Labor Pain Management Practices in Ethiopia: An Umbrella Review
Wondu Feyisa Balcha, Tewodros Worku Bogale, Gebeyehu Masresha Teferi, Amanuel Tebabal Nega, Wondimagegn Genaneh Shiferaw, Lewegneh Wegayehu Tessema, Solomon Medina Megule, Desalegn Getnet Demsie, Chernet Tafere, Zenaw Debasu Addisu, Kebede Feyisa, Fentahun Alemnew ChekoleIntroduction
Labor pain management is a core component of respectful maternity care. In Ethiopia, systematic reviews and meta-analyses have reported inconsistent findings, with wide variation in pooled prevalence and methodological quality. This fragmentation limits reliability and hinders evidence-based decision-making. We conducted an umbrella review synthesizing labor pain management practices and associated factors in Ethiopia.
Methods
This umbrella review was registered in PROSPERO (CRD420251141567). Searches were conducted in PubMed, ScienceDirect, Cochrane Library, Web of Science, African Journals Online, and grey literature (2010–2025). Methodological quality was assessed using A MeaSurement Tool to Assess Systematic Reviews, version 2, overlap with corrected covered area, and evidence credibility with the Ioannidis framework. Random-effects models pooled labor pain management practice prevalence, while fixed-effects models synthesized associated factors. Heterogeneity was assessed using Cochran’s Q and I 2 .
Results
Seven systematic reviews and meta-analyses comprising 92 primary studies and 31,824 obstetric care providers were initially identified. After reanalysis and exclusion of inappropriate primary studies, 88 studies with 29,875 obstetric care providers were included in the final synthesis. The pooled prevalence of overall labor pain management practice was 43% (95% CI: 39–47). Non-pharmacological labor pain management practice was 43% (95% CI: 42–44), while pharmacological labor pain management practice was 26% (95% CI: 22–31), declining to 21% (95% CI: 12–35) after bias adjustment. Evidence credibility was moderate for overall and non-pharmacological, but low for pharmacological systematic reviews and meta-analyses. Favorable attitudes, knowledge, education, midwifery profession, analgesic availability, supportive environments, work experience, birth companionship, and training were positively associated with systematic reviews and meta-analyses.
Conclusions
Labor pain management practice in Ethiopia remains suboptimal, with non-pharmacological approaches predominating and pharmacological methods underutilized. Strengthening provider training, ensuring analgesic availability, improving staffing and protocols, and promoting supportive policies may enhance equitable, evidence-based intrapartum care.