La estimulación eléctrica nerviosa transcutánea (TENS). El manejo del dolor durante el proceso de parto / Transcutaneous electrical nerve stimulation (TENS) for pain management during labor

En la actualidad, la analgesia epidural se perfila como el método farmacológico más empleado en obstetricia para el manejo del dolor durante el parto, pero esta técnica no está exenta de riesgos. Existen métodos no farmacológicos que se pueden utilizar alternativamente o en sinergia con la analgesia epidural, que no presentan efectos adversos sobre los resultados materno-fetales y que pueden ayudar a paliar el dolor. Entre estos métodos se encuentra la estimulación eléctrica nerviosa transcutánea (TENS). La TENS es una técnica fisioterapéutica especialmente indicada durante el periodo de dilatación, en el inicio del trabajo del parto, y mientras la mujer no percibe un dolor muy intenso. Su uso en el parto es relativamente reciente y controvertido. A pesar de ser bien recibido por mujeres y matronas, su eficacia no está demostrada claramente. Así pues, organismos como la Sociedad Española de Ginecología y Obstetricia o el Ministerio de Sanidad, Servicios Sociales e Igualdad, consideran esta terapia como un mecanismo de alivio del dolor no farmacológico de ineficacia demostrada en la fase activa del parto. Las mujeres deben tener la opción de elegir los métodos de alivio de dolor que quieren emplear en cualquier etapa de su parto. Los profesionales sanitarios son los responsables de conocer, investigar y trabajar con los diferentes métodos, ofreciendo a la gestante información adecuada y basada en evidencia científica sobre ellos (AU)

Currently, epidural analgesia is considered the most used method for pain management during labor, but this technique could have side effects. There are non-pharmacological methods that can be used alternatively or in synergy with epidural analgesia, without adverse effects on maternal and fetal outcomes. These methods include transcutaneous electrical nerve stimulation (TENS). TENS is a physiotherapy technique particularly suitable for the dilation period, during the first state of labor, and while women does not perceive a very intense pain. The use in childbirth is recent and controversial. Despite being well received by women and midwives, their effectiveness has not been clearly demonstrated. Organizations such as the Spanish Society of Gynaecology and Obstetrics and the Department of Health, consider this therapy an inefficient non-pharmacological mechanism for pain relief in the active stage of labor. Women should have the option to choose any pain relief mathod in any stage of their process. Health professionals are the responsible to know, investigate and work with these different methods, offering to pregnant women, adequate information, which must be based on scientific evidence (AU)

[INMERSION IN HOT WATER: A NATURAL HELPER IN LABOUR]. / Inmersión en agua caliente. UN AYUDANTE NATURAL EN EL PROCESO DE PARTO.

INTRODUCTION: The pain during the birth process is the result of a pile of physiological, psychological and socio-cultural stimulus. In our society, epidural analgesia is the most common technique used in obstetrics to relieve this pain, despite not being harmless. However, there are other complementary techniques based on methods that have demonstrated analgesic effects and they benefit of lacking adverse effects either on the mother or on the fetus. Among these methods is the immersion in warm water (WI). The aim of this review is to show the usefulness, advantages and disadvantages of WI, to make it an accessible resource for pregnant women and those who are responsible for their care. METHODS: Literature review about Water Immersion during the first and second stage of labor. RESULTS: The WI as a method to relieve discomfort and pain during labor was popularized by the obstetrician Michel Odent in 7980s. The Spanish Society of Gynecology and Obstetrics, among other associations, highly recommend its use during the cervical dilation period. It is benificial for the mother blood circulation, psychologically and for body mechanics; however, this use in the second stage of labor seems to be more controversial. CONCLUSIONS: WI is an analgesic non-invasive, accessible and affordable. Its use is associated with lower rates of intervention by professionals and provide a more focused attention on the needs of pregnant women.

Inmersión en agua caliente. Un ayudante natural en el proceso de parto / Inmersion in hot wáter: a natural helper in labour

Introducción. El dolor que acompaña al proceso de parto es resultado de un cúmulo de estímulos fisiológicos, psicológicos y socioculturales. En nuestra sociedad, la analgesia epidural es la técnica más empleada en obstetricia para aliviar este dolor, a pesar de no ser inocua. Sin embargo, existen otros métodos basados en técnicas complementarias que poseen efectos analgésicos demostrados y tienen el beneficio de no tener efectos perjudiciales para la gestante o el feto. Entre estos métodos se encuentra la inmersión en agua caliente (IA). El objetivo de esta revisión es dar a conocer la utilidad, ventajas e inconvenientes de la IA, para hacer de ella un recurso accesible para la gestante y los profesionales encargados de su atención. Métodos. Revisión bibliográfica acerca de la IA durante la primera y segunda etapa de parto. Resultados. La IA como método para aliviar el malestar y el dolor durante el trabajo de parto fue popularizado por el obstetra Michel Odent en la década de los ochenta. La Sociedad Española de Ginecología y Obstetricia, entre otras asociaciones, recomienda altamente su uso durante el periodo de dilatación, puesto que presenta beneficios para la gestante a nivel circulatorio, psicoafectivo y sobre su mecánica corporal; sin embargo, su utilización en la segunda etapa de parto parece más controvertida. Conclusiones. La IA es un método analgésico no invasivo, accesible y económico. Su uso se relaciona con menores tasas de intervención por parte de los profesionales al tiempo que permite proporcionar una atención más centrada en las necesidades de la gestante (AU)

Introduction. The pain during the birth process is the result of a pile of physiological, psychological and socio-cultural stimulus. In our society, epidural analgesia is the most common technique used in obstetrics to relieve this pain, despite not being harmless. However, there are other complementary techniques ased on methods that have demonstrated analgesic effects and they benefit of lacking adverse effects either on the mother or on the fetus. Among these methods is the immersion in warm water (WI). The aim of this review is to show the usefulness, advantages and disadvantages of WI, to make it an accessible resource for pregnant women and those who are responsible for their care. Methods. Literature review about Water Immersion during the first and second stage of labor. Results. The WI as a method to relieve discomfort and pain during labor was popularized by the obstetrician Michel Odent in 1980s. The Spanish Society of Gynecology and Obstetrics, among other associations, highly recommend its use during the cervical dilation period. It is benificial for the mother blood circulation, psychologically and for body mechanics; however, this use in the second stage of labor seems to be more controversial. Conclusions. WI is an analgesic non-invasive, accessible and affordable. Its use is associated with lower rates of intervention by professionals and provide a more focused attention on the needs of pregnant women (AU)

[Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Management During Labor]. / La estimulación eléctrica nerviosa transcutánea (TENS) en el manejo del dolor durante el proceso de parto.

Currently, epidural analgesia is considered the most used method for pain management during labor, but this technique could have side effects. There are non-pharmacological methods that can be used alternatively or in synergy with epidural analgesia, without adverse effects on maternal and fetal outcomes. These methods include transcutaneous electrical nerve stimulation (TENS). TENS is a physiotherapy technique particularly suitable for the dilation period, during the first state of labor, and while women do not perceive a very intense pain. The use in childbirth is recent and controversial. Despite being well received by women and midwives, their effectiveness has not been clearly demonstrated. Organizations such as the Spanish Society of Gynaecology and Obstetrics and the Department of Health, consider this therapy an inefficient non-pharmacological mechanism for pain relief in the active stage of labor. Women should have the option to choose any pain relief method in any stage of their process. Health professionals are the responsible to know, investigate and work with these different methods, offering to pregnant women, adequate information, which must be based on scientific evidence.

[THE CHAIR OF BIRTHS: A RESOURCE COMPANION OF VERTICALITY IN CHILDBIRTH]. / La silla de partos: un recurso acompañante de la verticalidad en el parto.

In primitive cultures, women chose to give birth in upright positions such as squatting or sitting, because these positions stimulate a physiological birth. In this way, in order to make easier the delivery support tools such as birthing chair (BC) are discovered. Later, with the medicalization of childbirth, the lithotomy position was introduced as standard practice, with the aim of promoting comfort to the birth attendant. Currently, this position is still prevalent in the hospital environment. The World Health Organization recommendations, stresses the importance of providing impartial information on birthing positions to women, so that she will decide how to give birth without professional influence as a limiting factor in maternal posture. The aim of this review is to make known the utility of the BC, the advantages and disadvantages associated with it, to make it an available resource in vertical childbirth. The BC is a low rise seat horseshoe shaped stable and sturdy structure, and sitting in the chair women acquire squatting position, considered the most natural. The BC is considered a useful tool for childbirth upright. Giving birth using the BC seems to be protective against episiotomies and Kristeller maneuver, provides comfort and empowerment of women and helps them to have a more positive birth experience.

[MANAGEMENT OF VAGINAL CONES IN THE TREATMENT OF PELVIC FLOOR REHABILITATION]. / Manejo de los conos vaginales en el tratamiento rehabilitador del suelo pélvico.

The pelvic floor (PF) is a sheet of muscles and other tissues that support the pelvic organs in their physiological positions. Throughout women's lives, these structures can become weak or be injured by events such as pregnancy, childbirth, surgery, overweight or constipation. PF dysfunction includes a group of disorders causing urinary incontinence, as well as genital prolapse or pelvic pain, and can significantly deteriorate women's quality of life. Vaginal cones (VC) represent a non-pharmacological, economical, safe and non-invasive method for the treatment of PF dysfunction; they allow the patient to increase the physiological consciousness of the musculature of the PF while promoting an increase in the muscle tone. The midwife, as a professional intimately connected with women's health care, works with the multidisciplinary team which treats pelvic dysfunctions; therefore, they need to provide updated information about the different methods for improving perineal function, including VC, and providing advice on their use and management, and establishing individualized exercise programs and tracking information for each case. The available scientific evidence on the effectiveness of the VC is limited and there may be other methods to treat PF dysfunctions.

Manejo de los conos vaginales en el tratamiento rehabilitador del suelo pélvico / Management of vaginal cones int he treatment of pelvic floor rehabilitation

El suelo pélvico (SP) es el conjunto de músculos encargados del soporte y mantenimiento de los órganos pélvicos en sus posiciones fisiológicas. A lo largo de la vida, esta estructura puede alterarse por situaciones como la gestación, el tipo de parto, las intervenciones quirúrgicas realizadas sobre la zona perineal, la obesidad o el estreñimiento, entre otras. La alteración de la funcionalidad del SP puede dar lugar a la aparición de patologías como los prolapsos genitales, las incontinencias urinarias o el dolor pélvico, que pueden ocasionar una importante alteración en la calidad de vida de la persona que las padece. Los conos vaginales (CV) suponen un método no farmacológico, económico, seguro y no invasivo para el tratamiento efectivo de la disfunción de la musculatura del SP, puesto que permite a la paciente aumentar la conciencia fisiológica de la musculatura de su SP al tiempo que promueve el aumento de la fuerza muscular. La matrona, como profesional íntimamente ligado a la atención de la mujer, forma parte del equipo multidisciplinar encargado del abordaje activo de las disfunciones pélvicas; por ello, debe ofrecer a la mujer información actualizada sobre los CV, asesorando sobre su uso y manejo y estableciendo programas de ejercicios y seguimiento individualizados para cada caso. La evidencia científica disponible acerca de la eficacia de los CV es limitada y señala que pueden existir otros métodos o tratamientos de eficacia semejante para el tratamiento rehabilitador del SP (AU)

The pelvic floor (PF) is a sheet of muscles and other tissues that support the pelvic organs in their physiological positions. Throughout women’s lives, these structures can become weak or be injured by events such as pregnancy, childbirth, surgery, overweight or constipation. PF dysfunction includes a group of disorders causing urinary incontinence, as well as genital prolapse or pelvic pain, and can significantly deteriorate women’s quality of life. Vaginal cones (VC) represent a non-pharmacological, economical, safe and non-invasive method for the treatment of PF dysfunction; they allow the patient to increase the physiological consciousness of the musculature of the PF while promoting an increase in the muscle tone. The midwife, as a professional intimately connected with women’s health care, works with the multidisciplinary team which treats pelvic dysfunctions; therefore, they need to provide updated information about the different methods for improving perineal function, including VC, and providing advice on their use and management, and establishing individualized exercise programs and tracking information for each case. The available scientific evidence on the effectiveness of the VC is limited and there may be other methods to treat PF dysfunctions (AU)

La silla de partos. Un recurso acompañante de la verticalidad en el parto / The chair of births: a resource companion of verticality in childbirth

Desde antiguo, en las culturas primitivas las mujeres elegían parir en posiciones verticales, como en cuclillas o sentadas, ya que favorecían la consecución de un parto y un nacimiento fisiológicos. Para facilitar la adquisición de estas posturas surgen instrumentos de apoyo como la silla de partos (SDP). Posteriormente, con la medicalización del parto, se introduce la posición de litotomía como una práctica habitual, con el único objetivo de favorecer la comodidad del asistente al parto. En la actualidad, esta posición sigue imperando en el entorno hospitalario. La Organización Mundial de la Salud subraya la importancia de ofrecer información imparcial sobre las posturas de parto a la mujer, para que sea ella misma la que decida cómo quiere dar a luz, sin que los profesionales actúen como factor limitante de la postura materna. El objetivo de esta revisión es dar a conocer la utilidad de la SDP, así como las ventajas e inconvenientes que se le asocian, para poder hacer de ella un recurso facilitador del parto en la posición vertical. La SDP es un asiento de poca altura con forma de herradura, de estructura estable y resistente. Cuando se sientan en ella, las mujeres adquieren la posición de cuclillas, considerada la más natural. La SDP se perfila como un instrumento útil para el parto en posición vertical. Dar a luz utilizando la SDP parece tener un efecto protector contra las episiotomías y la maniobra de Kristeller, proporciona una mayor comodidad y autonomía a la mujer, y contribuye a que tenga una experiencia de nacimiento más positiva (AU)

In primitive cultures, women chose to give birth in upright positions such as squatting or sitting, because these positions stimulate a physiological birth. In this way, in order to make easier the delivery support tools such as birthing chair (BC) are discovered. Later, with the medicalization of childbirth, the lithotomy position was introduced as standard practice, with the aim of promoting comfort to the birth attendant. Currently, this position is still prevalent in the hospital environment. The World Health Organization recommendations, stresses the importance of providing impartial information on birthing positions to women, so that she will decide how to give birth without professional influence as a limiting factor in maternal posture. The aim of this review is to make known the utility of the BC, the advantages and disadvantages associated with it, to make it an available resource in vertical childbirth. The BC is a low rise seat horseshoe shaped stable and sturdy structure, and sitting in the chair women acquire squatting position, considered the most natural. The BC is considered a useful tool for childbirth upright. Giving birth using the BC seems to be protective against episiotomies and Kristeller maneuver, provides comfort and empowerment of women and helps them to have a more positive birth experience (AU)

EPI-NO más que un dispositivo favorecedor de la elasticidad perineal para el parto / Epi-No: more than a flattering deviceto improve perineal elasticity in childbirth

En la actualidad, las principales causas de lesión de las estructuras del suelo pélvico están asociadas a cambios hormonales y mecánicos que se producen durante la gestación, así como al efecto de la expulsión fetal durante el parto. Estas alteraciones pueden afectar gravemente la calidad de la vida de la mujer, por lo que se hace imprescindible su abordaje precoz. Este abordaje debe comenzar desde la prevención y llevarse a cabo por un equipo multidisciplinar que conozca las diferentes terapias o dispositivos diseñados para el manejo de cada alteración. El EPI-NO es un dispositivo vaginal diseñado a finales de los años noventa con el objetivo de ejercitar la musculatura del suelo pélvico de cara al parto y restaurar el tono muscular en el posparto. Su uso es sencillo y no resulta lesivo para la gestante o su futuro bebé; asimismo, aporta numerosos beneficios para la gestante, entre los que se encuentran: reducción en el número de episiotomías y desgarros de 2.º y 3.er grado, aumento de la incidencia de periné intacto y prevención de la incontinencia urinaria en el embarazo y posparto, entre otros. Conociendo las necesidades de la mujer y los recursos disponibles a su alcance, los profesionales podrán orientar a la gestante en el uso del EPI-NO durante su proceso de embarazo, parto y posparto, y disminuir así la morbilidad asociada al parto (AU)

Currently, the main causes of damage to the pelvic floor structures are associated with hormonal and mechanical changes occurring during pregnancy, as well as the effect of fetal expulsion during delivery. These changes can severely affect the quality of life of women, so it is essential to his early approach. This approach should start from prevention and be carried out by a multidisciplinary team who knows the different therapies or devices designed for handling each alteration. The EPI-NO is a vaginal device designed in the late 90s with the aim of exercising the muscles of the pelvic floor facing the delivery and restore muscle tone postpartum. Its use is simple and not harmful to the pregnant woman or her unborn child; likewise, brings numerous benefits to the pregnant among which are: reduction in the number of episiotomies and tears 2nd and 3rd grade, increased incidence of intact perineum and prevention of urinary incontinence in pregnancy and postpartum, among others. Knowing the needs of women and the resources available to them, professionals can guide the mother in using the EPI-NO during their pregnancy, childbirth and postpartum, decreasing the morbidity associated with childbirth (AU)

Papel de la inyección de agua estéril en el control del dolor lumbar durante el proceso de parto / Role of sterile water injection in the control of back pain during birthing process

A lo largo del embarazo, el temor principal de las mujeres es el miedo al dolor de parto, lo que conlleva la búsqueda de un método eficaz para su alivio. La analgesia epidural es el método más utilizado en nuestro medio y el de mayor eficacia; sin embargo, en aquellas situaciones donde esta analgesia está contraindicada, o bien la mujer no la desea, los métodos no farmacológicos son fundamentales para conseguir un buen manejo del dolor. Dentro de los métodos no farmacológicos se encuentran las terapias complementarias y alternativas (TCA), las cuales, a pesar de no tener la misma eficacia en el alivio del dolor que la epidural, tienen efectos analgésicos importantes y son completamente inocuas para la gestante y el feto. La inyección de agua estéril (IAE) es una técnica englobada dentro de las TCA, que consiste en la administración de pequeñas cantidades de agua estéril, vía intradérmica o subcutánea, a ambos lados de la base de la columna vertebral, en una región conocida como el Rombo de Michaelis. Su indicación principal se basa en el alivio del dolor localizado en la zona lumbar que tiene lugar durante el parto. Posee un efecto analgésico importante que comienza a los pocos segundos de su administración y es más eficaz en las primeras fases del parto. La evidencia actual avala la alta eficacia de la técnica como un buen aliado en el alivio del dolor de la zona lumbar durante el parto, y su uso es altamente recomendado (AU)

During the pregnancy, the main concern of women is the fear of the labor pain. This fact makes women look for the complete relief of pain. For this reason, the technique used by excellence is the pharmacological analgesia (epidural). However, when the epidural analgesia is contraindicated or when women decide not to use it, the non pharmacological approaches to reduce labor pain are really useful. Complementary and alternatives therapies (CAT) are part of these methods and, even if they are not so effective in relieving pain than some pharmacological techniques, they have significant analgesic effects without side-effects on the fetus or mother. Intradermal water blocks or intracutaneous steril water injection is a type of Nonpharmacological Complementary Therapy which consists of intradermal or subcutaneous injections of small amonts of sterile water on both sides of the base of the spine in the lumbosacral region. It is prescribed for severe low back pain during labor. The technique has an important analgesic effect which begins a few seconds after it has been used, and pain refief could last 90-120 minutes. Its efficacy is backed up by many scientific researches, and it is really recommended to relieved the low back pain (AU)