Sterile water injections for childbirth pain: An evidenced based guide to practice

Mårtensson, Lena; Hutton, Eileen K.; Lee, Nigel; Kildea, Sue; Gao, Yu; Bergh, Ingrid

doi:10.1016/j.wombi.2017.12.001

Cited by 19 publications

(28 citation statements)

References 38 publications

(132 reference statements)

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“…Sterile water, administered into the skin bordering the Michaelis Rhomboid, is regularly used in countries such as Sweden and Australia to relieve this type of back pain in labour. Intracutaneous (also called intradermal) sterile water causes a brief but significant pain at the site of the injection and is thought to act via the gating theory of pain, with the somatic stimulation from the injection site overwhelming the pain referred there from the nerve plexus and viscera [ [3] , [4] – 5 ]. This has led to it being described as using ‘referred stimulation’ to relieve referred pain [6] .…”

Section: Introductionmentioning

confidence: 99%

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.

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Section: Introductionmentioning

confidence: 99%

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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“…The effect seemed to be related to the amount of sterile water in each injection and the number of injections. In general, four injection sites are recommended as the injections can be repeated without adverse effects for the mother and fetus ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Comparative Analgesic Effects of Intradermal and Subdermal Injection of Sterile Water on Active Labor Pain

et al. 2020

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Background The labor pain is one of the factors encouraging pregnant women for cesarean section delivery. Recently, intradermal and subdermal injection of distilled water has shown to be effective in improving this pain. Objectives The present study aimed to determine which method has a greater impact on labor pain reduction. Methods In this double-blind, randomized clinical trial, 121 nulliparous women with a gestational age of ≥ 37 weeks were randomly divided into three groups: (1) 0.5 cc sterile water injection subdermally at four sacral points with insulin needles (n = 40); (2) 0.5 cc sterile water injection intradermally (n = 39); and (3) needle contact with the mentioned points as the placebo (n = 42). Before the intervention, the VAS score was measured for labor pain, and it was repeated 10, 30, 60, and 90 min after the intervention. The results were compared between the three groups. Results Before the intervention, the mean VAS pain score had no significant difference between the three groups. However, 30, 60, and 90 min after the intervention, the mean pain score was significantly lower in the intradermal and subdermal injection groups than in the control group (P = 0.001); however, the difference between the intradermal and subdermal injection groups was not significant. Conclusions The injection of distilled water by either intradermal or subdermal method was associated with a significant reduction in the pain score during labor, but there was no difference between these two methods in terms of decreasing labor pain. As sterile water injection is a safe, effective, and low-cost method, it is proposed to increase the knowledge of midwives and obstetricians about this method.

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“…Kadınlar doğum ağrısıyla baş ederken yürüyüş yapmak, hareket etmek ve pozisyon değiştirmek yönünde eğilim göstermektedir (Simkin & Bolding, 2004 (Simkin & Bolding, 2004;Martensson et al, 2018). Derry ve arkadaşlarının (2012), 766 kadını inceledikleri Cochrane sistematik derlemesinde; uygulama yapılan kadınların daha az bel ağrısı algıladıkları belirtilmiştir (Derry, Straube, Moore, Hancock & Collins, 2012).…”

Section: Hareket öZgürlüğü/ Yürüyüş/ Pozisyon Değişikliğiunclassified

“…İntradermal su bloklarının kullanımı, doğumdaki bel ağrısını azaltmakta etkilidir. İntradermal su blokları, posterior superior iliak omurganın üzerine dört tane 0,05 ila 0,1 ml steril su enjeksiyonu (Simkin & Bolding, 2004;Martensson et al, 2018). Derry ve arkadaşlarının (2012), 766 kadını inceledikleri Cochrane sistematik derlemesinde; uygulama yapılan kadınların daha az bel ağrısı algıladıkları belirtilmiştir (Derry, Straube, Moore, Hancock & Collins, 2012).…”

Section: İntradermal Su Blokları/sterile Su Enjeksiyonuunclassified

Doğum Ağrısının Yönetiminde Farmakolojik Olmayan Ebelik Uygulamaları

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2020

Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri Ve Araştırmaları Dergisi

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Doğum, her kadın için özel bir süreçtir. Doğumun fizyolojisinden kaynaklanan ağrı, gebenin doğum sürecini doğrudan etkilemektedir. Doğum ağrısı yönetilebilen bir ağrıdır ve bu ağrının yönetimi; iyi bir ebelik bakımı ile sağlanabilir. Bu yüzden ebeler, ağrı yönetiminde farmakolojik olmayan yöntemleri intrapartum bakıma dahil ederek, doğum ağrısının yönetiminde aktif rol almalıdır. Ebeler, gebenin karar verme sürecine katılmasını sağlayarak; ağrıyla baş etmek için kullanılacak farmakolojik olmayan yöntemleri, kendi otonomisiyle uygulamalıdır. Bu amaçla; ebeler ağrının yönetiminde farmakolojik olmayan yaklaşımları takip etmeli; kanıta dayalı yöntemleri, gebeye özgü bireyselleştirilmiş ebelik bakımıyla uygulamalıdır. Bu derlemenin amacı; doğum ağrısının yönetiminde kullanılabilecek farmakolojik olmayan yöntemlerin detaylı incelenmesi ve bu yöntemler ile ilgili yapılan çalışmaların sonuçlarının belirlenmesi ile ebelik mesleği başta olmak üzere tüm sağlık profesyonellerine katkı sağlamaktır.

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Sterile water injections for childbirth pain: An evidenced based guide to practice

Cited by 19 publications

References 38 publications

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

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

Comparative Analgesic Effects of Intradermal and Subdermal Injection of Sterile Water on Active Labor Pain

Doğum Ağrısının Yönetiminde Farmakolojik Olmayan Ebelik Uygulamaları

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