Pain during child birth is one of the worst forms of pain, which can be experienced by women. Even though various safe and effective methods of pain reliefare widely in practice in many countries, in India their utilization is almost negligible.Lack of appropriate knowledge, attitude and behavior among relevant stakeholders may be a vital barrier in this regard. As there is scarcity of studies from India on this subject, this study is an attempt to fill this vital gap in the knowledge.

1. To assess the knowledge and attitude of pregnant women, CRRIs, Obstetricians and anesthesiologists about labor analgesia

2. To identify the barriers for widespread utilization oflabor analgesia

The study was a cross sectional study, conducted in a tertiary care teaching hospital. All the relevant stakeholders in provision or utilization of labor analgesia were included. The pregnant women were selected by simple random sampling and all the available obstetricians and anesthesiologists were included. A standardized and validated questionnaire, translated in to the local language was used for data collection.

A total of 100 pregnant women, 30 CRRIs, 21 obstetricians and 25 anesthesiologists were included in the study. In all the study groups, the median perceived severity of labor pain on a scale of 0 t0 100 was more than 75. All the anasthesiologistsfel that the labor pain is unbearable but bearable with pain. This proportion was 42.9%, 36.7% and only 8% among obstetricians, CRRIs and antenatal women. Majority(80%) of the antenatal women felt that the labor pain is the worst possible pain and nothing can be done about it. All the anasthesiologists and antenatal women felt that the labor pain should be relieved. Only a minor proportion of other study groups have felt that it should not be relieved. Only 16.7% of CRRIs and 14% of pregnant women were aware of labor analgesia. The proportion women offered labor analgesia in their previous delivery was only 8%. Prohibitive cost and fear of side effects were the main reasons for not opting it. Majority of women said, if there is a safe and effective method of pain relief available, they would opt for it. But this proportion dropped to 55%, when it was mentioned that the cost may go up by 30 to 40%.There were conflicting opinions from the obstetricians. Even though 95.2% of them felt that labor analgesia could improve the quality of child birth, majority of them also strongly believed that it may prolong the second or third stage of labor (81%) and may lead to forceps delivery (66.7%). Longer time required for anaesthesiologists and the cost are felt as main barriers by 66.7% and 71.4% of the obstetricians. Only about 20% of them felt that labor analgesia is not suitable for Indian scenario.

1. The perception about severity of labor pain is very high among all study groups

2. The knowledge about labor analgesia is very poor among antenatal women and medical students

3. Negative perceptions about safety among obstetricians, cost and requirement of longer time required for anaesthesiologists were identified as the important barriers.