Pain management for women in labour: an overview of systematic reviews

Jones, Leanne; Othman, Mohammad; Dowswell, Therese; Alfirević, Z̄arko; Gates, Simon; Newburn, Mary; Jordan, Susan J.; Lavender, Tina; Neilson, James P

doi:10.1002/14651858.cd009234

Cited by 78 publications

(102 citation statements)

References 73 publications

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“…(1,2) Epidural neuroaxial analgesia is the most often discussed and present in studies, due to its great effectiveness for pain relief. (1)(2)(3)(4) The provision of methods for pain relief during labor, in Brazil, still occurs less frequently than desired, even though the woman's right to receive care that offers pain control methods has been instituted by the Ministry of Health, (5) and was reinforced by the Rede Cegonha strategy in 2011, (6) and by normal birth guidelines in 2016. (7) The National Demographic and Health Survey in 2006, showed that only 30.4% of the Brazilian women had access to non-pharmacological and pharmacological measures for pain relief.…”

Section: Introductionmentioning

confidence: 99%

O uso de analgesia farmacológica influencia no desfecho de parto?

et al. 2017

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Objective: To investigate the association between pharmacological analgesia and childbirth outcomes. Methods: A cross-sectional study using a representative sample of childbirth performed in 2013, at a maternity hospital in Belo Horizonte, Minas Gerais. Data from 978 childbirths were included, excluding elective cesareans. The main exposure was the use of pharmacological analgesia during labor, with the outcome classified as vaginal, instrumental vaginal, or cesarean delivery. The association between analgesia and childbirth outcomes was assessed using multinomial logistic regression to obtain Odds Ratio (OR) estimates with their respective 95% confidence intervals. The final model was adjusted for the woman's age, number of previous births, presence of companion or doula, and cervical dilatation at the time of analgesia. Results: Among the total number of births, 87.1% were vaginal and 12.9% were cesarean. The prevalence of the use of pharmacological analgesia was 34.2%, and delivery with instrumentation was 8.4%. About 70% of the women had a normal risk pregnancy. Even after adjusting for confounding variables, the use of analgesia increased the chance of delivery with instrumentation by 3.5 times (p<0.0001); for women with high-risk pregnancies, this increase was even higher (OR=4.62; p<0.0001). There was no association between analgesia and cesarean section (p=0.320). Conclusion: The use of pharmacological analgesia modifies the outcome of childbirth, increasing the chances of delivery with instrumentation, especially in women with high-risk pregnancies. In this context, it is important to guide women about the potential risks and benefits of analgesia so they may make a safe choice. ResumoObjetivo: Investigar associação entre analgesia farmacológica e desfechos do parto. Métodos: Estudo transversal que utilizou amostra representativa dos partos realizados em 2013, em uma maternidade de Belo Horizonte, Minas Gerais. Foram incluídos dados de 978 partos, excluindo-se as cesarianas eletivas. A exposição principal foi o uso de analgesia farmacológica durante o trabalho de parto e o desfecho classificado como parto vaginal, vaginal instrumentalizado e cesariana. Verificou-se a associação entre analgesia e os desfechos do parto por meio de regressão logística multinominal para obter as estimativas de Odds Ratio (OR) com seus respectivos intervalos de 95% de confiança, e o modelo final foi ajustado por idade da mulher, número de partos anteriores, presença de acompanhante ou doula e dilatação cervical no momento da analgesia. Resultados: Do total de nascimentos, 87,1% foram vaginais e 12,9% cesariana. A prevalência do uso de analgesia farmacológica foi 34,2% e do parto instrumentalizado de 8,4%. Cerca de 70% das mulheres tiveram gestação de risco habitual. Mesmo após ajuste por confundidores, o uso da analgesia aumentou em 3,5 vezes a chance de parto instrumentalizado (p<0,0001) e para as mulheres com gestação de alto risco esse aumento foi ainda superior (OR=4,62; p<0,0001). Não houve associação do uso da ...

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Section: Introductionmentioning

confidence: 99%

O uso de analgesia farmacológica influencia no desfecho de parto?

et al. 2017

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“…Women choosing epidural anaesthesia may have increased efficiency of pain relief but as a consequence of this intervention are more likely to exper ience adverse outcomes including instrumental delivery, caesarean section for fetal distress, hypotension, motor blocks, fever and urine retention (Jones et al, 2012). Furthermore it appears women's satisfaction with the childbirth experience is not related to efficiency of pharmacological pain relief (Green et al, 2003;Hodnett, 2002) but to interpersonal elements of care such as continuity of carer (Hodnett et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Women׳s experiences of coping with pain during childbirth: A critical review of qualitative research

Gucht¹,

Lewis²

2015

Midwifery

109

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Objective: to identify and analyse qualitative literature exploring women's experiences of coping with pain during childbirth. Design: critical review of qualitative researchFindings: Ten studies were included, conducted in Australia, England, Finland, Iceland, Indonesia, Iran and Sweden. Eight of the studies employed a phenomenological perspective with the remaining two without a specific qualitative methodological perspective. Thematic analysis was used as the approach for synthesising the data in this review. Two main themes emerged as the most significant influences upon a woman's ability to cope with pain: (i) the importance of individualised, continuous support and (ii) an acceptance of pain during childbirth.This review found women felt vulnerable during childbirth and valued the relationships they had with health professionals. Many of the women perceived childbirth pain as challenging however they described the inherent paradox for the need for pain to birth their child. This allowed them to embrace the pain subsequently enhancing their coping ability.Key conclusions: women's experience of coping with pain during childbirth is complex and multi-faceted. Many women felt the need for effective support throughout childbirth and described the potential implications where this support failed to be provided. Feeling safe through the concept of continuous support was a key element of care to enhance coping ability and avoid feelings of loneliness and fear. A positive outlook and acceptance of pain was acknowledged by many of the women, demonstrating the beneficial implications for coping ability. These findings were consistent despite the socio-economic, cultural and contextual differences observed within the studies suggesting experiences of coping with pain during childbirth are universal. Implications for practice:

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“…The Cochrane Library has even devoted an entire systematic review to compiling all of the existing meta-analyses on the subject [80]. They cover a wide variety of different interventions: relaxation, massage, acupuncture, TENS (transcutaneous electric neurostimulation), injection of sterile water, hypnosis, and aromatherapy.…”

Section: Alternative Medicinementioning

confidence: 99%

Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 3: Interventions associated with oxytocin administration during spontaneous labor

Barasinski

Vendittelli

2017

Journal of Gynecology Obstetrics and Human Reproduction

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A c c e p t e d M a n u s c r i p t 2 2 SummaryObjectives. ─ The objective of our work was to determine the effects of co-interventions used during labor with oxytocin or for labor dystocia.Methods. ─ We searched for reports of the interventions we sought to study published between 1987 and 2015, looking especially for meta-analyses and randomized trials via the Medline database and the Cochrane Library. We limited our research to studies of spontaneous labor in singleton pregnancies at term. Conclusions. ─ Few of the co-interventions studied appear to modulate recourse to oxytocin.

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Pain management for women in labour: an overview of systematic reviews

Cited by 78 publications

References 73 publications

O uso de analgesia farmacológica influencia no desfecho de parto?

O uso de analgesia farmacológica influencia no desfecho de parto?

Women׳s experiences of coping with pain during childbirth: A critical review of qualitative research

Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 3: Interventions associated with oxytocin administration during spontaneous labor

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