation about the purpose of the study and the responsibility given before the interview took place to avoid unnecessary interruption and keep the rights of the participants. Professionals before data collection were evaluated the interview guide. Transferability is the transferability of the study was achieved by describing the study setting, sample, and data collection procedure clearly and in detail. The interview was conducted with the aid of digital audio records. Dependability is The dependability of the study was obtained through prolonged engagement with the participants to develop trust in the interviewer. This helps to increase the consistency of the study. Conformability is a detailed recording of each activity of the participant ensured the conformability of the study at the time of the interview and every procedure of the study. The principal investigator participated from the start to the end of the study.\u003c/p\u003e\u003c/div\u003e"},{"header":"Result","content":"\u003ch2\u003eSocio-demographic characteristics of respondents\u003c/h2\u003e\u003cp\u003eOf the 416 skill birth attendants invited for the study, 400 (96.1%) responded to the questionnaires. The mean age and standard deviation of study participants were 29.3 ± SD 3.58 years old. The half of participants was male 235(58.8%). Among the respondents, 360(90%) were Orthodox and 351(87.8) were midwives. Of the respondents, 326(81.5%) were BSC and 203(70.5%) had clinical experience group (6–10) years of clinical experience as skilled birth attendants (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-Demographic characteristics among skill birth attendants at Hospitals Found in Gondar province, Northwest Ethiopia, 2024 (n = 400)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency and percentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt; 30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e236(59%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;=30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e164(41%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e235(58.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e165(41.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProtestant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOrthodox\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e360(90%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMuslim\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e221(55.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e172(43%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(1.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral practitioner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(2.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMidwives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e357(89.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergence Surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(1.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eLevel of Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(1.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBSc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e346(86.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMSc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32(8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical Doctor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(3.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eClinical Experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;= 5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131(32.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6–10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e203(50.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66(16.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eKnowledge of skilled birth attendant of Non-pharmacological Labor Pain Management\u003c/h2\u003e\u003cp\u003eOf the 400 respondents, 248 (62%) had adequate knowledge of skilled birth attendant on non-pharmacological labor pain management and 115 (28.7%) had inadequate knowledge of skilled birth attendant on non-pharmacological labor pain management. The most commonly known non-pharmacological labor pain Management methods were Reassurance or psychological support 250(62.5%), Movement and Positioning 232(58%), and Back Massage and Touch 216(54%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKnowledge of skilled birth attendant on practice on Non-pharmacological Labor Pain Management at Hospitals Found in Gondar province, Northwest Ethiopia, 2024(n = 400)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, N (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo, N (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMovement and Positioning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e232 (58%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e169(42%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInstruction for Breathing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e164 (41%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e236(59%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCounter pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (9.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e363(90.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApplication of Cold or Heat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e107 (26.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e293(73.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBack Massage and Touch\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e216(54%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e184(46%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWater immersion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71(17.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e329(82.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTranscutaneous Electrical Nerve Stimulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24(6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e376(94%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcupuncture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30(7.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e370(92.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAromatherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e393(98.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpiritual Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99(25.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e301(75.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMusic therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70(17.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e330(82.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInstruction for relaxation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e116(29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e284(71%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShowing companion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78(19.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e322(80.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShow the patient how to bear down\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93(23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e307(76.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReassurance or psychological support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e250(62.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e150(37.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinimizing noise, adjusting room temperature\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62(15.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e328(84.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eAttitude of skilled birth attendants on practice of Non-pharmacological Labor Pain Management\u003c/h2\u003e\u003cp\u003eAmong the total respondents, 213 (53.3%) had a positive attitude toward non pharmacological labor pain management, and 46.3% had a negative attitude toward non-pharmacological labor pain management (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAttitude of skilled birth attendant on non-pharmacological labor pain relief at Hospitals Found in Gondar province, Northwest Ethiopia, 2024(n = 400)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrong agree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStrong disagree\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWomen does feel pain during labor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e298(74.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89(22.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(2.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4(1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerception of pain is unique and distinct for each woman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e129(32.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e226(56.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26(6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13(3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6(1.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePain during labor should be relieved\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78(19.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107(26.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71(17.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e99(24.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45(11.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYou have responsibility to manage labor pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e104(26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e132(33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104(26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53(13.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7(1.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-pharmacologic pain management methods can help the mother to cope with labor pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76(19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e178(44.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e118(29.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25(6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(0.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvery laboring mother should be managed with non-pharmacologic labor pain management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56(14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106(36.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e150(37.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e83(20.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4(1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-pharmacologic labor pain management method can be used in combination with pharmacologic methods.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e109(27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e145(36.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e111(27.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26(6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8(2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003ePractice of skilled birth attendants on non-pharmacological labor pain management\u003c/h2\u003e\u003cp\u003eOnly half (50.5%) CI = (44.5–55.5) of the respondents reported good practicing the NPLPM. Techniques such as laboring women in birthing positions, psychotherapy, and ambulating allowing mothers, were the most commonly used. Conversely, methods such as acupuncture and subcutaneous water injection have rarely used (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003epractice of skilled birth attendant on non-pharmacological labor pain management at Hospitals Found in Gondar province, Northwest Ethiopia, 2024(n = 400)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes (n, %)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo (n, %)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Care providers show the patient how to bear down\u003c/p\u003e\u003cp\u003eduring labor and delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e349(87.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51(12.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Care provider allow companion of her choice during\u003c/p\u003e\u003cp\u003elabor and delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e317(79.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83(20.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth care provider massage the back to relieve labor pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e248(62%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e152(38%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth care providers use hot or cold pack compress to relief\u003c/p\u003e\u003cp\u003elabor pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e136(34%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e264(66%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth care provider use psychotherapy to relief labor pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e334(83.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66(16.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth care provider use relaxation/ breathing technique to relieve labor pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e306(76.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94(23.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth care provider allows the mother to ambulate/labor Exercise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e330(82.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70(17.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth care provider use Acupuncture to relieve labor pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e400(100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth care provider use subcutaneous water injection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95(23.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e305(76.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003cb\u003eFactors associated with skilled birth attendant on practice of Non-pharmacological Labor Pain Management\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn the Bivariable logistic regression participants, age, sex, religion, educational status, years of experience, knowledge, and attitude towards non-pharmacological labor pain management were found significantly associated (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). In the multivariable logistic regression analysis, knowledge, and attitude remained significant. Professionals who had adequate knowledge of NPLPM had 2 times increased odds of practicing NPLPM than those with inadequate knowledge (AOR = 2,95%CI=(1.246–3.319)), similarly professionals who had a positive attitude on NPLMPM had 7.36 times increased odds of practice NPLPM compared to professionals with negative attitude (AOR = 7.36, 95% CI=(4.583–11.821))\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBi-variable and multi-variable analysis of factors associated with practice of non-pharmacological labor pain management methods among skill birth attendant at Hospitals Found in Gondar province, Northwest Ethiopia, 2024 (n = 400).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eNPLPM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e≤ 30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e≥ 31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.41(0.966–2.151)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.443\u003c/p\u003e\u003cp\u003e(0.885–2.352)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.79(0.531–1.179)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.071\u003c/p\u003e\u003cp\u003e(0.648–1.771)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProtestant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOrthodox\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.78(0.342–1.794)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.064\u003c/p\u003e\u003cp\u003e(0.409–2.764\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMuslim\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.53(0.634 − 0.166)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.064\u003c/p\u003e\u003cp\u003e(0.814–20.283)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.85(0.571–1.268)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.27(0.279–5.827)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eProfession\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral practitioner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMidwives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.263(0.054–1.282)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergency surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.381(0.067–2.172)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0571(0.057–5.775)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEducation status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e≤ First Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e≥ Second Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.638(0.828–3.242)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eClinical experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e≤ 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6–10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.245(0.050–1.195)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003cp\u003e(0.070–2.592)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.381(0.043–3.338)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003cp\u003e(0.010–2.385)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePoor\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e105\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e47\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eGood\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e97\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e151\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.478(2.266–5.337)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.034\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(1.246–3.319)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAttitude\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePositive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e58\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e155\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e8.94(5.678–14.106)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e7.360\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(4.583–11.821)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNegative\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e144\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e43\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eQualitative study results\u003c/h2\u003e\u003cp\u003eSocio-demographic characteristics of the interviewee’s five informants’ including health officers, facility manager, maternity ward coordinator, and labor ward midwives. The respondents were between the age of 26–35 years and they are from one comprehensive Hospital and four primary hospital. Three of them were Orthodox and had work experience of 6–10 years. All of them are BSC in qualification\u003c/p\u003e\u003cp\u003e\u003cb\u003eThematic analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eUtilization and Experience of Techniques: Skilled birth attendants (SBAs) employ a range of non-pharmacological techniques to effectively manage labor pain. These techniques encompass massage, warm compresses, deep breathing techniques, psychotherapy, and postural corrections. SBAs have observed that these strategies have a positive impact on women in labor, resulting in reduced pain levels and enhanced comfort.\u003c/p\u003e\u003cp\u003e\"As both a mother and a midwife, I employed a range of non-pharmacological techniques to assist during labor. I discovered that practicing deep breathing, providing massages, and adjusting positions significantly alleviated the intensity of contractions. This sense of control over my body and the act of giving birth proved to be incredibly empowering.\"(A midwifes with 6 year experience)\u003c/p\u003e\u003cp\u003ePerceived Benefits and Efficacy: SBAs underscored the numerous benefits of non-pharmacological labor pain management. They stressed their effectiveness in promoting relaxation, reducing stress and anxiety, minimal to zero adverse effects, and enhancing the overall childbirth journey for women. SBAs noted that empowering women with the means to actively participate in their labor and delivery process through these methods contributed to a greater sense of control and agency.\u003c/p\u003e\u003cp\u003e“Non-pharmacological approaches provide women with a holistic and natural method to manage pain during labor. Breathing, exercises and massage are effective techniques that can induce relaxation, alleviate stress, and improve the overall birthing process.”( A midwifes with 9 years’ experience)\u003c/p\u003e\u003cp\u003e“Non-drug approaches offer minimal to zero adverse reactions in contrast to drug-based treatments, rendering them safe and appropriate for a diverse group of women. These methods enable women to play an active role in their childbirth process and may decrease the necessity for medical interventions.”( A midwife with 8 Years’ experience)\u003c/p\u003e\u003cp\u003eChallenges and limitations: Despite the benefits they offer, SBAs encountered challenges when implementing non-pharmacological pain management techniques. These challenges encompass time constraints during busy labor and delivery shifts, as well as limited availability of resources like hydrotherapy facilities or birthing balls. SBAs also encountered instances where women's cultural preferences and restrictions hindered the use of certain strategies.\u003c/p\u003e\u003cp\u003e“Nevertheless, accessing or affording specific non-pharmacological alternatives might pose a challenge for certain women, particularly in resource-limited settings. Moreover, women's acceptance and utilization of these methods can be influenced by cultural beliefs and preferences.”(A midwife with 6 year experience)\u003c/p\u003e\u003cp\u003e“The efficacy of non-pharmacological techniques may differ among women, potentially failing to offer adequate pain relief. Furthermore, healthcare professionals might need further education to successfully incorporate these methods into obstetric practices.”(A midwife with 8 years’ experience)\u003c/p\u003e\u003cp\u003e“Inadequate training and resources in healthcare settings pose major obstacles. Numerous midwives do not receive formal instruction on non-pharmacological methods, and hospitals may lack the essential equipment or facilities to facilitate their use.”(A midwifes with 9 years’ experience)\u003c/p\u003e\u003cp\u003e“Time limitations during hectic labor and delivery shifts create an additional obstacle. Due to the large number of patients and insufficient staffing, it can be difficult to allocate enough time to properly implement these methods for every woman in labor. Consequently, there is less time available for individual patient care, leading to a decreased ability to offer thorough pain management assistance.”(A midwifes with 7 years’ experience)\u003c/p\u003e\u003cp\u003e“The presence of inadequate infrastructure, such as inconsistent electricity and water supply, may impede the successful execution of specific non-pharmacological approaches like water births or the utilization of medical devices such as Transcutaneous electrical nerve stimulation (TENS) machines.”(A midwifes with 10 years’ experience)\u003c/p\u003e\u003cp\u003eFacilitators of Integration: Incorporating non-pharmacological approaches into obstetric treatment becomes more feasible with the utilization of existing community structures and resources, active community involvement and awareness campaigns, policy backing, comprehensive education and training for healthcare professionals.\u003c/p\u003e\u003cp\u003e“It is crucial to offer training and capacity building to healthcare providers. Equipping midwives and other obstetric care providers with in-depth education on non-pharmacological methods, along with hands-on skills training, enables them to effectively incorporate these techniques into their professional practice.” (A midwifes with 7 years’ experience)\u003c/p\u003e\u003cp\u003e“Investing in infrastructure and equipment holds immense importance. It is essential for healthcare facilities to possess the required resources to facilitate non-pharmacological approaches, including birthing pools, spaces for relaxation, and training materials.” (A midwifes with 10 years’ experience)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we reported the practice of labor pain management and associated factors among skilled birth attendants.\u003c/p\u003e\u003cp\u003eThe present study established that the prevalence of skilled attendants who practice non-pharmacologic labor pain management was 50.5%. This study finding is in line with the study done in the Tigray Region and Egypt which was 43.3% and 44.9% respectively(22, 28). Our findings show that these areas are moderately but consistently using non-pharmacological labor pain management in different settings.\u003c/p\u003e\u003cp\u003eThis study result is higher than the studies performed in the Gedeo zone, Gamo Gofa zone, and India which were 37%, 37.5%, and 37%repectively(20, 29). This may be due to a difference in the study period, level of health institution, and sample size, this study was conducted only in public hospitals.\u003c/p\u003e\u003cp\u003eAlthough this finding is still lower than the findings Harari region, Ethiopia, and Saudi Arabia that was 59.3%,66%, and 68.3% respectively(26, 30). This may be due to a difference in the study period, level of health institution, and sample size, this study was conducted only in public hospitals.\u003c/p\u003e\u003cp\u003eThe majority of interviewers SBAs successfully manage labor pain by using a variety of non-pharmacological treatments like massage, deep breathing exercises, psychotherapy, and positional modifications. This is similar to what the study conducted in Tanzania and Ghana, which stated most healthcare providers reported that they did routinely offer non-pharmacological options, such as counseling women about the nature and severity of labor pain and trying to provide psychological support and assurance (31, 32).\u003c/p\u003e\u003cp\u003eSBA who has adequate knowledge of NPLPM was 2 times more likely to use the NPLPM method than SBA who has inadequate knowledge. (AOR\u0026thinsp;=\u0026thinsp;2, (95%), CI (1.246\u0026ndash;3.319)) Similarly lack of knowledge is one of the barriers to the use of NPLPM in Kenya and Nigeria (33, 34).\u003c/p\u003e\u003cp\u003eThis finding is opposite to a study done in Kembata which reported skilled birth attendants who had inadequate knowledge were 3.9 times more likely to use NPLPMs than those who had adequate knowledge (AOR: 3.9, 95% CI: 2.27, 6.83)(35). This difference may be in this study SBAs who had a high level of education were more likely to practice NPLPM, and professionals who had a high level of education were more likely to have adequate knowledge, they practice what they knew.\u003c/p\u003e\u003cp\u003eMost interviewer's SBAs understood the usefulness and benefits of using non-pharmacological methods in managing labor pain fostering calm, lowering tension and anxiety, and improving the childbirth experience for women were highlighted. Our study revealed, similarly conducted in Tanzania that increasing women's comfort and self-confidence, as well as their ability to cope with pain, were the most reported benefits(31).\u003c/p\u003e\u003cp\u003eThe attitude of the professionals is significantly and positively associated with obstetric pain relief, where skilled birth attendants who had positive attitudes were 7.3 times more likely to practice obstetric pain relief than those who had negative attitudes (AOR\u0026thinsp;=\u0026thinsp;7.3, 95% CI\u0026thinsp;=\u0026thinsp;4.583\u0026ndash;11.821). The finding was consistent with the study conducted in Bangladesh, Nigeria, and Ethiopia (26, 34, 36). Healthcare professionals with a positive attitude are more inclined to possess the necessary skills and carry out their duties effectively. Positive attitudes towards NPLPM can lead to more compassionate care and a greater willingness to adopt and advocate for these methods.\u003c/p\u003e\u003cp\u003eThe qualitative findings factor of non-pharmacological labor pain management are limited access to resources and equipment, time constraints during busy shifts, and cultural barriers affecting the utilization of certain techniques. Further, factors facilitating the integration of non-pharmacological methods into obstetric care were identified, including comprehensive education and training for healthcare providers, community engagement and awareness campaigns, policy support, and investment in infrastructure and equipment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe practice of non-pharmacological labor pain management is low. The profession of knowledge and attitude of the professionals are significantly associated factors that affect the practice of non-pharmacological labor pain relief for mothers during childbirth. In the qualitative part of this study limited access to resources and equipment, time constraints during busy shifts, cultural, comprehensive education and training for healthcare providers, policy support, and investment in infrastructure and equipment barriers affecting the utilization of certain techniques.\u003c/p\u003e"},{"header":"List of abbreviation and acronym","content":"\u003cp\u003eAOR Adjusted odds ratio\u003c/p\u003e\u003cp\u003eCOR Crude odds ratio\u003c/p\u003e\u003cp\u003eCI Confidence interval\u003c/p\u003e\u003cp\u003eNPLPRMs Non-Pharmacological Labor pain relief methods\u003c/p\u003e\u003cp\u003eSBA Skilled birth attendant\u003c/p\u003e\u003cp\u003eTENS Transcutaneous electrical nerve stimulation\u003c/p\u003e\u003cp\u003eUoGSCH University of Gondar Specialized Comprehensive Hospital\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and consent to participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll method were conducted according the ethical standards of the declaration Helsinki. The study was conducted under the Ethiopian Health Research Ethics Guidelines. Ethical clearance was obtained from the University of Gondar's Ethical Review Committee with Ref-Mid/W.H/03/2016 E.C. A formal letter of administrative and case team manager approval was obtained from the three hospitals. Informed consent was taken from each of the study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets used and analyzed during this study was available from corresponding\u0026nbsp;author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNotapplicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the study participant and data collectors as well as supervisors for their dedication to data collection in an organized manner.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMcDoland R. 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The nature and management of labor pain: Part I. Nonpharmacologic pain relief. American Family Physician. 2003;68(6):1109-13.\u003c/li\u003e\n\u003cli\u003eOhaeri B, Owolabi G, Ingwu J. Skilled health attendants\u0026rsquo; knowledge and practice of pain management during labour in health care facilities in Ibadan, Nigeria. European Journal of Midwifery. 2019;3.\u003c/li\u003e\n\u003cli\u003eMcCauley M, Stewart C, Kebede B. A survey of healthcare providers\u0026rsquo; knowledge and attitudes regarding pain relief in labor for women in Ethiopia. BMC pregnancy and childbirth. 2017;17:1-6.\u003c/li\u003e\n\u003cli\u003eBitew A, Workie A, Seyum T, Demeke T. Utilization of obstetric analgesia in labor pain management and associated factors among obstetric care givers in Amhara Regional State Referral Hospitals, Northwest Ethiopia: a hospital-based cross-sectional study. J Biomed Sci. 2016;5(2):3.\u003c/li\u003e\n\u003cli\u003eMousa O, Abdelhafez AA, Abdelraheim AR, Yousef AM, Ghaney AA, El Gelany S. Perceptions and practice of labor pain-relief methods among health professionals conducting delivery in minia maternity units in Egypt. Obstetrics and gynecology international. 2018;2018.\u003c/li\u003e\n\u003cli\u003eFoto LL, Zenebe WA, Ali Y, Geltore TE. Perceptions and practice of labor pain-relief methods and its perceived barriers among Obstetric Care Providers in Public Health Facilities of Gedeo Zone, Southern Ethiopia: Mixed Study, 2021. 2023.\u003c/li\u003e\n\u003cli\u003eEyeberu A, Debela A, Getachew T, Dheresa M, Alemu A, Dessie Y. Attitude and Utilization of Non-Pharmacological Labor Pain Management among Obstetrics Care Providers in Harari Regional State Health Facilities, Ethiopia. 2022.\u003c/li\u003e\n\u003cli\u003eMwakawanga DL, Mselle LT, Chikwala VZ, Sirili N. Use of non-pharmacological methods in managing labour pain: experiences of nurse-midwives in two selected district hospitals in eastern Tanzania. BMC pregnancy and childbirth. 2022;22(1):376.\u003c/li\u003e\n\u003cli\u003eBoateng EA, Kumi LO, Diji AK-A. Nurses and midwives\u0026rsquo; experiences of using non-pharmacological interventions for labour pain management: A qualitative study in Ghana. BMC pregnancy and childbirth. 2019;19:1-10.\u003c/li\u003e\n\u003cli\u003eRamasamy P, Kwena A, Emarah A, Kangethe S. Knowledge, attitude, practice and barriers to educational implementation of nonpharmacological pain management during labor in selected hospitals, Kenya. Central African Journal of Public Health. 2018;4(1):20-6.\u003c/li\u003e\n\u003cli\u003eOgboli-Nwasor E, Adaji S, Bature S, Shittu O. Pain relief in labor: a survey of awareness, attitude, and practice of health care providers in Zaria, Nigeria. Journal of pain research. 2011:227-32.\u003c/li\u003e\n\u003cli\u003eGeltore TE, Taye A, Kelbore AG. Utilization of obstetric analgesia in labor pain management and associated factors among obstetric caregivers in public health facilities of Kembata Tembaro Zone, Southern Ethiopia. Journal of pain research. 2018:3089-97.\u003c/li\u003e\n\u003cli\u003eTasnim S. Perception about pain relief during normal labour among health care providers conducting delivery. Medicine today. 2010;22(1):20-3.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Non-Pharmacological, Labor Pain Management, Skill Birth Attendant, Gondar, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-7958863/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7958863/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eLabor pain management involves both pharmacological and non-pharmacological approaches. The main goal of non-pharmacological therapies is to assist laboring women in managing their discomfort. Although managing labor through non - pharmacological methods facilitates labor progression and promotes early initiation of breastfeeding, its practical application is not acknowledged in Ethiopia.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo assess practice of non-pharmacological labor pain management and associated factors among skilled birth attendants at hospitals in Gondar Province, Northwest Ethiopia, 2024.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eA mixed methods study was conducted from December 15, 2023, to February 5, 2024. Four hundred sixteen skilled birth attendants from 18 public hospitals were selected using the census-sampling method and purposive in quantitative and qualitative respectively. Data was collected with a structured self-administered questionnaire, observation checklist, and in-depth interviews. Epi Info version 7.3 and SPSS version 25 were used for quantitative data entry and analysis respectively. Bi-variable and multivariable logistic regression analysis was done for quantitative data. A P-value of \u0026lt;\u0026thinsp;0.05 was used as the criterion for statistical significance. Thematic analysis of qualitative data was done with NVivo version 14.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe practice of non-pharmacological labor pain management is 50.5% (45.5\u0026ndash;55.5). Profession knowledge (AOR\u0026thinsp;=\u0026thinsp;2, 95% CI\u0026thinsp;=\u0026thinsp;1.246\u0026ndash;3.319) and attitude (AOR\u0026thinsp;=\u0026thinsp;7.3, 95% CI\u0026thinsp;=\u0026thinsp;4.583\u0026ndash;11.821) were found to be significantly associated with the practice of non-pharmacological labor pain management. Resource and time constraints and infrastructural and training gaps were reported as reasons for the poor practice of non-pharmacological labor pain management.\u003c/p\u003e\u003ch2\u003eConclusion and Recommendation:\u003c/h2\u003e\u003cp\u003eThe practice of non-pharmacological labor pain management is not comprehensive. Professional knowledge and attitudes of the professionals are significantly associated with their practice of non-pharmacological labor pain Management. Health facilities need for comprehensive education, training programs, should be equipped with necessary resources, and should be developed to optimize workflow and prioritize comprehensive pain management support for laboring women.\u003c/p\u003e","manuscriptTitle":"Practice of Non-Pharmacological Labor Pain Management and Associated Factors among Skilled Birth Attendants at Hospitals Found In Gondar Province, Northwest Ethiopia (2024 G.C): Mixed Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 09:50:36","doi":"10.21203/rs.3.rs-7958863/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"19771230872138398105760798296714758002","date":"2026-05-14T18:09:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-17T12:09:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169236510887181283547645167584763778147","date":"2025-12-05T07:50:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-04T15:21:38+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-10T11:14:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-08T08:53:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-08T08:52:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-10-27T07:08:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2e1b7cce-08ac-41e0-b8ef-ba8d727bec1a","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"19771230872138398105760798296714758002","date":"2026-05-14T18:09:43+00:00","index":85,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-10T08:25:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 09:50:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7958863","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7958863","identity":"rs-7958863","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}