INTRODUCTION: Despite the high demand for pain relief during labor, access to labor analgesia remains limited in low-resource settings due to different challenges such as shortage of staff, inadequate equipment and supplies, insufficient training, high cost, and lack of local protocols. This project aimed to evaluate the feasibility of implementing a labor analgesia program at a major teaching hospital in Rwanda.
METHODS: This was a quality improvement project testing the implementation of the first labor analgesia program at the University Teaching Hospital of Kigali from August 2019 till July 2023. Descriptive statistics in Microsoft Excel (2010) were used for analysis.
RESULTS: 153 women underwent labour analgesia during our evaluation period. All women had adequate pain control (100%). Most women underwent epidural 136 (88.9%), followed by combined spinal epidural 13 (8.5%), and single-shot spinal anesthesia 4 (2.6%). Most labour analgesia procedures were conducted by anesthesiologists with residents 98 (64%) or anesthesiologists alone 45 (29.4%).
Most women had spontaneous vaginal delivery 102 (67%), however, 51 women had cesarian section (CS) mainly due to non-reassuring fetal heart rate (FHR) 30 (58.9%) and labor arrest 10 (19.6%). Most of them had no maternal or neonatal event 44 (86%). No post-dural puncture headache, infection, or epidural hematoma was recorded.
CONCLUSION: The results of this quality improvement project suggest that labour analgesia is feasible in low-resource settings and highlight essential areas for improvement, such as staffing and availability of equipment. This project provides valuable lessons for other anesthesiologists and hospitals in similar settings aiming to establish labor analgesia programs. More investments are needed in order to sustain and expand the labour analgesia program for women in low-resource settings.
