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Michelle Dearduff, Mellanie Hopkins, Pamela Mayle, Bradley Shultz

A systematic review of the effectiveness of nonpharmacological pain relief methods during labor and delivery. Michelle Dearduff, Mellanie Hopkins, Pamela Mayle, Bradley Shultz. BACKGROUND. Nonpharmacological Pain Relief Methods Massage Acupuncture Acupressure Hot and cold packs

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Michelle Dearduff, Mellanie Hopkins, Pamela Mayle, Bradley Shultz

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  1. A systematic review of the effectiveness of nonpharmacological pain relief methods during labor and delivery Michelle Dearduff, Mellanie Hopkins, Pamela Mayle, Bradley Shultz

  2. BACKGROUND • Nonpharmacological Pain Relief Methods • Massage • Acupuncture • Acupressure • Hot and cold packs • Aromatherapy • Sterile Water Injections

  3. Search Strategy • Random Controlled Trials • Descriptive and Experimental Studies • CINAHL, MedLine, Electronic Journal Database, Academic Search Premier • Terms searched: • Nonpharmacological pain relief during labor • Specific pain relief measures such as acupressure, acupuncture, aromatherapy, sterile water injections • Alternative therapies for labor and delivery

  4. Search Criteria - Inclusions • Random controlled trials and experimental and descriptive studies pertaining to nonpharmacological pain relief techniques for labor and delivery. • Safe management of labor and delivery pain.

  5. Search Criteria - Exclusions • Studies pertaining to water births or alternative birth plans. • Studies not related to massage, acupuncture, acupressure, hot and cold packs, aromatherapy or sterile water injections. • Pertinent studies in a foreign language without translation.

  6. Complications • Limited samples • Highly individualized perception of pain • Underpowered trials • Not one specific method or combination of techniques helps all women or even the same woman throughout labor and delivery

  7. Main Results • 9 trials that introduced over 16,000 subjects to different interventions relating to non-pharmacological pain relief. • Interventions • 1 relating to a mixture of 10 different interventions • 1 relating to hot/cold/perineal massage therapy • 2 relating to regular massage • 1 relating to sterile water injection • 1 relating to acupuncture • 2 relating to acupressure • 1 relating to aromatherapy

  8. Results • The first study shown on Table 1 indicated that out of 10 interventions, breathing exercises were most beneficial. • Massage proves to be an acceptable intervention that decreases the intensity of labor pain in the first and second phase of cervical dilation. • Over 90% of the subjects who participated in the sterile water injections stated that they were satisfied to over-satisfied.

  9. Results • The study using acupuncture yielded the highest number of subjects – 15,109 participants • Acupuncture when used as a labor analgesia has decreased the number of epidurals. • Both trials involved with acupressure resulted in a lessening of labor pains. • L14 and BL67 acupressure lessened pains during the active phase of the first stage of labor • SP6 acupressure decreased labor pains and shortened length of delivery.

  10. Results • Aromatherapy was used in the trial containing the second largest subject pool – 513. • This trial resulted in lessening the pain perception in nulliparous mothers. • This is a growing intervention in maternity care that is cost effective.

  11. Results • Table 1 on the next slide compares and explains the outcomes of each of the nine trials that were performed. • All of these non-pharmacologic trials reduced the maternal pain perceived during labor and delivery in some form. • Certain interventions worked better on some areas of pain than others and also worked better on some women than others.

  12. Summary • 9 trials that involved over 16,000 participants were studied. • Breathing exercises reported to be the most effective • Aromatherapy was reported to be the least effective • Cost Effective

  13. Nursing implication • Offer Alternative Methods in nursing practice • Incorporate these nonpharmocological pain relief methods in standards of care

  14. Nursing actions • Acquire more knowledge about alternative therapies • Offer these alternative therapies in other practices as well • Make these alternative therapies more available to laboring women • Midwifery

  15. Future Research • Effects of non-pharmalogical methods on the newborn • Larger sample size • Length of pain relief effectiveness

  16. Proposed Research Design • Use of pain relief technique that has no adverse effect on the baby. • Include full assessment and evaluation of the newborn • Experimental study with pre test and post test

  17. Conclusion • Options for pain relief during labor • Nonpharmalogical techniques • Managing labor pain safely

  18. References • Brown, S., Douglas, C., & Flood, L. (2001). Women’s evaluation of intrapartum nonpharmacological pain relief methods used during labor. Journal of Perinatal Education, 10(3), 1-8. • Burns, E., Zobbi, V., Panzeri, D., Oskrochi, R., & Regalia, A. (2007). Aromatherapy in childbirth: a pilot randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 114(7), 838-844. • Chung, U., Hung, L., Kuo, S., & Huang, C. (2003). Effects of LI4 and BL 67 acupressure on labor pain and uterine contractions in the first stage of labor. Journal of Nursing Research, 11(4), 251-260.

  19. References • Kimber, L., McNabb, M., Mc Court, C., Haines, A., & Brocklehurst, P. (2008). Massage or music for pain relief in labour: A pilot randomised placebo controlled trial. European Journal of Pain, 12(8), 961-969. • Mei-Yueh, C., Chung-Hey, C., & Kuo-Feng, H. (2006). A Comparison of Massage Effects on Labor Pain Using the McGill Pain Questionnaire. Journal of Nursing Research, 14(3), 190-197. • Mi Kyeong, L., Soon Bok, C., & Duck-Hee, K. (2004). Effects of SP6 Acupressure on Labor Pain and Length of Delivery Time in Women During Labor. Journal of Alternative & Complementary Medicine, 10(6), 959- 965. • Nesheim, B., & Kinge, R. (2006). Performance of acupuncture as labor analgesia in the clinical setting. ActaObstetricia Et GynecologicaScandinavica, 85(4), 441-443.

  20. References • Peart, K. (2008). Managing labour pain safely. Australian Journal of Advanced Nursing, 25(3), 43-48. • Rodriguez, M. (2005). Transcutaneous electrical nerve stimulation during birth. British Journal of Midwifery, 13(8), 522-526. • Sanders, J., Peters, T., & Campbell, R. (2005). Techniques to reduce perineal pain during spontaneous vaginal delivery and perineal suturing: a UK survey of midwifery practice. Midwifery, 21(2), 154-160. • Schmidt, N. & Brown, N. (2009). Evidence-based practice for nurses: Appraisal and application of research. Boston: Jones and Bartlett Publishing Co.

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