Nonpharmacological Methods to Reduce Pain During Active Labor in A Real-life Setting.

OBJECTIVE: To evaluate the association between pain intensity in the active phase of the first stage of labor with the use or not of nonpharmacological methods for pain relief in a real-life scenario. METHODS: This was an observational cross-sectional study. The variables analyzed were obtained by a questionnaire with the mothers (up to 48 hours postpartum) to investigate the intensity of pain during labor using the visual analog scale (VAS). The nonpharmacological pain relief methods routinely used in obstetric practice were evaluated by consulting medical records. The patients were separated into two groups: Group I - patients who did not use nonpharmacological methods for pain relief and Group II -patients who used these methods. RESULTS: A total of 439 women who underwent vaginal delivery were included; 386 (87.9%) used at least 1 nonpharmacological method and 53 (12.1%) did not. The women who did not use nonpharmacological methods had significantly lower gestational age (37.2 versus 39.6 weeks, p < 0.001) and shorter duration of labor (24 versus 114 min, p < 0.001) than those who used the methods. There was no statistically significant difference in the pain scale score using the VAS between the group that used nonpharmacological methods and the group that did not (median 10 [minimum 2-maximum 10] versus 10 [minimum 6-maximum 10] p = 0.334). CONCLUSION: In a real-life setting, there was no difference in labor pain intensity between the patients who used nonpharmacological methods and those who did not use them during the active phase of labor.

OBJETIVO: Avaliar a associação da intensidade da dor na fase ativa da dilatação do parto em mulheres de acordo com a utilização ou não de métodos não farmacológicos para alívio da dor em cenário de vida real. MéTODOS: Trata-se de um estudo observacional de corte transversal. As variáveis analisadas foram obtidas através de questionário com as puérperas (até 48 horas pós-parto) investigando a intensidade da dor no parto pela escala visual analógica (EVA). As medidas não farmacológicas de alívio da dor, utilizadas rotineiramente na prática obstétrica, foram avaliadas pela consulta aos prontuários. As pacientes foram separadas em dois grupos: Grupo I ­ pacientes que não utilizaram medidas não farmacológicas para alívio da dor e Grupo II - pacientes que utilizaram estas medidas. RESULTADOS: Foram incluídas 439 mulheres que tiveram parto vaginal, sendo que 386 (87,9%) utilizaram, pelo menos, uma medida não farmacológica e 53 (12,1%) não utilizaram. As mulheres que não utilizaram as medidas não farmacológicas apresentaram idade gestacional significativamente menor (37,2 versus 39,6 semanas, p < 0,001) e menor duração do trabalho de parto (24 versus 114 minutos, p < 0,001) quando comparadas às que utilizaram as medidas. Não houve diferença estatisticamente significativa na pontuação da escala da dor pela EVA de acordo com a categorização pelo uso ou não de métodos não farmacológicos (mediana 10 [mínimo 2­máximo 10] versus 10 (mínimo 6­máximo 10), p = 0,334]. CONCLUSãO: Em cenário de vida real, as pacientes submetidas aos métodos não farmacológicos não apresentaram diferença em relação à intensidade da dor quando comparadas às que não os utilizaram durante a fase ativa do trabalho de parto.

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.

Effects of the addition of transcutaneous electrical stimulation to non-pharmacological measures in labor pain: study protocol for a randomized controlled trial.

BACKGROUND: Labor, although natural and physiological, is a period that can be marked by stress, pain, anxiety, suffering, fear, and anguish for a woman. Thus, non-pharmacological methods that reduce pain during labor are important to allow a better experience without the use of medications. Therefore, the aim of this study is to evaluate the effects of non-pharmacological pain relief methods, added or not to the application of transcutaneous electrical stimulation (TENS), on pain, satisfaction with the childbirth, duration of labor, and newborn conditions. METHODS: This is a randomized controlled clinical trial, with a non-probabilistic convenience sample, composed of women in the first active stage of labor, admitted to a public institution. The parturients will be divided into 3 groups: group 1 (n = 36) composed of parturients who will have continuous support and will be encouraged to walk, adopting different positions with the use of the Swiss ball and receiving back massage for 30 min; group 2 (n = 36) composed of parturients who will also have continuous support and will be encouraged to walk, adopt different positions using the Swiss ball, and will receive the application of TENS for 30 min; and group 3 (n = 36) composed of parturients who will have continuous support and will be encouraged to walk, adopting different positions with the use of the Swiss ball, and will receive placebo TENS application for 30 min. The outcomes evaluated in the study will be pain intensity assessed by the visual analog scale of pain applied before, immediately after, and 30 min and 1 h after the interventions; Experience and Satisfaction with Childbirth Questionnaire (QESP) applied 12 to 24 h after delivery; and data regarding delivery (type of delivery, total duration of labor, and possible obstetric complications) and neonate (weight, height, possible complications, Apgar score in the first and fifth minutes). DISCUSSION: With this research, it is expected to understand the effects of the intervention through TENS electrostimulation added to other non-pharmacological methods for pain management during labor. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (REBEC) RBR-68kh6j . Registered on March 17, 2020.

Análise das boas práticas de atenção ao parto em maternidade pública de Roraima / Analysis of good practices for child care in Roraima public maternity

Objetivo: Analisar se boas práticas de atenção ao parto estão sendo executadas e quais necessitam ser aperfeiçoadas no Hospital Materno Infantil Nossa Senhora de Nazaré (HMINSN), em Boa Vista-RR. Métodos: Foram registrados os partos normais de setembro de 2019 a março de 2020, pela equipe administrativa do hospital, na base de dados do Apice On. Nove recomendações de boas práticas da Organização Mundial da Saúde (OMS) foram avaliadas e comparadas com outros serviços do País. Resultados: Observou-se que, em comparação com outros serviços do Brasil, entre as nove práticas analisadas, quatro apresentaram melhor resultado no HMINSN, com alta proporção de acompanhantes (90,1%), aplicação de ocitocina no terceiro período (98,7%), amamentação na primeira hora pós-parto (81,5%) e baixo número de episiotomia (8,8%). Além disso, atingiu metas do Apice On em quatro boas práticas, que são a presença de acompanhante (meta: acima de 90%), a aplicação de ocitocina no terceiro período (meta: acima de 90%), o clampeamento tardio do cordão umbilical (meta: acima de 90%) e a episiotomia (meta: abaixo de 10%). Conclusão: Este estudo identificou que é preciso melhorar as taxas de prescrição de dieta livre e o contato pele a pele na primeira hora pós-parto. De modo geral, o HMINSN tem apresentado bons indicadores em relação a outros serviços do País e vem buscando aprimorar a organização da equipe e do serviço para que todas as recomendações da OMS sejam efetivamente praticadas.(AU)

Objective: Analyze whether good practices for child care are being carried out and which need to be improved at the Hospital Materno Infantil Nossa Senhora de Nazaré (HMINSN), in Boa Vista-RR. Methods: Normal deliveries from September 2019 to March 2020 were recorded by the hospital's administrative staff in the Apice On database. Nine recommendations of World Health Organization (WHO) good practices were evaluated and compared with other services in the country. Results: It was observed, in comparison with other services in Brazil, among the nine practices analyzed, four of them had better results at HMINSN, with a high proportion of companions (90.1%), application of oxytocin in the third period (98.7 %), breastfeeding in the first hour postpartum (81.5%) and low number of episiotomy (8.8%). In addition, it reached Apice On targets in four good practices, which are the presence of a companion (target: above 90%), the application of oxytocin in the third period (target: above 90%), the late clamping of the umbilical cord (target: above 90%) and episiotomy (target: below 10%). Conclusion: This study identified that it is necessary to improve the prescription rates of free diet and skin-to-skin contact, in the first postpartum hour. In general, HMINSN has presented good indicators in relation to other services in the country and has been seeking to improve the organization of the team and the service, so that all WHO recommendations are effectively practiced.(AU)

Tecnologias não invasivas de cuidado utilizadas por enfermeiras obstétricas: contribuições terapêuticas / Tecnologías de atención no invasiva utilizadas por las enfermeras obstétricas: contribuciones terapêuticas / Non-invasive care technologies used by obstetric nurses: therapeutics contributions

Resumo Objetivo descrever as contribuições terapêuticas da utilização de tecnologias não invasivas de cuidado, oferecidas por enfermeiras obstétricas, durante o trabalho de parto. Método estudo qualitativo e descritivo, com oito enfermeiras obstétricas da casa de parto do Rio de Janeiro. Os dados foram coletados de setembro a dezembro de 2018, através de entrevistas semiestruturadas, e submetidos à técnica de análise temática. Resultados para aliviar a dor e promover relaxamento, recorrem ao estímulo à participação do acompanhante e à respiração consciente, à aplicação da massagem, à promoção do ambiente acolhedor e ao uso da água morna e dos óleos essenciais. Para ativar o trabalho de parto, auxiliar na descida da apresentação e correção do posicionamento fetal, incentivam posicionamentos verticalizados e movimentos corporais, com alguns instrumentos. Conclusões e implicações para a prática tecnologias não invasivas de cuidado possuem contribuições terapêuticas e conformam um cuidado desmedicalizado, respeitoso e centrado na mulher, que promove a autonomia feminina.

Resumen Objetivo describir las contribuciones terapéuticas de la utilización de tecnologías de atención no invasivas que ofrecen las enfermeras obstétricas durante el trabajo de parto. Método estudio cualitativo y descriptivo, con ocho enfermeras obstétricas de una casa de partos de Río de Janeiro. Los datos fueron recolectados de septiembre a diciembre de 2018, a través de entrevistas semiestructuradas, y sometidos a la técnica de análisis temático. Resultados para aliviar el dolor y favorecer la relajación, se recurre a fomentar la participación del acompañante y la respiración consciente, la aplicación de masajes, la promoción de un ambiente acogedor y el uso de agua tibia y aceites esenciales. Para activar el trabajo de parto, facilitan en el descenso de la presentación y corrección del posicionamiento fetal, fomentan las posiciones verticales y los movimientos corporales, con algunos instrumentos. Conclusiones e implicaciones para la práctica las tecnologías de atención no invasiva tienen aportes terapéuticos y conforman un cuidado desmedicalizado, respetuoso y centrado en la mujer que promueve la autonomía femenina.

Abstract Objective to describe the therapeutics contributions of the use of non-invasive care technologies offered by obstetric nurses during labor. Method a qualitative and descriptive study, with eight obstetric nurses from a birthing center in Rio de Janeiro. Data were collected from September to December 2018, through semi-structured interviews, and subjected to thematic analysis technique. Results to relieve pain and promote relaxation, they resort to encouraging the companion's participation and conscious breathing, the application of massage, the promotion of a supportive environment and the use of warm water and essential oils. To activate labor, assist in descending the presentation and correction of fetal positioning, they encourage vertical positioning and body movements, with some instruments. Conclusions and implications for practice non-invasive care technologies have therapeutic contributions and form a not medicalized, respectful and women-centered care that promotes female autonomy.

Non-pharmacological therapies applied in pregnancy and labor: an integrative review.

OBJECTIVE: To identify non-pharmacological therapies applied during pregnancy and labor. METHOD: Integrative review conducted in the databases: PubMed, ScieLO and PEDro, searching for articles from 2008 in English, Spanish and Portuguese. The descriptors used were: pregnancy, childbirth, physiotherapy, alternative and complementary medicine, alternative therapy, non-pharmacological therapy, biomechanical therapy. RESULTS: Forty-one articles were analyzed and subdivided into ten categories of nonpharmacological therapies: massage, perineal massage, hot bath, supportive care, childbirth preparation group, breathing techniques, pelvic floor exercises, transcutaneous electrostimulation, Swiss ball and spontaneous pushing. Six articles (60%) showed a positive outcome for reduction of pain in labor and all of them had a positive outcome for different variables of labor, such as reduction of time, anxiety and pelvic floor laceration rates. CONCLUSION: The use of non-pharmacological therapies was efficient to reduce the effects of labor and childbirth, such as pain, duration of labor, anxiety, laceration and episiotomy.

Complementary therapies in labor: randomized clinical trial. / Terapias complementares no trabalho de parto: ensaio clínico randomizado.

OBJECTIVE: To evaluate the effect of isolated and combined warm shower bath and perineal exercise with Swiss ball, on perception of pain, anxiety and labor progression. METHOD: Randomized, controlled clinical trial with 128 patients allocated into three groups of therapies: isolated and combined bath and ball. Pain and anxiety perception was evaluated before and thirty minutes after therapeutic intervention through visual analogic scales (VAS). RESULTS: Pain perception score increased, and anxiety decreased in all groups, mainly when using a shower bath. The cervical dilation increased in all groups (p<.001), as well as the number of uterine contractions increased, mainly in the group that used combined bath and ball and also showed shorter labor time. CONCLUSION: The studied therapies contribute to maternal adaptation and well-being and favor labor's evolution.

Evidências científicas sobre métodos não farmacológicos para alívio a dor do parto / Evidencias científicas sobre métodos no farmacológicos para aliviar el dolor de parto / Scientific evidence on non-pharmacological methods for relief of labor pain

Resumo Objetivo Identificar na literatura nacional e internacional, estudos sobre a eficácia de métodos não farmacológicos na redução da dor do parto. Métodos Revisão integrativa realizada nas bases de dados MEDLINE/PUBMED, SCOPUS, CINAHL, LILACS e BDENF, com recorte temporal entre os anos de 2013 a 2018, em português, inglês e espanhol. Utilizado a metodologia PICo para construir a pergunta de pesquisa e selecionar descritores controlados e não controlados, que foram combinados com os operadores booleanos "AND", "OR" e "NOT". Resultados Foram selecionados 19 artigos. Dentre os métodos não farmacológicos encontrados, destacam-se: a acupuntura e suas principais variações (acupressão e auriculoterapia) (29,17%), hidroterapia (25%), exercícios perineais com a bola suíça (16,67%), terapias térmicas (8,33%) e os demais métodos (20,83%). Conclusão A acupuntura e a acupressão agem tanto sobre aspectos fisiológicos da dor como sobre sua subjetividade. O banho quente de aspersão, a musicoterapia, a aromaterapia e as técnicas de respiração promovem o relaxamento e a diminuição dos níveis de ansiedade. As terapias térmicas contribuem para a analgesia local de regiões afetadas pela dor. Os exercícios na bola suíça são importantes para reduzir a dor e adotar a posição vertical, importante na progressão do trabalho de parto.

Resumen Objetivo Identificar en la literatura nacional e internacional estudios sobre la eficacia de métodos no farmacológicos para reducir el dolor de parto. Métodos Revisión integradora realizada en las bases de datos MEDLINE/PUBMED, SCOPUS, CINAHL, LILACS y BDENF, con un recorte temporal entre los años 2013 y 2018, en portugués, inglés y español. Se utilizó la metodología PICO para elaborar la pregunta de investigación y seleccionar descriptores controlados y no controlados, que fueron combinados con los operadores booleanos "AND", "OR" y "NOT". Resultado Se seleccionaron 19 artículos. Entre los métodos no farmacológicos encontrados, se destacan: la acupuntura y sus principales variantes (acupresión y auriculoterapia) (29,17%), hidroterapia (25%), ejercicios perineales con pelota suiza (16,67%), terapias térmicas (8,33%) y demás métodos (20,83%). Conclusión La acupuntura y la acupresión actúan tanto sobre aspectos fisiológicos del dolor, como sobre su subjetividad. La ducha caliente, la musicoterapia, la aromaterapia y las técnicas de respiración promueven la relajación y la reducción de los niveles de ansiedad. Las terapias térmicas contribuyen como analgésico local en regiones afectadas por el dolor. Los ejercicios con pelota suiza son importantes para reducir el dolor y adoptar la posición vertical, importante en la progresión del trabajo de parto.

Abstract Objective To identify studies on the efficacy of non-pharmacological methods in reducing labor pain in the national and international literature. Methods Integrative review in the MEDLINE/PUBMED, SCOPUS, CINAHL, LILACS, and BDENF databases, limiting to studies published between 2013 and 2018, in Portuguese, English, and Spanish. The PICo methodology was used to build the research question and select the controlled and uncontrolled descriptors, which were combined with the "AND", "OR," and "NOT" Boolean operators. Results A total of 19 articles were selected. The non-pharmacological methods found were: acupuncture and its core variations (acupressure and auriculotherapy) (29.17%), hydrotherapy (25%), perineal exercises with the Swiss ball (16.67%), thermal therapies (8.33%), and other methods (20.83%). Conclusion Acupuncture and acupressure worked on both physiological aspects of pain and the subjective nature of pain. The warm bath, music therapy, aromatherapy, and breathing techniques promoted relaxation and decreased the levels of anxiety. Thermal therapies contributed to local analgesia in regions affected by pain. Exercises with the Swiss ball were important for pain relief, and the vertical position was important for labor.

Kinesiologic tape for labor pain control: Randomized controlled trial.

Background: Kinesiologic taping has been studied for managing diverse types of dysfunctions and pain, but not for managing pain during labor. Objective: This study evaluated the effectiveness and safety of using kinesiologic tape (KT) during labor relative to pain, maternal satisfaction, and obstetric and neonatal outcomes. Method: The study was a single-blind randomized controlled trial composed of 60 pregnant women divided into two groups. In the kinesiologic tape group (KTG), the tape was applied to the region of spinal nerves T10-L1 and S2-S4; in the control group (CG), the tape was applied to the region of spinal nerves T1-T4. Study participants were low-risk pregnant women with spontaneous onset of labor and no previous Cesarean section. Outcomes evaluated were pain, duration of labor, type of delivery, uterotonic and anesthetic requirement, neonatal vitality, and satisfaction with delivery and tape use. Intention-to-treat analysis was performed, and risk ratios with a 95% CI were estimated. Results: After the first hour of tape use, a significant increase in pain was observed in the CG (p = 0.002). However, there were no differences between groups relative to the remaining outcomes assessed. In the KTG, 59% of participants reported satisfaction with tape use, whereas in the CG, 44% reported satisfaction with tape use. Conclusion: Despite its safety, the KT technique did not prove to effectively control labor pain.

Terapias complementares no trabalho de parto: ensaio clínico randomizado / Terapias complementarias en el trabajo de parto: ensayo clínico randomizado / Complementary therapies in labor: randomized clinical trial

Resumo OBJETIVO: Avaliar o efeito do banho quente de chuveiro e exercício perineal com bola suíça isolados e de forma combinada, sobre a percepção da dor, ansiedade e progressão do trabalho de parto. MÉTODO: Ensaio clínico randomizado e controlado com 128 parturientes alocadas em três grupos de terapias, banho, bola, isolados e combinados. A percepção da dor e ansiedade foi avaliada antes e trinta minutos após a intervenção terapêutica por meio de escala visual analógica (EVA). RESULTADOS: Houve aumento no escore de dor e redução da ansiedade em todos os grupos, sobretudo quando utilizaram banho de chuveiro. A dilatação cervical, aumentou em todos os grupos de intervenção (p<,001) bem como o número de contrações uterinas, principalmente quem utilizou banho e bola associados como também mostrou menor duração do tempo de trabalho de parto. CONCLUSÃO: As terapias estudadas contribuem para adaptação e bem-estar materno e favorecem a evolução do trabalho de parto.

Resumen OBJETIVO: Evaluar el efecto de la ducha caliente y del ejercicio perineal con pelota suiza, separadamente y de forma combinada, sobre la percepción del dolor, la ansiedad y la progresión del trabajo de parto. MÉTODO: Ensayo clínico aleatorizado y controlado junto a 128 parturientes asignadas en tres grupos de terapias, ducha caliente, pelota suiza separadamente y de forma combinada. La percepción de dolor y de ansiedad se evaluó antes y treinta minutos después de la intervención terapéutica por medio de escala visual analógica. RESULTADOS: Hubo un incremento en la puntuación de dolor y una reducción de la ansiedad en todos los grupos, sobre todo cuando se utilizó la ducha. La dilatación cervical aumentó en todos los grupos de intervención (p<,001) así como el número de contracciones uterinas, principalmente en el grupo que utilizó las dos terapias combinadas, ducha caliente con pelota suiza. Asimismo se constató menor duración del tiempo de trabajo de parto. CONCLUSIÓN: Las terapias estudiadas contribuyen a la adaptación y el bienestar materno y favorecen la evolución del trabajo de parto.

Abstract OBJECTIVE: To evaluate the effect of isolated and combined warm shower bath and perineal exercise with Swiss ball, on perception of pain, anxiety and labor progression. METHOD: Randomized, controlled clinical trial with 128 patients allocated into three groups of therapies: isolated and combined bath and ball. Pain and anxiety perception was evaluated before and thirty minutes after therapeutic intervention through visual analogic scales (VAS). RESULTS: Pain perception score increased, and anxiety decreased in all groups, mainly when using a shower bath. The cervical dilation increased in all groups (p<.001), as well as the number of uterine contractions increased, mainly in the group that used combined bath and ball and also showed shorter labor time. CONCLUSION: The studied therapies contribute to maternal adaptation and well-being and favor labor's evolution.

Efetividade de procedimentos não farmacológicos para o alívio da dor de parturientes: contribuições para a enfermagem obstétrica / Effectiveness of non-pharmacological procedures for pain relief in parturients: contributions to obstetric nursing

Estudo que apresentou como objeto o uso de procedimentos não farmacológicos para alívio da dor em parturientes. O objetivo geral foi conhecer a efetividade de três procedimentos não farmacológicos: o uso do gelo; o uso da água aquecida através do banho; e o uso da massagem na região lombar de gestantes, quanto à sua capacidade de produzir o alívio da dor na fase ativa do trabalho de parto. E os objetivos específicos: medir, a intensidade da dor autoreferida pelas parturientes antes, durante e após cada aplicação dos procedimentos não farmacológicos; analisar os escores numéricos referentes ao alívio da dor e descrever as avaliações das parturientes sobre os efeitos produzidos pelos procedimentos não farmacológicos. A tese é: O uso do gelo, da água aquecida através do banho de aspersão ou da massagem na região lombar de gestantes, quando empregados como procedimentos não farmacológicos na fase ativa do trabalho de parto são eficazes em produzir o alívio da dor. Ao mesmo tempo, contribui para a evolução fisiológica do trabalho de parto e parto. Baseou-se nos princípios da desmedicalização e no emprego de procedimentos não farmacológicos recomendados pela Organização Mundial de Saúde e ratificados pelo Ministério da Saúde no Brasil. Trata-se de um estudo clínico de intervenção prospectivo, não randomizado, que utilizou uma escala numérica como instrumento para medir a dor autorreferida de parturientes antes, durante e após cada aplicação de um dos procedimentos não farmacológicos. Os resultados evidenciaram que: A maioria das parturientes preferiu a aplicação da massagem na região lombar (21) e banho de aspersão (17). O uso de gelo foi realizado em 7 parturientes. Foi possível observar que a quantidade mulheres que referiram de aumento da dor não ultrapassou a quantidade de mulheres que referiram alívio, principalmente quando a dilatação está em 9cm. Pode-se observar, pela descrição dos comportamentos das parturientes, que poucas referiram medo e grande parte se disse confiante e sentindo-se bem. Algumas mulheres cochilaram e a maioria caminhou livremente. Apenas oito parturientes (17,7%) solicitaram interrupção após a aplicação da intervenção na primeira vez e a grande maioria (91,1%) referiu satisfação com o procedimento aplicado. Em relação ao bebê, em nenhum caso foi necessário realizar aspiração, reanimação com emprego de oxigênio, intubação traqueal, massagem cardíaca ou medicação para reanimação. Não foi detectado nenhum caso de bradicardia ou desaceleração dos batimentos cardíacos do feto. Após o parto, todas as parturientes foram encaminhadas ao Alojamento Conjunto com seus bebês sem necessidade de atendimentos de urgência, ou de internação em setores de atendimento a situações de risco. Confirmando a tese proposta, o estudo concluiu que os procedimentos não farmacológicos foram efetivos em produzir o alívio da dor das parturientes, e que são instrumentos facilitadores da ação fisiológica e natural do organismo feminino, no trabalho de parto.

This study approached the use of non-pharmacological procedures for pain relief in parturients. The general objective was to know the effectiveness of three non-pharmacological procedures: the use of ice; the use of heated water through the bath; and the use of lumbar region massage in pregnant women, regarding its ability to produce pain relief in the active phase of labor. The specific objectives were: to measure the self-reported pain intensity by parturients before, during and after each application of non-pharmacological procedures; to analyze numerical scores related to pain relief and to describe the evaluations of parturients about the effects produced by non-pharmacological procedures. The thesis is: The use of ice, warm water through a shower bath or massage in the lower back of pregnant women, when employed as non-pharmacological procedures in the active phase of labor, are effective in producing pain relief. At the same time, it contributes to the physiological evolution of labor and delivery. It was based on the principles of de-medicalization and the use of non-pharmacological procedures recommended by the World Health Organization and ratified by the Ministry of Health in Brazil. This is a prospective, nonrandomized intervention clinical study that used a numerical scale as a tool to measure self-reported pain in parturients before, during and after each application of one of the non-pharmacological procedures. The results showed that: Most of the parturients preferred the application of lumbar massage (n=21) and spray bath (n=17). The use of ice was performed in seven parturients. It was observed that the amount of owmen who described increasing pain did not exceed those who described pain relief, mainly when the cervical dilation was at 9cm. It can be observed from the description of the behaviors of the parturients that few mentioned fear and most of them said they were confident and feeling well. Some women dozed off and the majority walked freely. Only eight parturients (17.7%) asked for interruption after the intervention was applied for the first time and the vast majority (91.1%) reported satisfaction with the procedure applied. Regarding the baby, none of them needed aspiration, oxygen resuscitation, tracheal intubation, cardiac massage or medication resuscitation. No cases of bradycardia or deceleration of the fetal heartbeat were detected. After delivery, all parturients were referred to the rooming-in with their babies with no needs for urgent care or hospitalization in risk care sectors. Confirming the proposed thesis, the study concluded that non-pharmacological procedures were effective in producing pain relief of parturients, and are instruments that facilitate the physiological and natural action of the female organism in labor.

Effect of led photobiomodulation on analgesia during labor: Study protocol for a randomized clinical trial.

BACKGROUND: Labor pain is one of the most intense pains experienced by women, which leads to an increase in the number of women opting to undergo a cesarean delivery. Pharmacological and nonpharmacological analgesia methods are used to control labor pain. Epidural analgesia is the most commonly used pharmacological analgesia method. However, it may have side effects on the fetus and the mother. Light-emitting diode (LED) photobiomodulation is an effective and noninvasive alternative to pharmacological methods. OBJECTIVES: To evaluate the effects of LED photobiomodulation on analgesia during labor. METHODS: In total, 60 women in labor admitted to a public maternity hospital will be selected for a randomized controlled trial. The participants will be randomized into 2 groups: intervention group [analgesia with LED therapy (n = 30)] and control group [analgesia with bath therapy (n = 30)]. The perception of pain will be assessed using the visual analogue scale (VAS), with a score from 0 to 10 at baseline, that is, before the intervention. In both the groups, the procedures will last 10 minutes and will be performed at 3 time points during labor: during cervical dilation of 4 to 5 cm, 6 to 7 cm, and 8 to 9 cm. At all 3 time points, pain perception will be evaluated using VAS shortly after the intervention. In addition, the evaluation of membrane characteristics (intact or damaged), heart rate, uterine dynamics, and cardiotocography will be performed at all time points. EXPECTED OUTCOMES: The use of LED photobiomodulation will have an analgesic effect superior to that of the bath therapy.

Non-pharmacological interventions during childbirth for pain relief, anxiety, and neuroendocrine stress parameters: A randomized controlled trial.

AIM: This study aimed to investigate the effect of warm shower hydrotherapy and perineal exercises with a ball on pain, anxiety, and neuroendocrine stress parameters during childbirth. METHODS: This randomized controlled trial was conducted with 128 women during childbirth, admitted for hospital birth in São Paulo, Brazil, from June 2013 to February 2014. The participants were randomly assigned into one of the following intervention groups: received warm shower hydrotherapy (GA); performed perineal exercises with a ball (GB); and combined intervention group, which received warm shower hydrotherapy and perineal exercises with a ball (GC) (n = 39). Pre-and post-intervention parameters were evaluated using visual analogue scales for pain and anxiety, and salivary samples were collected for the stress hormones analysis. RESULTS: Pain, anxiety, and epinephrine release decreased in the group performing perineal exercises with a ball (GB). ß-endorphin levels increased in this group (GB) after the intervention and showed significant difference in capacity to cause this effect (P = .007). However, no significant differences were observed in cortisol, epinephrine, and norepinephrine levels. CONCLUSIONS: Warm showers and perineal exercises could be considered as adjunct therapy for women suffering from pain, anxiety, and stress during childbirth. Clinical Trial Registry RBR-84xprt.

Sequential application of non-pharmacological interventions reduces the severity of labour pain, delays use of pharmacological analgesia, and improves some obstetric outcomes: a randomised trial.

QUESTION: Among women in labour, does sequential application of non-pharmacological interventions relieve labour pain, shorten labour, and delay pharmacological analgesia use? DESIGN: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Eighty women admitted in labour at the end of a low-risk pregnancy. INTERVENTION: Participants in the experimental group received three interventions for up to 40minutes each in particular stages of labour: exercise on a Swiss ball at 4 to 5cm of cervical dilation; lumbosacral massage at 5 to 6cm dilation; and a warm shower at >7cm dilation. Participants in the control group received usual maternity unit care. Participants in both groups were encouraged to try not to avoid or delay use of pharmacological analgesia. OUTCOME MEASURES: Pain severity was reported on a visual analogue scale. Maternal and neonatal data were collected from official birth records. Satisfaction with care was recorded with a questionnaire. RESULTS: Some participants took analgesic medication before the study was complete, so pain was analysed with a last observation carried forward approach. In this analysis, the experimental group had significantly lower pain severity immediately after: exercises (MD 24mm, 95% CI 15 to 34), massage (14mm, 95% CI 4 to 25), and showering (17mm, 95% CI 5 to 29), which allowed delayed and reduced use of analgesic medication. Other significant benefits included: faster expulsion (MD 18minutes, 95% CI 5 to 30), improved neonatal status, and higher maternal satisfaction. No adverse effects were identified. CONCLUSION: This sequence of non-pharmacological interventions significantly reduced labour pain from 4cm to beyond 7cm of cervical dilation, as reflected in decreased and delayed use of analgesic medication. Women in labour could be encouraged to use these interventions, especially if they seek to minimise or delay use of analgesic medication. TRIAL REGISTRATION: NCT01389128. [Gallo RBS, Santana LS, Marcolin AC, Duarte G, Quintana SM (2018) Sequential application of non-pharmacological interventions reduces the severity of labour pain, delays use of pharmacological analgesia, and improves some obstetric outcomes: a randomised trial. Journal of Physiotherapy 64: 33-40].

Women's autonomy in the process of labour and childbirth: integrative literature review. / Autonomia feminina no processo de parto e nascimento: revisão integrativa da literatura.

OBJECTIVE: To identify the available evidence in scientific literature on healthcare practices that interfere with the autonomy of Brazilian women in the labour and delivery process. METHOD: The search for papers was conducted in the databases LILACS, Scopus and PubMed, between 1996 and 2015, according to a guiding question and exclusion criteria, resulting in the selection of 22 papers to compose the analytic body. RESULTS: The main practices that favoured the exercise of women's autonomy were out-of-hospital care practices; care practices of support and comfort; and educational care practices. By contrast, the practices that limited autonomy were authoritarian care practices; standardised or routine care practices; care practices that intensify the painful sensation of childbirth; and impersonal and cold care practice. CONCLUSION: There was an alarming contrast between the daily healthcare routine and ministerial recommendations.

Autonomia feminina no processo de parto e nascimento: revisão integrativa da literatura / Autonomía femenina en el proceso de parto y nacimiento: revisión integradora de la literatura / Womens autonomy in the process of labour and childbirth: integrative literature review

RESUMO Objetivo Identificar as evidências disponíveis na produção científica acerca das práticas de assistência à saúde que interferem no exercício da autonomia das mulheres brasileiras no processo de parto e nascimento. Método A busca dos artigos foi desenvolvida nas bases de dados LILACS, Scopus e PubMed, no período entre 1996 e 2015, tendo como eixo orientador a questão norteadora e os critérios de exclusão, sendo selecionados 22 artigos como corpus de análise. Resultados Foram evidenciadas como práticas que favorecem o exercício da autonomia feminina: práticas assistenciais extra-hospitalares; práticas assistenciais de apoio e conforto; e práticas assistenciais educativas. Em contrapartida, revelaram-se como práticas limitantes ao exercício da autonomia: práticas assistenciais autoritárias; práticas assistenciais padronizadas ou rotineiras; práticas assistenciais que intensificam a sensação dolorosa do parto; e prática assistencial impessoal e fria. Conclusão Revelou-se uma situação de alerta relativa ao grande descompasso existente entre o cotidiano assistencial e as recomendações ministeriais.

RESUMEN Objetivo Identificar la evidencia disponible en la literatura científica acerca de las prácticas de atención de salud que interfieren con el ejercicio de la autonomía de las mujeres brasileñas en el proceso de parto y el nacimiento. Método La búsqueda de artículos se desarrolló en las bases de datos LILACS, Scopus y en PubMed, en el período comprendido entre 1996 y 2015, con el principio rector de los rectores criterios de interrogación y exclusión, y seleccionó 22 artículos como un corpus de análisis. Resultados Hemos puesto de relieve las prácticas que favorecen el ejercicio de la autonomía de la mujer: las prácticas de atención ambulatoria; prácticas de apoyo y consuelo; prácticas educativas y atención. Por el contrario se han demostrado como una limitación del ejercicio práctico de la autonomía: las prácticas de atención autoritarias; prácticas de cuidados estandarizados o de rutina; cuidado prácticas que mejoran la sensación dolorosa del parto; y la práctica de la atención impersonal y fría. Conclusión Se puso de manifiesto una situación de alerta en el gran desajuste entre su vida cotidiana y recomendaciones ministeriales.

ABSTRACT Objective To identify the available evidence in scientific literature on healthcare practices that interfere with the autonomy of Brazilian women in the labour and delivery process. Method The search for papers was conducted in the databases LILACS, Scopus and PubMed, between 1996 and 2015, according to a guiding question and exclusion criteria, resulting in the selection of 22 papers to compose the analytic body. Results The main practices that favoured the exercise of women’s autonomy were out-of-hospital care practices; care practices of support and comfort; and educational care practices. By contrast, the practices that limited autonomy were authoritarian care practices; standardised or routine care practices; care practices that intensify the painful sensation of childbirth; and impersonal and cold care practice. Conclusion There was an alarming contrast between the daily healthcare routine and ministerial recommendations.

Effects of auriculotherapy on labour pain: a randomized clinical trial.

OBJECTIVE: Assessing the effects of auriculotherapy in pain control and its outcomes on the duration of labour. METHOD: This is a randomized, controlled, double-blind trial with preliminary data. Thirty pregnant women with gestational age ≥ 37 weeks, cervical dilatation ≥ 4 cm and two or more contractions in 10 minutes were selected and randomly divided into three groups: auriculotherapy, placebo and control. Auriculotherapy was applied using crystal beads on four strategic points. RESULTS: No statistical significance was found between the groups with regard to pain; however, the women from the auriculotherapy group had lower intensity and less perception of pain at 30, 60 and 120 minutes of treatment. The average duration of labour was shorter in the auriculotherapy group (248.7 versus placebo 414.8 versus control 296.3 minutes); caesarean section rates were higher in the placebo group (50%) and the same in the other groups (10%). CONCLUSION: Mothers who received auriculotherapy presented a tendency for greater pain control and shorter labour duration; however, caesarean section rates in this group were similar to the control group. This trial precedes a larger study in progress. Registration of Brazilian Clinical Trials: RBR-47hhbj. OBJETIVO: Avaliar os efeitos da auriculoterapia no controle da dor e seus desfechos na duração do trabalho de parto. MÉTODO: Trata-se de um ensaio controlado, randomizado e duplo-cego, com dados preliminares. Foram selecionadas 30 parturientes com idade gestacional ≥ 37 semanas, dilatação cervical ≥ 4 cm e duas ou mais contrações em 10 minutos, divididas aleatoriamente em três grupos: auriculoterapia, placebo ou controle. A auriculoterapia foi aplicada com microesferas de cristais em quatro pontos estratégicos. RESULTADOS: Não houve significância estatística entre os grupos com relação à dor; no entanto, as mulheres do grupo de auriculoterapia, apresentaram menor intensidade e menor percepção da dor aos 30, 60 e 120 minutos do tratamento. A média de duração do trabalho de parto foi menor no grupo de auriculoterapia (248,7 versus placebo 414,8 versus controle 296,3 minutos); a taxa de cesárea foi maior no grupo placebo (50%) e igual nos outros (10%). CONCLUSÃO: As parturientes que receberam auriculoterapia apresentaram tendência a um maior controle da dor e menor duração do trabalho de parto, porém a taxa de cesárea neste grupo foi semelhante à do grupo controle. Este ensaio precede um estudo maior, em andamento. Registro Brasileiro de Ensaio Clínico: RBR-47hhbj.

The effects of acupressure on labor pains during child birth: randomized clinical trial.

OBJECTIVE: to analyze the effects of acupressure on the sanyinjiao point for pregnant women in labor at public maternity wards. METHOD: single-blind controlled clinical trial, randomly done employing a pragmatic profile. We selected 156 pregnant women in their ≥ 37 week/s, who had cervical dilations of ≥ 4 cm and with two or more contractions in 10 minutes. The pregnant women were randomly divided into three groups at a university hospital in the suburbs of Sao Paulo, Brazil, in order to receive either acupressure treatment, a placebo or participate as part of a control group. The acupressure was applied on the sanyinjiao point during the contractions for 20 minutes. Then the intensity of the pain was evaluated using the Visual Analogue Scale (VAS). RESULTS: The averages for the pain measured using the VAS were not different for the three groups that were a part of the study (p-value=0.0929), however they were less in the acupressure groups immediately after receiving the treatment (p-value=<0.0001). This was also the case where the treatment lasted for 1 hour (p-value=0.0001). This was the case in comparison with placebo and control groups. CONCLUSION: the use of acupressure on the sanyinjiao point is a useful way to alleviate pain in a non-invasive manner. It can improve the quality of care given to pregnant women in labor. Register: RBR-9mhs8r.

The effects of acupressure on labor pains during child birth: randomized clinical trial / Efeitos da acupressão sobre a dor no trabalho de parto: ensaio clínico randomizado / Efectos de la acupresión sobre el dolor en el trabajo de parto: ensayo clínico aleatorio

ABSTRACT Objective: to analyze the effects of acupressure on the sanyinjiao point for pregnant women in labor at public maternity wards. Method: single-blind controlled clinical trial, randomly done employing a pragmatic profile. We selected 156 pregnant women in their ≥ 37 week/s, who had cervical dilations of ≥ 4 cm and with two or more contractions in 10 minutes. The pregnant women were randomly divided into three groups at a university hospital in the suburbs of Sao Paulo, Brazil, in order to receive either acupressure treatment, a placebo or participate as part of a control group. The acupressure was applied on the sanyinjiao point during the contractions for 20 minutes. Then the intensity of the pain was evaluated using the Visual Analogue Scale (VAS). Results: The averages for the pain measured using the VAS were not different for the three groups that were a part of the study (p-value=0.0929), however they were less in the acupressure groups immediately after receiving the treatment (p-value=<0.0001). This was also the case where the treatment lasted for 1 hour (p-value=0.0001). This was the case in comparison with placebo and control groups. Conclusion: the use of acupressure on the sanyinjiao point is a useful way to alleviate pain in a non-invasive manner. It can improve the quality of care given to pregnant women in labor. Register: RBR-9mhs8r.

RESUMO Objetivo: analisar os efeitos da acupressão no ponto sanyinjiao sobre a dor na fase ativa do trabalho de parto, em gestantes atendidas em maternidade pública. Método: trata-se de um ensaio clínico controlado e randomizado, simples-cego e de caráter pragmático. Foram selecionadas 156 mulheres com idade gestacional ≥ 37 semanas, dilatação cervical ≥ 4 cm e com duas ou mais contrações em 10 minutos. As gestantes foram divididas aleatoriamente em três grupos em um hospital universitário do interior do estado de São Paulo, Brasil, para receber acupressão, placebo ou participar como controle. A acupressão foi aplicada no ponto sanyinjiao durante as contrações, por 20 minutos, e a intensidade da dor avaliada por meio de uma Escala Analógica Visual (EAV). Resultados: as médias de dor pela EAV não foram diferentes nos três grupos na admissão (p-valor=0,0929), porém foram menores no grupo de acupressão imediatamente após (p-valor=<0,0001) e com 1 h do tratamento (p-valor=0,0001) ao se comparar com placebo e controle. Conclusão: a acupressão no ponto sanyinjiao se mostrou uma medida útil no alívio da dor, não invasiva e um meio de melhorar a qualidade dos cuidados a parturiente. Registro: RBR-9mhs8r.

RESUMEN Objetivo: analizar los efectos de la acupresión, en el punto sanyinjiao, sobre el dolor en la fase activa del trabajo de parto, en embarazadas atendidas en maternidad pública. Método: ensayo clínico controlado y aleatorio, simple ciego y de carácter pragmático. Fueron seleccionadas 156 mujeres con edad gestacional ≥ 37 semanas, dilatación cervical ≥ 4 cm y con dos o más contracciones en 10 minutos. Las embarazadas fueron divididas aleatoriamente en tres grupos en un hospital universitario del interior del estado de Sao Paulo, Brasil, para recibir acupresión, placebo o participar como control. La acupresión fue aplicada en el punto sanyinjiao durante las contracciones, por 20 minutos; la intensidad del dolor fue evaluada por medio de una Escala Analógica Visual (EAV). Resultados: los promedios del dolor por la EAV no fueron diferentes en los tres grupos en la admisión (valor p=0,0929), sin embargo fueron menores en el grupo de acupresión inmediatamente después (valor p=<0,0001) y también después de 1 hora del tratamiento (valor p=0,0001) al compararse con el placebo y control. Conclusión: la acupresión en el punto sanyinjiao se mostró una medida útil en el alivio del dolor, no invasiva y un medio de mejorar la calidad de los cuidados la parturienta. Registro: RBR-9mhs8r.