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

Wendy Christiaens UGent, Mieke Verhaeghe UGent and Piet Bracke UGent (2010) BMC HEALTH SERVICES RESEARCH. 10.
abstract
Background: A cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in 2 maternity care models. Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process. Methods: Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Two questionnaires were filled out by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. However, only women having a hospital birth without obstetric intervention (N = 327) were included in this analysis. A logistic regression analysis has been performed. Results: Labour pain acceptance and personal control in pain relief render pain medication use during labour less likely, especially if they occur together. Apart from this general result, we also find large country differences. Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts. This country difference cannot be explained by labour pain acceptance, since -in contrast to our working hypothesis - Dutch and Belgian women giving birth in a hospital setting are characterised by a similar labour pain acceptance. Our findings suggest that personal control in pain relief can partially explain the country differences in coping with labour pain. For Dutch women we find that the use of pain medication is lowest if women experience control over the reception of pain medication and have a positive attitude towards labour pain. In Belgium however, not personal control over the use of pain relief predicts the use of pain medication, but negative attitudes towards labour. Conclusions: Apart from individual level determinants, such as length of labour or pain acceptance, our findings suggest that the maternity care context is of major importance in the study of the management of labour pain. The pain medication use in Belgian hospital maternity care is high and is very sensitive to negative attitudes towards labour pain. In the Netherlands, on the contrary, pain medication use is already low. This can partially be explained by a low degree of personal control in pain relief, especially when co-occurring with positive pain attitudes.
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author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
EXPERIENCE, PREGNANCY, EXPECTATIONS, SELF-EFFICACY, ANALGESIA, HOME BIRTH, CHILDBIRTH SATISFACTION, LABOR PAIN, WOMENS DECISION-MAKING, NO EPIDURAL-ANESTHESIA
journal title
BMC HEALTH SERVICES RESEARCH
BMC Health Serv. Res.
volume
10
article_number
268
Web of Science type
Article
Web of Science id
000282887600001
JCR category
HEALTH CARE SCIENCES & SERVICES
JCR impact factor
1.721 (2010)
JCR rank
33/71 (2010)
JCR quartile
2 (2010)
ISSN
1472-6963
DOI
10.1186/1472-6963-10-268
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1040635
handle
http://hdl.handle.net/1854/LU-1040635
date created
2010-09-10 11:13:14
date last changed
2015-06-17 09:12:36
@article{1040635,
  abstract     = {Background: A cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in 2 maternity care models. Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process. Methods: Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Two questionnaires were filled out by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. However, only women having a hospital birth without obstetric intervention (N = 327) were included in this analysis. A logistic regression analysis has been performed. Results: Labour pain acceptance and personal control in pain relief render pain medication use during labour less likely, especially if they occur together. Apart from this general result, we also find large country differences. Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts. This country difference cannot be explained by labour pain acceptance, since -in contrast to our working hypothesis - Dutch and Belgian women giving birth in a hospital setting are characterised by a similar labour pain acceptance. Our findings suggest that personal control in pain relief can partially explain the country differences in coping with labour pain. For Dutch women we find that the use of pain medication is lowest if women experience control over the reception of pain medication and have a positive attitude towards labour pain. In Belgium however, not personal control over the use of pain relief predicts the use of pain medication, but negative attitudes towards labour. Conclusions: Apart from individual level determinants, such as length of labour or pain acceptance, our findings suggest that the maternity care context is of major importance in the study of the management of labour pain. The pain medication use in Belgian hospital maternity care is high and is very sensitive to negative attitudes towards labour pain. In the Netherlands, on the contrary, pain medication use is already low. This can partially be explained by a low degree of personal control in pain relief, especially when co-occurring with positive pain attitudes.},
  articleno    = {268},
  author       = {Christiaens, Wendy and Verhaeghe, Mieke and Bracke, Piet},
  issn         = {1472-6963},
  journal      = {BMC HEALTH SERVICES RESEARCH},
  keyword      = {EXPERIENCE,PREGNANCY,EXPECTATIONS,SELF-EFFICACY,ANALGESIA,HOME BIRTH,CHILDBIRTH SATISFACTION,LABOR PAIN,WOMENS DECISION-MAKING,NO EPIDURAL-ANESTHESIA},
  language     = {eng},
  title        = {Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands},
  url          = {http://dx.doi.org/10.1186/1472-6963-10-268},
  volume       = {10},
  year         = {2010},
}

Chicago
Christiaens, Wendy, Mieke Verhaeghe, and Piet Bracke. 2010. “Pain Acceptance and Personal Control in Pain Relief in Two Maternity Care Models: a Cross-national Comparison of Belgium and the Netherlands.” Bmc Health Services Research 10.
APA
Christiaens, Wendy, Verhaeghe, M., & Bracke, P. (2010). Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands. BMC HEALTH SERVICES RESEARCH, 10.
Vancouver
1.
Christiaens W, Verhaeghe M, Bracke P. Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands. BMC HEALTH SERVICES RESEARCH. 2010;10.
MLA
Christiaens, Wendy, Mieke Verhaeghe, and Piet Bracke. “Pain Acceptance and Personal Control in Pain Relief in Two Maternity Care Models: a Cross-national Comparison of Belgium and the Netherlands.” BMC HEALTH SERVICES RESEARCH 10 (2010): n. pag. Print.