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Pain management during labour at the El-Emarati Hospital: a clinical audit. BACKGROUND: The aim of this study was to assess the practice of pain management for women in labour at El-Emarati Hospital in Rafah, Gaza Strip, and to compare this management with the guidelines by the National Institute for Health and Care Excellence (NICE). METHODS: A data collection sheet was prepared and completed for each patient admitted to the delivery room. Patients were enrolled consecutively between Feb 1 and April 1, 2016. Data collection sheets, based on NICE guidelines, were completed by the audit team (TAH, MSF, and RYA). Verbal consent was obtained from all participants. FINDINGS: 50 patients were included in the audit. 22 patients were primigravidae, and 28 patients were multigravidae. At least one or more non-pharmacological pain management method was used for each patient. 50 (100%) patients were managed by breathing and relaxing techniques. 35 (70%) patients also received abdominal massage. 20 (40%) patients had their pain managed pharmacologically. None of the patients was informed beforehand about possible side-effects of the drugs used, and none of the patients was offered or received regional anaesthesia for pain management during labour. INTERPRETATION: We found a substantial shortfall in the management of pain during labour, especially as many options and techniques are not used or offered to patients. Another weakness was the limited discussion and lack of choice available to patients with respect to the use of pain relief. Pain is a highly subjective experience and varies greatly between patients, so preferences for use of pain relief will differ between individuals, and this should be reflected in practice. FUNDING: None.