Effect of Warm and Cold Acupressure Applied to the LI4 Acupressure Point on Childbirth Comfort During Labor: A Randomized Controlled Trial.

Context: Labor pain is considered one of the most well-known types of severe pain. For this reason, non-pharmacological methods employed for managing labor pain are necessary to help pregnant women cope with labor pain and increase their childbirth comfort. Objectives: The aim of this study was to determine the effect of cold and warm acupressure applied to the LI4 acupressure point on childbirth comfort in primiparous women during labor. Design: This study was designed as a randomized controlled experimental trial. Setting: The study was conducted between August 2020 and March 2021 at 2 hospitals in northern Turkey offering similar maternity services. Participants: The sample consisted of 129 healthy pregnant women: 44 in the warm acupressure group, 44 in the cold acupressure group and 41 in the control group. Intervention: Participants were randomly assigned to one of the three groups. The researcher applied cold or warm acupressure pouches, respectively, on the women in the 2 experimental groups on the LI4 acupressure point for 10 minutes during the active and transition phases of labor. The application was suspended for 1 hour, and then repeated 3 more times. No acupressure was administered in the control group. Outcome Measures: The Personal Information Form (PIF), Labor Monitoring Form (LMF), Visual Analog Scale (VAS) and Childbirth Comfort Questionnaire (CCQ) were used to gather study data. Results: There was a statistically significant difference between both the intergroup and intra-group pain scores in the experimental and control groups (P < .05) and childbirth comfort scores in the experimental and control groups in terms of groups and timing (P < .05). Conclusion: In this study, both warm and cold acupressure were found to alleviate labor pain. The warm acupressure, in particular, had a more positive effect on childbirth comfort. Thus, warm and cold acupressure can be recommended to relieve labor pain and increase childbirth comfort.

The trends and hotspots of research on non-pharmacological interventions for labor pain management: a bibliometric analysis.

INTRODUCTION: This study aimed to examine important points of focus, trends, and depth of research on non-pharmacological interventions for the management of labor pain worldwide from a macro perspective and present an extensive definition of research fields regarding non-pharmacological interventions. METHODS: Bibliometric methods were used in this study. With comprehensive keyword lists, the Web of Science and PubMed databases were searched using different screening strategies for publications made until 25 February 2023. RESULTS: Studies on non-pharmacological interventions in the management of labor pain have continued to develop since 2003 with great momentum. In this study, the most productive country in research on non-pharmacological interventions was found to be Iran, while Australia, the USA, China, and the United Kingdom were the most notable ones in terms of collaboration. The most prevalently studied non-pharmacological interventions were hydrotherapy and acupuncture. The results of the co-word analysis revealed 5 main themes about this field of research. CONCLUSION: The results of this study showed that interest in studies on non-pharmacological interventions in the management of labor pain has increased, the quality of research in the field is high, international collaboration is increasingly higher, and technological approaches have started to emerge in relevant studies.

Non-pharmacological labor pain relive methods: utilization and associated factors among midwives and maternity nurses in Najran, Saudi Arabia.

BACKGROUND: Traditionally, pharmacological pain relief methods have been the most acceptable option for controlling labor pain, accompanied by numerous adverse consequences. Non-pharmacological labor pain relive methods can reduce labor pain while maintaining an effective and satisfying delivery experience and delaying the use of pharmacological methods. This study explores the utilization of non-pharmacological labor pain relive methods and its associated factors among midwives and maternity nurses. METHODS: A cross-sectional research was conducted in Maternal and Children Hospital/Najran, Saudi Arabia, from April to May 2023 and incorporated a convenience sample of 164 midwives and maternity nurses. The data was collected using a self-reported questionnaire composed of five sections; basic data, facility-related factors, non-pharmacological labor pain relive utilization and attitude scales, and knowledge quiz. A logistic regression was used to determine the associated factors with non-pharmacological labor pain relive utilization. RESULTS: The results revealed that 68.3% of participants utilized non-pharmacological labor pain relive methods. The midwives and maternity nurses helped the parturient to tolerate labor pain by applying the non-pharmacological labor pain relive methods, including; positioning (55.5%), breathing exercises (53.7%), comfortable and relaxing environment (52.4%), therapeutic communication (47%), positive reinforcement (40.9%), relaxation (40.2%), and therapeutic touch (31%). In addition, working unit, providers-patient ratio, working hours, non-pharmacological labor pain relive training, years of experience, and non-pharmacological labor pain relive attitude were significant determinants of non-pharmacological labor pain relive utilization (P < 0.05). CONCLUSIONS: High non-pharmacological labor pain relive utilization was significantly associated with nurses' older age and higher education, working in the delivery room, lower nurse-patient ratio, lower working hours, in-services training, increased years of experience, and positive attitude. The study sheds light on the importance of handling the pre-mentioned factors to enhance non-pharmacological labor pain relive utilization.

Effect of Acupressure on Anxiety and Pain Levels in Primiparous Women During Normal Labor: A Randomized Controlled Trial.

Background: Normal labor is stressful, and the intense pain and anxiety can have an adverse effect on the mother, the fetus, and the delivery procedure. This study aimed to determine how acupressure applied to multiple acupoints during normal labor affected labor pain and anxiety in primiparous women. Method: This study was a double-blinded randomized controlled trial that involved 43 primiparous women aging 20-30 years who were referred for normal labor. Subjects were randomly allocated to one of two groups: acupressure or control. Acupressure was administered to the Large Intestine 4 (LI4), Heart 7 (He-7), and Spleen 6 (SP6) acupoints in the acupressure group, whereas sham acupressure was administered to the control group. The study assessed the mothers' anxiety levels using the Spielberger Inventory questionnaire and measured their pain levels using the visual analog scale before and after the intervention. In addition, pulse rate and blood pressure were also measured. Result: In the acupressure group, both the anxiety score and pain level showed a substantial improvement (p < 0.001), but in the control group, only the anxiety score showed a significant improvement (p < 0.001). After the intervention, the difference in anxiety and pain scores between the two groups is statistically significant (p < 0.001). Furthermore, neither group's blood pressure nor pulse rate showed any significant changes (p < 0.05). Conclusion: According to the study's findings, acupressure targeting LI4, He-7, and SP6 acupoints was effective in relieving anxiety and pain during labor. Compared with the sham acupressure group, the acupressure group showed a greater decrease in both anxiety and pain levels. As such, acupressure may be recommended as an effective, affordable, and accessible technique for managing pain and anxiety during labor. This study has been registered in the database of clinical trials under the identifier Clinicaltrials.gov NCT05411289.

Effect of Music Therapy on Intensity of Labor Pain among Primigravid Mothers admitted in a Tertiary Level Hospital.

BACKGROUND: Childbirth is a most welcomed and positive life experience for the majority of women, despite the pain. Most of them manage it well with minimal assistance while few of them require some intervention to reduce the pain. The objective of this study was to find out the effect of music therapy on intensity of labor pain among primigravid women. METHODS: A quasi-experimental pre-test post-test non-equivalent control group design was used. Sample consisted of 42 primigravid women admitted in labor room of a teaching hospital in Kathmandu. The intensity of labor pain was measured using Visual Analogue Scale and Behavior Rating Scale in latent and active phase of labor in both experimental and control groups. Then 30 minutes of music therapy was provided to the experimental group in the latent and active phase of labor. The post-test was carried out in both groups after the music therapy to experimental group during the latent and active phase using the same instruments. The collected data was entered in Statistical Package for Social Sciences version 16. Descriptive statistics and inferential statistics were used to describe the findings. FINDINGS: The mean difference of total pain between experimental and control groups during latent phase was 1.9 (t=2.31, p=0.023) in pre-test and 6.57 (t=3.91, p=0.000) in post-test. The mean difference of total pain between experimental and control groups during active phase was 1.00 (t=1.08, p=0.286) during pre-test and 6.95(t=3.744, p=0.001) during post-test. CONCLUSIONS: Music therapy tends to reduce labor pain both during the latent and active phase of labor.

Effect of infrared belt and hot water bag on labor pain intensity among primiparous: a randomized controlled trial.

BACKGROUND: Labor pain is complex, paradoxical and varied in every parturient woman. Management of labor pain has been a crucial component in maternity care. Heat therapy is one of the proposed method for labor pain relief. Infrared is one of the methods of heat therapy but there is any study in this regard. This study aimed to compare the effect of the infrared belt and hot water bag on the severity of pain in the first stage of labor among primiparous women. METHODS: In this clinical trial in the first stage of labor, 20-min cycles of heat therapy were conducted at the dilations of 4-5 and 6-7 cm in the intervention group 1 by an infrared belt and in the intervention group 2 by hot water bag, respectively. The control group received routine care. The severity of the pain was measured by the short-form McGill Pain Questionnaire. RESULTS: In total, 136 women consented to participate in this clinical trial study. The mean score of pain intensity was significantly lower in the two intervention groups compared to the control group (P < 0.001). The mean pain intensity was significantly lower in the infrared belt group than in the hot water bag group (P < 0.001). CONCLUSIONS: Based on these findings, heat therapy with an infrared belt reduced the severity of pain in the first stage of labor. The infrared belt could be used and recommended as a safe and effective pain relief in childbirth and maternity care. TRIAL REGISTRATION: This study was registered in the Iran Clinical Trial Center with the code of IRCT20190805044446N1 .

The Efficacy of Prenatal Yoga on Labor Pain: A Systematic Review and Meta-analysis.

Objective: This study investigated the effects of prenatal yoga on labor pain. Methods: A systematic review of articles on prenatal yoga for childbirth pain was conducted, and relevant pain score results data were collected for the meta-analysis. The intervention group was treated with yoga movement, and the control group, with routine prenatal examination. All randomized controlled trials were included, but pregnancies with internal complications were excluded. Results: A total of 47 references were obtained from PubMed, Embase, the Cochrane database, and ClinicalTrials.gov. After applying the exclusion criteria, five studies were included for the review and meta-analysis. A total of 581 women were enrolled. The SMD value summarized for the four studies was -1.05, and the 95% confidence interval was -1.45 to -0.65, which was statistically significant (z = 5.15; P < .01), suggesting that yoga can significantly reduce labor pain. Conclusions: Prenatal yoga can relieve labor pain and is recommended for pregnant women.

Effectiveness of breathing exercise on the duration of labour: A systematic review and meta-analysis.

Background: Prolonged labour intensifies labour pain, and failure to address labour pain may lead to abnormal labour and augments the usage of operative interventions. Prolonged labour is common among women, resulting in maternal morbidity, increased caesarean section (CS) rates, and postpartum complications. It may bring forth negative birth experiences that may increase the preference for CS. There is a dearth of evidence concerning the effectiveness of breathing exercises on the duration of labor. As per our knowledge, this is the first systematic review and meta-analysis on the effect of breathing exercises on the duration of labor. This systematic review and meta-analysis aimed to appraise the evidence concerning the effectiveness of breathing exercises on the duration of labour. Methods: Electronic databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Web of Science, SCOPUS, and ClinicalKey were searched for randomized controlled trials, quasi-experimental studies published in the English language between January 2005 to March 2022 that reported on the effectiveness of breathing exercises on the duration of labour. Duration of labour was the primary analysed outcome. The secondary outcomes assessed were anxiety, duration of pain, APGAR scores, episiotomy, and mode of delivery. Meta-analysis was done using RevMan v5.3. Results: The reviewed trials involved 1418 participants, and the study participants ranged from 70 to 320. The mean gestational weeks of the participants among the reported trials was 38.9 weeks. Breathing exercise shortened the duration of the intervention group's second stage of labour compared with the control group. Conclusions: Breathing exercise is a beneficial preventive intervention in shortening the duration of second stage of labour. Registration: The review protocol was registered with PROSPERO (CRD42021247126).

Effect of Foot Massage on Labor Pain in Parturient Women.

Background: Massageis one of the non-pharmacologic methods used to control pain and help pregnant women cope with the pain and positively affect labor. Objective: The aim of this study was to determine the effect of foot massage in pregnant women during labor, labor pain, the duration of the delivery, interventions, postpartum bleeding and the emotional state of the mother. Design: This study was designedas a randomized controlled experimental study. Setting: The research was carried out in primipara women who cameto the clinic for childbirth in Karaman State Hospital, Turkey, between December 2016 and May 2017. Patients: Patients comprised 80 primiparous women who were randomly assigned to either the intervention (foot massage) group (n = 40) or the control group (n = 40) in accordance with the study criteria. Intervention: Routine nursing care was provided in both groups during the latent labor phase; all women signed an informed consent form. In the first phase of birth, the intervention group received a classic foot massage for 20 minutes on each foot at 3 different times, for a total of 60 minutes (cervical dilatation was 4-5 cm, 6-7 cm and 8-9 cm during this phase). Outcome Measures: Data were obtained by using an information form to gather demographic and obstetric characteristics, the labor assessment form for labor and birth records, the Visual Analog Scale (VAS) to evaluate labor pain severity, an observation-based form for emotional behavior during labor and the Labor Agentry Scale (LAS) to evaluate the emotional state of the mothers. Results: We found that the pain severity in women who received the foot massage decreased after the intervention according to their VAS scores, and they experienced less pain in the postpartum period. In addition, in the intervention group, it was observed that the second and third stages of labor were shorter, the women showed less negative behavioral responses during delivery and were satisfied with their foot massage. Conclusion: In conclusion, it was determined that foot massage could be effective and reliable intervention in the management of labor pain.

The effects of interferential electrical stimulation current on labor pain and duration of active phase of labor in primiparous women: A randomized controlled trial.

BACKGROUND: Labor pain is one of the most severe pains experienced by a woman during her life. Interferential current (IFC) is a type of transcutaneous electrical stimulation that can reduce pain, especially deep ones. OBJECTIVE: This randomized controlled clinical trial (RCT) aimed to study the effects of quadripolar IFC on pain and the duration of the active phase of labor in primiparous women. METHOD: In this RCT, 60 primiparous women were randomized into two groups of IFC and sham IFC. The IFC group received IFC in two periods. The sham group received sham IFC. Primary outcomes were labor pain in different times of active phase and duration of active phase, and secondary outcomes were delivery satisfaction; the number of infants transferred to neonatal intensive care units (NICUs), fetal heart rate (FHR) disorders, Apgar score, partograph variables, and adverse side effects were recorded. RESULT: Between-group changes showed a significant decrease in labor pain during the active phase in the IFC group compared to the sham IFC group (mean difference (MD) = -0.95; 95% confidence interval (95% CI) = -1.35 to -0.55; P < .001). The mean of active phase duration was significantly shorter in the IFC group than in the sham IFC group (MD = -38.25; 95% CI = -62.84 to -13.67; P = .003). CONCLUSION: This study showed the effectiveness of interferential electrical stimulation during labor to reduce pain and duration of the active phase, which can be valuable in improving the quality of care and encouraging natural childbirth.

The effectiveness of auricular acupressure on pain management during labor: A systematic review and meta-analysis of randomized controlled trials.

AIM: This meta-analysis aimed to systematically evaluate the effectiveness of auricular acupressure on pain management during labor. METHODS: Six English and three Chinese electronic databases were comprehensively searched from inception to 6 November 2021. The PRISMA checklist was followed. The methodological quality of the included studies was assessed with the Cochrane Collaboration Bias Risk Assessment Tool. The meta-analysis was performed using Review Manager 5.3 software. Heterogeneity between studies was calculated using I2 . RESULTS: Five studies comprising 312 participants were included. The labor pain scores of the auricular acupressure group were significantly lower than those of the usual care group at cervix dilations of 6, 8, and 10 cm, with mean differences (95% confidence intervals) of -1.05 (-1.41, -0.69), -1.44 (-2.07, -0.82), and -1.96 (-3.30, -0.61), respectively. Auricular acupressure can thus effectively improve the labor pain perception at cervix dilations of 6, 8, and 10 cm. Moreover, auricular acupressure shortened the active phase, and had the trend of shortening the second and third stages of labor. There was no evidence that auricular acupressure had an effect on the rate of cesarean section or the 1 and 5 min Apgar scores. CONCLUSION: Effective labor pain relief, better labor pain perception, and the lack of adverse effects support the use of auricular acupressure. More high-quality and rigorous trials are needed to verify our findings before we can make strong recommendations.

The Effect of Music on Labor Pain and Duration: A Systematic Review and Meta-Analysis.

Context: The use of music in obstetrics increases every day, and it is extensively used in the control of labor pain. Objective: This study was conducted to determine the effect of music on labor pain and duration. Design and Setting: This systematic review and meta-analysis was carried out between October 15 and November 15, 2022. The search was done in the PubMed and ScienceDirect, MEDLINE, Ovid, EBSCO CINAHL Plus, and Cochrane Library databases. Outcomes meassures: According to the inclusion criteria, 12 studies included in the systematic review and meta-analysis were determined. The data were analyzed using Review Manager 5.4. The methodological quality of the studies was assessed with the RoB 2 tool. Results: Twelve articles were included in this study. According to the study results, listening to music was revealed to be statistically significantly effective in reducing pain intensity in terms of relieving labor pain (SMD:-0.98, Z=8.33, P < .001). Listening to music in the active phase was found to further decrease pain intensity compared to the latent phase (latent phase: SMD:-0.56 and active phase: SMD:-1.26), but it did not affect labor duration (MD:-0.76, Z=1.72, P = .09). Conclusion: Listening to music was determined to be effective in reducing pain intensity. The music genre selected by the researchers was found to further reduce pain intensity during labor compared to pregnant women's own choices, and it was elucidated that listening to music with headphones was effective in pain control but listening to music did not affect labor duration. PROSPERO Registration no: CRD42022367480.

Non-pharmacological measures for pain relief in childbirth: a systematic review / Medidas não farmacológicas para alívio da dor do parto: revisão sistemática

Abstract Objectives: to evaluate the effectiveness of non-pharmacological measures used by obstetric nurses to relieve pain during labor. Methods: this is a systematic review of the databases carried out in the United States National Library of Medicine, Cumulative Index to Nursing and Allied Heal Literature, Scopus, Web of Science and Latin American and Caribbean Literature in Health Sciences, the descriptors were: labor pain, labor, obstetric and obstetric nursing. The search and selection followed the PRISMA recommendations, were carried out from August to September 2020, and randomized clinical trials were eligible and analyzed using descriptive statistics. Results: 17 clinical trials made up the final sample, which highlight the use of non-pharmacological measures with diversified benefits for labor, namely: thermal therapy (20%); massage/sacral massage (15%); Swiss ball exercises (15%); acupressure (15%); auriculotherapy (10%); music therapy (10%); aromatherapy (5%); acupuncture (5%); and dance (5%). Conclusion: the non-pharmacological measures found in this review are efficient to promote pain reduction during labor, associated with a decrease in the use of drug interventions.

Resumo Objetivos: avaliar a efetividade das medidas não farmacológicas utilizadas por enfermeiros obstetras para o alívio da dor durante o trabalho de parto. Métodos: trata-se de uma revisão sistemática realizada nas bases de dados United States National Library of Medicine, Cumulative Index to Nursingand Allied Heal Literature, Scopus, Web of Science e Literatura Latino-americana e do Caribe em Ciências da Saúde, os descritores foram: labor pain, labor, obstetric e obstetric nursing. A busca e seleção seguiu as recomendações do PRISMA, aconteceu de agosto a setembro de 2020, foram elegíveis ensaios clínicos randomizados e foram analisados por meio de estatística descritiva. Resultados: 17 ensaios clínicos compuseram a amostra final, os quais destacam a utilização de medidas não farmacológicas com benefícios diversificados para o trabalho de parto, a saber: terapia térmica (20%); massagem/massagem sacral (15%); exercícios em bola suíça (15%); acupressão (15%); auriculoterapia (10%); musicoterapia (10%); aromaterapia (5%); acupuntura (5%); e dança (5%). Conclusão: as medidas não farmacológicas encontradas nesta revisão são eficientes para promover a redução da dor durante o trabalho de parto, associando-se com a diminuição do uso de intervenções medicamentosas.

The most appropriate cervical dilatation for massage to reduce labor pain and anxiety: a randomized clinical trial.

BACKGROUND: Managing labor pain by performing massage is one of the useful strategies to reduce the rate of cesarean section and increase the tendency of women for pregnancy. Therefore, it is necessary to determine the best time for massage therapy to reduce the labor pain and anxiety. In this regard, the present study was conducted to determine the cervical dilatation appropriate for performing massage in order to reduce the labor pain and anxiety. METHODS: This randomized clinical trial study was conducted on 60 nulliparous pregnant women. Eligible participants with active phase of labor were divided randomly into two groups. The intervention group received the massage three times in of dilatation 5-7-9 cm for 20 min each time by same person without the use of oil in the LDR, based on Kimber massage instructions. In the control group, all routine care was performed except massage. Pain intensity was assessed using pain ruler. Demographic and anxiety data were collected through questionnaires. RESULTS: The difference between the mean pains in the studied groups was significant in 7 cm (p < 0.0001) of cervical dilatation but was not significant in 5 cm (p = 0.084) and 9 cm (p = 0.591) dilatation. Massage effectively decreased pain intensity. The mean maternal anxiety was not significant at the beginning of the study, but was significant after performing massage (p < 0.0001) and anxiety score in the massage group decreased from 63.36 ± 5.28 (severe anxiety) at the beginning to 42.60 ± 5.83 (moderate anxiety) at the end of the study. In the control group, it increased from 66.33 ± 7.66 to 67.1 ± 5.65. CONCLUSION: The appropriate dilatation of cervix for massage in order to reduce labor pain was observed in 7 cm. Also, massage had a significant effect on reducing anxiety. Therefore, massage is recommended as a routine care in 7 cm cervical dilatations. TRIAL REGISTRATION: This trial was registered with the Iran Trial Center (trial ID: IRCT20140118016255N5). https://en.irct.ir/trial/28120.

The impact of antenatal massage practice on intrapartum massage application and their associations with the use of analgesics during labour : Sub-analysis of a randomised control trial.

BACKGROUND: Massage during labour is one form of intrapartum non-pharmacological pain relief but it is not known whether the frequency of practicing these massage techniques among couples during the antenatal period could enhance the effectiveness of intrapartum massage. This study was to evaluate the association between compliance of antenatal massage practice with intrapartum application and their impact on the use of analgesics during labour. METHODS: This was a sub-analysis of a childbirth massage programme which was carried out in two public hospitals with total births of around 8000 per year. Data from women who were randomized to the massage group were further analysed. After attending the pre-birth training class on massage at 36 weeks gestation, couples would be encouraged to practice at home. Their compliance with massage at home was classified as good if they had practiced for at least 15 minutes for three or more days in a week, or as poor if the three-day threshold had not been reached. Application of intrapartum massage was quantified by the duration of practice divided by the total duration of the first stage of labour. Women's application of intrapartum massage were then divided into above and below median levels according to percentage of practice. Logistic regression was used to assess the use of epidural analgesia or pethidine, adjusted for duration of labour and gestational age when attending the massage class. RESULTS: Among the 212 women included, 103 women (48.6%) achieved good home massage compliance. No significant difference in the maternal characteristics or birth outcomes was observed between the good and poor compliance groups. The intrapartum massage application (median 21.1%) was inversely associated with duration of first stage of labour and positively associated with better home massage practice compliance (p = 0.04). Lower use of pethidine or epidural analgesia (OR 0.33 95% CI 0.12, 0.90) was associated with above median intrapartum massage application but not antenatal massage compliance, adjusted for duration of first stage of labour. CONCLUSIONS: More frequent practice of massage techniques among couples during antenatal period could enhance the intrapartum massage application, which may reduce the use of pethidine and epidural analgesia. TRIAL REGISTRATION: (CCRBCTR) Unique Trial Number CUHK_ CCRB00525 .

Effects of acupressure and shower applied in the delivery on the intensity of labor pain and postpartum comfort.

BACKGROUND AND PURPOSE: Labour pain is a constantly increasing pain. This study thus aims to determine the effects of acupressure and shower on labour pain and postpartum comfort. METHODS: In this randomized controlled trial (RCT), the control group consisted of 40 pregnant women, while the experimental groups consisted of 80 pregnant women in total. The experimental groups received routine labour care and either acupressure or showers upon reaching three cervical dilations (4-5, 6-7 and 8-10 cm). The control group only received routine labour care. A maternal information form (MIF), the Visual Analog Scale (VAS) and the Postpartum Comfort Questionnaire (PPCQ) were used to collect data. RESULTS: Pain was significantly reduced in both of the experimental groups, in contrast to the control group, in all periods of the study (p < 0.001). Postpartum comfort also significantly increased in the experimental groups compared to the control group (p < 0.05). CONCLUSION: Acupressure and showering are effective in reducing labour pain and increasing postpartum comfort. Midwives and nurses can therefore apply them as inexpensive and easy to administer methods for labour pain relief.

Use of non-pharmacological methods in managing labour pain: experiences of nurse-midwives in two selected district hospitals in eastern Tanzania.

BACKGROUND: Labour pain usually brings with it many concerns for a parturient and her family. The majority of the women in labour pain may require some sort of pain relief method during this period, be it pharmacological or non-pharmacological. In Tanzania, the use of non-pharmacological methods to relief labour pain remains low among nurse-midwives. We analysed the experiences of nurse-midwives in the use of non-pharmacological methods to manage labour pain, in two selected districts of Pwani and Dar es Salaam regions in eastern Tanzania. This paper describes Non-pharmacological Methods (NPMs) currently used by nurse-midwives, the facilitators, myths and fears related to the use of NPMs. MATERIALS AND METHODS: An exploratory qualitative study using in-depth interviews was conducted with 18 purposively recruited nurse-midwives working in labour wards in two selected district hospitals in Pwani and Dar es Salaam regions in eastern Tanzania. Qualitative conventional content analysis was used to generate categories describing the experience of using non-pharmacological methods in managing labour pain. RESULTS: This study revealed that nurse-midwives encouraged women to tolerate labour pain and instructed them to change positions and to do deep breathing exercises as a means to relief labour pain. Nurse-midwives' inner motives facilitated the use of non-pharmacological strategies for labour pain relief despite the fear of using them and myths that labour pain is necessary for childbirth. CONCLUSION: This study generates information about the use of non-pharmacological strategies to relief labour pain. Although nurse-midwives are motivated to apply various non-pharmacological strategies to relief labour pain, fear and misconceptions about the necessity of labour pain during childbirth prohibit the effective use of these strategies. Therefore, together with capacity building the nurse-midwives in the use of non-pharmacological strategies to relief labour pain, efforts should be made to address the misconceptions that may partly be of socio-cultural origin.

Labor Analgesia: A Systematic Review and Meta-Analysis of Non-Pharmacological Complementary and Alternative Approaches to Pain during First Stage of Labor.

the aim of the study was to conduct a meta-analysis to evaluate the efficacy of non-invasive and non-pharmacological techniques on labor first-stage pain intensity. Literature databases were searched from inception to May 2021, and research was expanded through the screening of previous systematic reviews. Inclusion criteria were: (1) population: women in first stage of labor; (2) intervention: non-pharmacological, non-invasive, or minimally invasive intrapartum analgesic techniques alternative and/or complementary to pharmacological analgesia; (3) comparison: routine intrapartum care or placebos; (4) outcomes: subjective pain intensity; and (5) study design: randomized controlled trial. Risk of bias of included studies was investigated, data analysis was performed using R version 3.5.1. Effect size was calculated as difference between the control and experimental groups at posttreatment in terms of mean pain score. A total of 63 studies were included, for a total of 6146 patients (3468 in the experimental groups and 2678 in the control groups). Techniques included were massage (n = 11), birth balls (n = 5) mind-body interventions (n = 8), heat application (n = 12), music therapy (n = 9), dance therapy (n = 2), acupressure (n = 16), and transcutaneous electrical nerve stimulation (TENS) (n = 8). The present review found significant evidence in support of the use of complementary and alternative medicine for labor analgesia, and different methods showed different impact. However, more high-quality trials are needed.

Effect of the labour roadmap on anxiety, labour pain, sense of control, and gestational outcomes in primiparas.

BACKGROUND AND PURPOSE: The pain and uncertainty of the labour process can lead to anxiety. Birth ball exercises are one of the pain relief methods for the labour process. This study aimed to explore the outcomes of the use of the labour roadmap with birth balls in primiparas. MATERIALS AND METHODS: This randomized controlled trial involved Chinese women between the gestational ages of 37-42 weeks who were randomly assigned to the experimental or control group. The outcomes of labour pain, anxiety, and self-control were collected using the Short-Form McGill Pain Questionnaire, visual analogue scale-anxiety, and Labor Agentry Scale, respectively. RESULTS: The study found improvements in anxiety, pain, and self-control (P < 0.05), as well as the duration of the first stage of labour (P < 0.05) in the intervention group, but there were no significant differences in the duration of the second and third stages of labour, volume of bleeding, or the 1-min Apgar score between the two groups (P = 0.09, 0.07, 0.06, 0.63, respectively). CONCLUSION: The labour roadmap was effective for improving self-control, reducing pain and anxiety during labour, and accelerating the first stage of labour.