Cross sectional study of Australian midwives knowledge and use of sterile water injections for pain relief in labour

Lee, Nigel; Mårtensson, Lena; Kildea, Sue

doi:10.1016/j.wombi.2011.11.002

Cited by 16 publications

(36 citation statements)

References 20 publications

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“…In this context SWI was referred to as an "intervention" (Lee, et al, 2012). Although there is no precise definition in the midwifery/obstetric literature regarding what constitutes an intervention during labour, in this study the term is used to refer to a treatment that is either clinically justified or one instigated for convenience, clinician's choice or to achieve efficiency.…”

Section: Theme I: Swi -Midwifery Strategy or Medical Intervention?mentioning

confidence: 99%

“…Sterile water injections (SWI) are often perceived by midwives as a reliable and effective means of pain relief for women with back pain in labour (Lee, Martensson, & Kildea, 2012) However, the significant pain associated with the injection may be sufficient to deter labouring women from considering using SWI for pain relief (Hutton, 2009;Martensson & Wallin, 2008b). Procedural, also referred to as clinically inflicted, pain is not often considered when reviewing medical procedures performed on adults, in particular those related to pain relief (Madjar, 1998), for example the insertion of spinal or epidural catheters.…”

Section: Introductionmentioning

confidence: 99%

“…epidural anaesthesia. In a study which explored Australian midwives knowledge and use of SWI, findings suggested that some viewed the procedure as invasive, whilst others were sceptical about the analgesic effects (Lee, et al, 2012). This raises the question of whether SWI sits within the midwifery scope of supporting normal birth or, as it is an injection, is more likely to be seen as a medical intervention.…”

Section: Introductionmentioning

confidence: 99%

“…Although the use of SWI as an analgesic option in labour is common in Sweden (Martensson & Wallin, 2006), it is less so in other countries including the United Kingdom, Australia and the United States of America (Lee, et al, 2012;Martensson, McSwiggin, & Mercer, 2008a).…”

Section: Introductionmentioning

confidence: 99%

“…A contributing factor to differences in uptake may be opposition to the use of SWI, with an Australian survey reporting that over 30% of midwives had experienced resistance to the use of SWI from other midwifery and/or medical colleagues (Lee, et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

‘Tough love’: The experiences of midwives giving women sterile water injections for the relief of back pain in labour

2017

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Section: Theme I: Swi -Midwifery Strategy or Medical Intervention?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

‘Tough love’: The experiences of midwives giving women sterile water injections for the relief of back pain in labour

2017

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Midwives knowledge and education/training in complementary and alternative medicine (CAM): A national survey

Mollart

Stulz

Foureur

2021

Complementary Therapies in Clinical Practice

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Caesarean delivery rates and analgesia effectiveness following injections of sterile water for back pain in labour: A multicentre, randomised placebo controlled trial

et al. 2020

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Background About a third of women experience severe back pain during labour. Injecting small volumes of intracutaneous sterile water into the lumbar region can be used to relieve this pain, however the procedure is controversial and previous reviews call for high quality trials to establish efficacy. We evaluated the impact on birth outcomes and analgesic effects of sterile water injections. Methods A multicentre, double-blind trial undertaken between December 2012 and December 2017 in one British and 15 Australian maternity units. Women experiencing severe back-pain in labour were assigned (1:1) by an independently generated randomisation schedule stratified by site to injections of either sterile water or saline placebo. Participants and caregivers were blinded to group allocation. The primary outcome was caesarean delivery rate. Main secondary outcomes included at least 30% or 50% reduction in self-reported pain scores at 30, 60 and 90 minutes after treatment. Intention to treat analysis were used and the level of significance for the multiple clinical outcomes was set at p <0.001 with the Bonferroni correction applied. The study is registered with the ACTRN Registry number, ACTRN1261100022195 Findings Between December 9, 2012, and December 15, 2017, 1166 women were recruited and randomised: 587 women received sterile water injections (SWI) and 579 a saline placebo. Seven women in the SWI group and 12 in the placebo group were excluded as consent was not completed, leaving 580 and 567, respectively, included in the analysis. The proportions of caesarean delivery were 17·1% (82 of 580) in the SWI group and 14·8% (82 of 567) in the placebo (RR 1·16, 95% CI 0·88–1.51; p = 0·293). At 30 min post treatment 60·8% (330 of 543) of women in the SWI group reported a 30% reduction in self-reported pain compared to 31·4% (163 of 520) placebo (RR 1·94, 95% CI 1·68–2·24; p =<0·001) and 43·3% (235 of 534) SWI reported a 50% reduction versus 18·1% (94 of 520) placebo (RR 2·39, 95% CI 1·95–2·94; p =<0·001). The analgesic effect of SWI compared to placebo remained significant at 60 and 90 min post-treatment. There were no significant differences in other maternal or neonatal outcomes. Interpretation Compared to placebo, injections of sterile water did not reduce rates of caesarean delivery. For the main secondary outcome of pain relief the intervention did result in significantly more women reporting at least 30% and 50% reduction in pain for up to 90 min. Water injections have no effect on birth outcomes though can be an effective treatment for the relief of labour-related back pain. Funded by the National Health and Medical Research Council.

show abstract

Cross sectional study of Australian midwives knowledge and use of sterile water injections for pain relief in labour

Cited by 16 publications

References 20 publications

‘Tough love’: The experiences of midwives giving women sterile water injections for the relief of back pain in labour

‘Tough love’: The experiences of midwives giving women sterile water injections for the relief of back pain in labour

Midwives knowledge and education/training in complementary and alternative medicine (CAM): A national survey

Caesarean delivery rates and analgesia effectiveness following injections of sterile water for back pain in labour: A multicentre, randomised placebo controlled trial

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