Exposed parturients were statistically older than unexposed ones (33.6 years ± 4.1 versus 29.5 years ± 3.6). Parturients aged 30 - 35 years were most likely to use analgesia (P = 0.04) (Table 1).

The majority of parturients were also married (P = 0.12) mostly coming from the coastal region (P = 0.0004) (Table 1).

In the same vein, the use of analgesia was more frequent among parturients whose minimum monthly income was 200,000 FCFA (P < 0.0001) (Table 1).

Drug administration

The only anaesthetic used was bupivacaine (35/35; 100%), mostly combined with fentanyl (32/33; 96.2%). It was often administered by an electric syringe (24/35; 68.6%) (Table 2).

Analgesia technique used

The local anaesthetic used was bupivacaine with fentanyl as the main adjuvant in 96.9% of cases (Table 2).

The pain experienced by the parturients was more intense under analgesia in the VAS during the active phase of labour (9 versus 9, P < 0.0001), during expulsion (1 versus 6; P < 0.001) and even at the 6th-hour postpartum (1 versus 1; P < 0.004 (Table 3).

The majority of patients (14/35; 40%) delivered within the first 3 hours. And these were less likely to have pain, on the other hand, parturients under analgesia were five times more likely to have paresthesias (P = 0.004; 95% CI = 1.85 - 18.99; RR = 5.92) and three times more likely to have prolonged second stage labour (P = 0.006; 95% CI = 1.43 - 9.31; RR = 3.65) (Table 4).

Factors associated with the use of analgesia during childbirth were: having an age greater than 30 years (OR = 7.54, 95% CI = 2.65 - 21.45; P = 0.0002) being from the Littoral region (OR = 8.76, 95% CI = 2.20 - 34.87; P = 0.002), working in a private setting (OR = 11.49, 95% CI = 3.96 - 33.30; P < 0.0001) and having

an income of more than 200,000 CFA francs (OR = 60.17, 95% CI = 13.09 - 276.46; P < 0.0001) (Table 5).

During our study, 35 parturients benefited from analgesia delivery out of a total population of 114 parturients, a frequency of 30.7%; this is lower than a study conducted by Koteles et al. in October 2012 in Canada where the rate of use of epidural analgesia was 57.3% in women who had a vaginal delivery [7]. This low rate could be explained by the fact that parturients in our African context wish to respect their cultural beliefs (58.2%) and have a less medicalised delivery (59.5%). This rate is however higher than that found by Imarengiaye et al. in a study conducted in September 2013 in a tertiary hospital in Nigeria, where the rate of use of epidural analgesia during labour during the study period was 1.3% [8]. This increase is thought to be partly due to the lack of information about the possibility of pain-free delivery, the lack of trained staff, and even infrastructure in these tertiary hospitals.

The mean ages were 33.6 ± 4.1 years for parturients who used analgesia during labour and 29.5 ± 3.6 years for parturients who did not receive analgesia during labour. Parturients aged 30 - 40 years were twice as likely to use analgesia during labour.

Parturients employed in the public and private sectors were respectively 2 to 3 times and 3 to 4 times more likely to use analgesia during labour. The same was true for parturients with a minimum monthly income of 200,000 FCFA, who were 8 times more likely to use analgesia. A similar finding was made in a study carried out in Canada in 2012 by Koteles et al. on the maternal characteristics and satisfaction associated with the use of intrapartum epidural analgesia in Canadian women, where he found that women who had recourse to epidural analgesia were twice as likely to have a high salary [7]. This can be explained by the fact that giving birth under epidural analgesia is expensive in our hospitals and therefore not affordable for people with a low standard of living.

Throughout our study, the only analgesia technique observed to relieve the pain of labour was delivery under epidural analgesia (100%) with bupivacaine as the local anaesthetic used; The majority of anaesthetists (98%) recommended, in accordance with the literature, the use of epidural analgesia during labour [9] [10] [11].

Similarly a study by Lavand et al. in 2009 in Belgium on patient-controlled intravenous analgesia as an alternative to epidural analgesia during labour: Questioning the use of the short-acting opioid remifentanil in the French part of Belgium where delivery under epidural analgesia was found in 68%. When epidural analgesia was not available or contraindicated, parenteral opioid administration (tramadol or pethidine) was proposed in 19% (7/36) of hospitals, then a third choice was the use of entonox to relieve labour pain in 11%, a pudendal block by obstetricians in 28% of hospitals and non-pharmaceutical alternatives (i.e. hypnosis, relaxation therapy, baths, and massage) in 19% [12].

Finally, a study conducted by Pottecher et al. in France in 2012 aimed to provide an overview of the mechanisms and pathways of labour pain (including new knowledge on the integration of the nociceptive signal) and highlight the need for effective labour pain relief found that among the current methods of obstetric analgesia, regional analgesia (the most common technique being epidural analgesia) offers the best efficacy/safety ratio due to pharmacological innovations. Systemic analgesia (parenteral opioids, non-opioid analgesics, and inhaled anaesthetic agents) offers an alternative to regional analgesia but remains less effective and more dangerous. Non-drug approaches (i.e. psycho prophylaxis and physical methods) can be effective when used with epidural analgesia but are often not powerful enough when used alone [13]. Our results could be explained by the fact that epidural analgesia confers more advantages because the equipment needed to perform it is available, less expensive, consciousness is maintained and there are few side effects.

During the entire recruitment period in the maternity wards of the Yaoundé Gynaecological-Obstetric Hospital, Yaoundé Central Hospital, and Douala General Hospital, we found that only 6.3% of parturients were given a suggestion by the midwives to better cope with the pain of labour in the labour ward. This is lower than the rate found by Lawani and Nigeria in 2012 who conducted a study on the recommendation of analgesia during labour in Nigeria where 49% of obstetricians offered obstetric analgesia. Only 13.3% routinely offered obstetric analgesia to parturients [14]. This low rate could be explained by the fact that our midwives sometimes have little knowledge about the practice of obstetric analgesia and also fear a prolongation of the duration of labour that could extend the hours of monitoring the parturient.