Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Abraham Mukaindo

Second Supervisor/Advisor

Dr. Gilbert Mwaka

Third Supervisor/Advisor

Dr. Caroline Kathomi


Obstetrics and Gynaecology (East Africa)


Background: Epidural analgesia (EA) is considered the gold standard for relief of labour pains due to its effectiveness, safety and flexibility of use. There is a disparity of utilization between high and low & middle income countries with lack of knowledge and resources implicated. Aga Khan University Hospital Nairobi is a well-resourced facility with a well-established EA service. This study explores the perceptions, beliefs and attitudes of women seen at the facility towards EA and how these affect their decision to use the method. It also explores health care providers’ views on the method and how they influence the women’s choice. Finally, it considers the perspectives of the women and health workers on what approaches could be taken to improve uptake of the method.


Primary Objectives

1. To explore women’s perceptions, beliefs and attitudes towards epidural analgesia use in labour.

2. To explore obstetric healthcare providers’ perceptions, beliefs and attitudes towards epidural analgesia use in labour.

Secondary objective

1. To explore the views of women and health care providers on what approaches would increase uptake of epidural analgesia in labour.

Methodology: This exploratory qualitative study involved in-depth interviews (IDIs) conducted among pregnant women, consultant and resident obstetricians and anaesthesiologists and two focused group discussions (FGDs) conducted among midwives, at the Aga Khan University Hospital, Nairobi (AKUHN). Interviews were carried out to theoretical saturation after which verbatim transcription of the audio recordings into textual form was done followed by thematic content analysis using the framework method proposed by Ritchie and Spencer.

Results: Six main themes emerged from the study; factors determining perceptions, beliefs and attitudes to epidural analgesia; knowledge of participants regarding epidural analgesia; actual perceptions, beliefs and attitudes regarding epidural analgesia; usual practice by health care providers regarding labour pain relief; barriers to the use of epidural analgesia and the views of women and health care providers on how to improve uptake of epidural analgesia.

Conclusion: Misperceptions exist among women and healthcare providers regarding epidural analgesia. Awareness needs to be raised to dispel the myths and disseminate accurate information regarding the method. Cost is a significant barrier to uptake of the method and measures to improve affordability should be taken into consideration.