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Sterile water injections and acupuncture as treatment for labour pain
University of Skövde, School of Life Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Most women experience pain during labour. Complementary pain relief methods such as sterile water injections and acupuncture are two alternatives for the child birthing women. The lack of knowledge about the use of these methods in clinical practice creates the need to develop and evaluate them.

Aims and methods: To elucidate whether the new subcutaneous method of administering sterile water, as well as the previously described intracutaneous injection method, were effective for the relief of labour pain. Ninety-nine women in labour were randomized to either intracutaneous- , subcutaneous injections of sterile water or to placebo (Paper I). To investigate if there was any difference in perceived pain between the intracutaneous and subcutaneous techniques during injection of sterile water. One hundred female volunteers were given injections with both techniques in a cross-over trial (Paper II). To elucidate the clinical use of acupuncture and sterile water injections as pain relief and relaxation during childbirth in Swedish delivery wards. Five hundred and sixty-five midwives answered a questionnaire about their use of these methods (Paper III). To elucidate if there were any differences between acupuncture and sterile water injections in terms of pain relief and relaxation during labour. One hundred and twenty-eight pregnant women in childbirth were randomized to either sterile water injections or acupuncture (Paper IV).

Results: Paper I: VAS pain scores were significantly lower in both treatment groups 10 minutes (p=0.001) and 45 minutes (p=0.005) after treatment, compared with the placebo group. Paper II: subcutaneous injections were still perceived as less painful than intracutaneous injections after trial, day and injection location were taken into consideration (p<0.001). Paper III: the midwives’ estimated frequency of administration of acupuncture was much higher than that of sterile water injections, 25 % versus 2 %. The intracutaneous injection technique was more common in clinical practice than the subcutaneous technique. Sterile water injections were used exclusively for pain relief during labour while acupuncture was used for both pain relief and relaxation during labour. Paper IV: women given sterile water injections experience significantly less labour pain and a higher degree of relaxation in labour, compared to women given acupuncture (p<0.001).

Conclusions: The results indicate that the subcutaneous injection technique is preferable when using sterile water injections for low back pain during labour. Sterile water injections seem to provide more pain relief and a higher degree of relaxation, compared to acupuncture. However, acupuncture is a more common pain relief method in clinical practice.

Place, publisher, year, edition, pages
Göteborgs universitet , 2006. , 66 p.
Keyword [en]
Labour pain, pain relief, sterile water injections, acupuncture, survey
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medical sciences
Identifiers
URN: urn:nbn:se:his:diva-1881ISBN: 91-628-6904-3 OAI: oai:DiVA.org:his-1881DiVA: diva2:32157
Public defence
(English)
Available from: 2008-01-08 Created: 2008-01-08 Last updated: 2013-11-20Bibliographically approved
List of papers
1. Subcutaneous versus intracutaneous injections of sterile water for labour analgesia: a comparison of perceived pain during administration
Open this publication in new window or tab >>Subcutaneous versus intracutaneous injections of sterile water for labour analgesia: a comparison of perceived pain during administration
2000 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 107, no 10, 1248-1251 p.Article in journal (Refereed) Published
Abstract [en]

Objective To investigate whether, during injections of sterile water, there is any difference in perceived pain between intracutaneous and subcutaneous injections.

Design Blind controlled trial with cross-over design.

Setting Göteborg and Skövde, Sweden.

Participants One hundred healthy female volunteers.

Methods The women were randomised into two groups and subjected to two trials, within one week of each other. During the first trial one group ( n= 50 ) received the intracutaneous injection first, followed by the subcutaneous injection. The second group ( n= 50 ) was given the subcutaneous injection first, followed by intracutaneous injection. In both groups all the injections were given in reverse order during the second trial.

Main outcome measures Experienced pain during the administration of sterile water injections, measured by visual analogue scale.

Results The analysis showed intracutaneous injections to be significantly more painful than subcutaneous injections, even after adjusting for injection day and for left/right site of injection (mean 60.8 vs 41.3,  P < 0.001 ).

Conclusions The findings suggest that the less painful subcutaneous injection technique should be used.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2000
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:his:diva-2568 (URN)10.1111/j.1471-0528.2000.tb11615.x (DOI)000089558100010 ()11028576 (PubMedID)2-s2.0-0033804554 (Scopus ID)
Available from: 2009-01-21 Created: 2009-01-21 Last updated: 2013-01-28
2. Acupuncture versus subcutaneous injections of sterile water as treatment for labour pain
Open this publication in new window or tab >>Acupuncture versus subcutaneous injections of sterile water as treatment for labour pain
2008 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 2, 171-177 p.Article in journal (Refereed) Published
Abstract [en]

Two methods for pain relief and relaxation during labour are sterile water injections and acupuncture. In several studies, sterile water injections have been shown to provide good pain relief, particularly for low back pain during labour. The acupuncture studies for pain relief during labour are not as concordant. Therefore, the aim of this study was to explore if there were any differences between acupuncture and sterile water injections regarding pain relief and relaxation during labour. METHODS: A randomised controlled trial. Some 128 pregnant women at term were randomly assigned to receive acupuncture (n=62) or sterile water injections (n=66). The primary endpoint was to compare the differences between pre-treatment pain levels and maximum pain in the 2 groups. RESULTS: The main results of this study were that sterile water injections yielded greater pain relief (p<0.001) during childbirth compared to acupuncture. The secondary outcome showed that women in the sterile water group had a higher degree of relaxation (p<0.001) compared to the acupuncture group. The women's own assessment of the effects also favoured sterile water injections (p<0.001). There were no significant differences regarding requirements for additional pain relief after treatment between the 2 groups. CONCLUSIONS: Women given sterile water injection experience less labour pain compared to women given acupuncture.

Place, publisher, year, edition, pages
John Wiley & Sons, 2008
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medical sciences
Identifiers
urn:nbn:se:his:diva-2569 (URN)10.1080/00016340701797799 (DOI)000252762000006 ()18231884 (PubMedID)2-s2.0-38649129367 (Scopus ID)
Available from: 2009-01-21 Created: 2009-01-21 Last updated: 2013-01-28Bibliographically approved
3. Use of Acupuncture and Sterile Water Injection for Labor Pain: A Survey in Sweden
Open this publication in new window or tab >>Use of Acupuncture and Sterile Water Injection for Labor Pain: A Survey in Sweden
2006 (English)In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 33, no 4, 289-296 p.Article in journal (Refereed) Published
Abstract [en]

Acupuncture and sterile water injections are nonpharmacological pain relief methods used for labor pain in Swedish delivery wards. Their use has changed over time, the reasons for which are unclear, and acupuncture is currently in more common use than sterile water injections. The aim of this study was to elucidate the clinical use of acupuncture and sterile water injections as pain relief and relaxation during childbirth in Sweden. Methods: Twelve hundred questionnaires were sent out to all delivery wards in Sweden. Nine hundred sixty midwives fulfilled the inclusion criteria, and the response rate was 565 (59%). Results: Acupuncture was used for both pain relief and relaxation, whereas sterile water injections were used almost exclusively for pain relief. The midwives' own choice of pain relief during childbirth for a possible future delivery was similar to their choice of method in clinical practice. Conclusions: Our study shows that acupuncture was used for both pain relief and relaxation, whereas sterile water injections were used almost exclusively for pain relief. The results also indicate a weakness in midwives' awareness and use of scientific knowledge and general recommendations about these methods

Place, publisher, year, edition, pages
Wiley-Blackwell, 2006
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:his:diva-1940 (URN)10.1111/j.1523-536X.2006.00121.x (DOI)000242110600005 ()17150067 (PubMedID)2-s2.0-33751219890 (Scopus ID)
Available from: 2008-04-09 Created: 2008-04-09 Last updated: 2013-01-28
4. Labour pain treated with cutaneous injections of sterile water: a randomised controlled trial
Open this publication in new window or tab >>Labour pain treated with cutaneous injections of sterile water: a randomised controlled trial
1999 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 106, no 7, 633-637 p.Article in journal (Refereed) Published
Abstract [en]

Objective To evaluate the relief of pain in labour with subcutaneous and intracutaneous injections of sterile water, compared with placebo.

Design Randomised controlled trial.

Setting Labour ward with approximately 3000 deliveries annually in a suburban area near Gothenburg, Sweden.

Participants Ninety-nine pregnant women at term, requiring pain relief for severe lower back pain during the first stage of labour. The women were randomised to receive four injections of 0.1 mL sterile water (without salt) intracutaneously ( n= 33 ), four injections of 0.5 mL sterile water subcutaneously ( n= 33 ) or placebo treatment ( n= 33 ).

Main outcome measures Reduction of labour pain measured by visual analogue scale.

Results The median visual analogue scale pain score for labour pain was significantly lower compared with initial values in the two study groups and compared with placebo at 10 and 45 minutes after treatment. The median reductions in visual analogue scores after 10 minutes were 5.0 cm and 4.5 cm in the intracutaneous and subcutaneous injection groups, respectively; women in the placebo group scored a median reduction of 1.7 cm. After 45 minutes the median reductions in the visual analogue scores were 4.9 cm and 4.0 cm in the intracutaneous and subcutaneous injection groups, respectively, compared with 1.0 cm for women in the placebo group. No significant differences in analgesic effect or pain experienced during administration were found between the two study groups.

Conclusion The new subcutaneous method of administering sterile water, as well as the earlier described intracutaneous injection method, were effective for the relief of pain in labour.

Place, publisher, year, edition, pages
Wiley-Blackwell, 1999
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:his:diva-2567 (URN)10.1111/j.1471-0528.1999.tb08359.x (DOI)000081320500004 ()10428516 (PubMedID)2-s2.0-0033011219 (Scopus ID)
Available from: 2009-01-21 Created: 2009-01-21 Last updated: 2013-01-28

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