A SYSTEMATIC REVIEW OF THE EFFECTIVENESS OF NONPHARMACOLOGICAL PAIN RELIEF METHODS DURING LABOR AND DELIVERYMichelle Dearduff, Mellanie Hopkins, Pamela Mayle, Bradley Shultz

BACKGROUND Nonpharmacological Pain Relief Methods

Massage Acupuncture Acupressure Hot and cold packs Aromatherapy Sterile Water Injections

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

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.

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.

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

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

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.

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.

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.

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.

Author Method Used

Study Type

Variables

Sample Used

Findings

Misc.

Brown et al. (2001)

Combination [1]

Descriptive Survey

Laboring women

46 laboring women

[2] [3]

Sanders et al. (2005)

Variety [4] Questionnaire

[5] 207 heads of midwifery

[6] [7]

Kimber et al. (2008)

Massage or music

Randomized controlled trial

[8] 4 small trials

[9] [10]

Peart et al. (2008)

Sterile water injection

Study with pre/post test

[11] 60 women during labor

[12] [13]

Mei-Yueh et al. (2006)

Massage Randomized controlled trial

[14] 60 primiparas

in labor

[15] Cost effective

treatment

Nesheim et al. (2006)

acupuncture

Randomized controlled trial

[16] 15,109 laboring patients [17]

[18] [19]

Chung et al. (2003)

Acupressure

Study with pre/post test

[20] 127 parturient

women[21]

[22] [23]

Mi Kyeong et al. (2004)

Acupressure

Randomized controlled trial

[24] 75 women in labor [25]

[26] [27]

Burns et al. (2007)

Aromatherapy

Randomized controlled trial

[28] 513 women during labor [29]

[30] [31]

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

NURSING IMPLICATION Offer Alternative Methods in nursing

practice

Incorporate these nonpharmocological pain relief methods in standards of care

NURSING ACTIONSAcquire more knowledge about

alternative therapies

Offer these alternative therapies in other practices as well

Make these alternative therapies more available to laboring womenMidwifery

FUTURE RESEARCH Effects of non-pharmalogical methods on the

newborn

Larger sample size

Length of pain relief effectiveness

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

CONCLUSION Options for pain relief during labor

Nonpharmalogical techniques

Managing labor pain safely

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.

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. Acta Obstetricia Et Gynecologica Scandinavica, 85(4), 441-443.

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.