Decrease Labor Pain Research Articles

Comparison of the Effect of Incremental Bolus and Incremental Infusion Regimens of Remifentanil on Labour Pain

Background: Most pregnant women who deliver in obstetrics units require pharmacological or non-pharmacological pain relievers that could provide potent analgesic effects with least maternal and neonatal adverse effects. Objectives: The aim of this investigation was to compare the efficacy and adverse maternal and neonatal effects of Remifentanil given by bolus patient-controlled analgesia (PCA) versus continuous intravenous (IV) infusion for labor analgesia. Patients and Methods: This randomized, single-blind clinical trial was conducted on 82 nulliparous parturient women in the active phase of labor, admitted to Ali Ebn-e Abitaleb Hospital, Zahedan, Iran from January 2010 to March 2013. The participants were randomly assigned into two equal groups of 41. In the infusion group, patients received incremental Remifentanil IV infusion from 0.025 to 0.1 µg/kg/min. In the bolus group, participants received incremental PCA bolus Remifentanil from 0.25 to 0.4 µg/kg with a lock-out time of four minutes. Average Visual Analog Scale (AVAS) pain scores in stages 1 and 2, labor duration, adverse effects, neonatal outcomes, total amount of administered Remifentanil and maternal satisfaction were assessed. Results: In both methods, the pain scores were significantly reduced after Remifentanil administration in both stages of labor (P < 0.001). There were no statistically significant differences in the pain intensity reduction between the groups (P = 0.49, P = 0.36, in the stages I and II of labor, respectively). There were no statistically remarkable differences between the two groups for labor duration (P = 0.4), neonatal outcomes (P = 0.9) and maternal satisfaction (P = 0.8). The total amount of administered Remifentanil was significantly lower in infusion group compared to bolus group (P = 0.001). Conclusions: Remifentanil in both infusion and bolus methods could decrease labor pain in both stages without serious maternal or neonatal adverse effects and without increasing the duration of labor. The average dose of Remifentanil needed to reduce pain was significantly lower in the infusion method compared to the bolus method.

Comparison between Water Birth and Land Birth in terms of Fetal and Neonatal Outcomes

Introduction: Although warm water is used for labor pain reduction, there is controversy regarding the potential complications of water birth. Therefore, this study was performed to evaluate fetal and neonatal complications of water birth versus those observed in conventional modes of delivery. Methods:This clinical randomized trial was performed on 200 pregnant women at Mashhad Omolbanin Hospital in years 2008-2009. In total, 100 subjects were allocated to the conventional delivery group and 100 women were included in the water birth group. In the water birth group, the patients were allowed to move freely and fluid intake was not limited. In the conventional delivery group, delivery was performed on a bed via a routine mode of delivery. Delivery duration, neonatal infection during the first week after delivery, early neonatal Apgar score, neonatal eye infection, and rate of NICU admission were compared between the two groups. Finally, 88 women in the conventional delivery group and 83 cases in the water birth group remained in the study. After data collection, data were analyzed using SPSS version 14, and Kolmogorov–Smirnov, Chi-square, and t-student tests were performed. P-value less than 0.05 was considered significant. Results:The mean duration of the first stage (P<0.344), second stage (P=0.372), and third stage (P=0.523) of labor was not statistically different between the two groups. Cesarean section rate in the conventional delivery group was significantly higher than that of the water birth group (P=0.018). Also, 1- (P=0.026) and 5-minute (P≤ 0.001) Apgar scores in the water birth group were significantly higher than those of the conventional delivery group. No significant differences were observed between the two groups in terms of other variables. Conclusion:Water birth can decrease labor pain and reduce the need for medical interventions; also, it does not have any adverse effects on the neonate. Therefore, it can be a suitable alternative for conventional deliveries. With proper selection of individuals and accurate monitoring during delivery, water birth can be a completely healthy method without further risks for the mother or the fetus.

Reduction in labor pain by intrathecal midazolam as an adjunct to sufentanil

BackgroundAnesthesia today has strived to decrease labor pain in a tolerable and controllable fashion. Intrathecal midazolam has been introduced as an adjunct to analgesics. The study was planned to assess the efficacy, safety and duration of analgesia produced by intrathecal midazolam adjunct to sufentanil in decreasing labor pain.MethodsIn a randomized clinical trial 80 parturient included in the study. The two groups were matched for age, cervical dilation, gravid, gestational age, and other demographic characteristics. Combination of sufentanil and midazolam administered intrathecally to experimental group and compared to sufentanil group. Time to reach maximum block, and pain score was measured and recorded.ResultsGroups were matched for age and weight and other demographic characteristic. No significant adverse effect was seen in both groups including decrease in Apgar score. Duration of analgesia was 92.0 ± 12.7 in sufentanil group and 185.2 ± 15.2 minutes in midazolam and sufentanil group which was significantly different (P = 0.002). Numeric rating scale score was significantly lower in midazolam group compare to sufentanil group at 120 min (P = 0.01), 150 min (P = 0.0014), and 180 min (P = 0.001).ConclusionsIntrathecal midazolam as an adjunct to opioid could significantly enhance analgesia in labor pain with no significant adverse effect. Intrathecal injection of midazolam is an appropriate alternative to parenteral or epidural analgesia in small hospital settings.

Comparison of remifentanil: Entonox with Entonox alone in labor analgesia

Background:We designed a study to evaluate the effectiveness of continuous low dose infusion of remifentanil adding to self-administration of entonox administered for pain relief during the active phase of first stage of labor.Materials and Methods:Thirty healthy term pregnant women recruited in our randomized double-blind, cross over study. They received the study medicines during two 30-min periods with a 15-min wash-out sequence after each period. Fifteen parturient used remifentanil as a single bolus dose followed by constant low dose infusion and self-administration of entonox (group R) during the first period and entonox and saline (group P) during the second period, while the remainder of the parturient used the drugs in a reverse order. Pain and Ramsay score, maternal and fetal hemodynamic, and ventilation were assessed during each intervention.Results:In this study, mean pain severity scores were 8 ± 0.9 before and 5.4 ± 1.7 after intervention in group P, and 7.8 ± 0.1, 3.5 ± 1.3 in group R, respectively. Mean pain severity difference was 2.6 ± 1.5 in group P, while 4.3 ± 1.5 in group R; so, use of entonox and remifentanil can decrease labor pain two times more in comparison with entonox/placebo (normal saline). However, hemodynamic and ventilation parameter in remifentanil/entonox period were same as in entonox/placebo period. No statistical differences were seen in mean Ramsay score between group R and P. There was no episode of maternal bradycardia, hypotension, or hypoxemia.Conclusion:Not only adding low dose infusion of remifentanil to self-administration of entonox was notable in labor pain reduction, it did n’t make more parturient and neonatal side-effects.

Effects of LI4 Acupressure on Labor Pain in the First Stage of Labor

Complementary and alternative medicines have been used to decrease labor pain for many years. Despite reports that some of these methods reduce pain, increase maternal satisfaction, and improve other obstetric outcomes, they have received limited attention in the US medical literature. The purpose of this study was to evaluate the effects of LI4 acupressure on labor pain in the first stage of labor, on labor duration, and on patient satisfaction. A single, blind, randomized clinical trial was performed with eligible women (N = 100) who were at the beginning of the active phase of labor (3-4 cm dilatation of cervix with regular uterine contractions). The women in the acupressure group (n = 50) received LI4 acupressure at the onset of the active phase for the duration of each uterine contraction over a period of 20 minutes, and the women in the control group (n = 50) received a touch on this point without massage. Labor pain was measured using a structured questionnaire of a subjective labor pain scale (visual analogue scale) before the intervention, immediately after the intervention, 20 and 60 minutes after the intervention, and then every hour. There were significant differences between the groups in subjective labor pain scores immediately and 20, 60, and 120 minutes after intervention (P ≤ .001). Active phase duration (3-4 cm dilatation to full dilatation) and second stage duration (full dilatation to birth) were shorter in the acupressure group. The women in the acupressure group reported greater satisfaction. LI4 acupressure was effective at decreasing pain and duration of labor. The participants were satisfied, and no adverse effects were noted.

FP07-2 The Noble Quran and Psychotherapy

Childbirth is a physiological event in every development of a woman to become a mother. This event can cause trauma because of the pain she experienced. The main factors in labor are passage, passager and power, psychological (psychological factors) and childbirth helpers. A woman needs physical, emotional, psychosexual and psychosocial maturity before marriage and becomes pregnant. Feelings of anxiety, fear of pain will make women uneasy facing pregnancy, childbirth and childbirth, non-pharmacological therapy that can be given in various ways, namely; acupressure, acupuncture, cold compresses, warm compresses, hydrotherapy, hypnotherapy, endorphin massage, relaxation and distraction techniques. The effectiveness of giving murotal Al-Quran audio will increase the power of faith and provide peace of mind.The purpose of this study is to determine the effectiveness of Murotal Al Quran Therapy on Decreasing Labor Pain and Anxiety in Maternity in the First Phase in Maternity Clinic Ar-Rahmah Indralaya Ogan Ilir. The population of this research was maternity inpartu when I was an active phase which amounted to 20 people.The type of research used in this study was quasi-experiment. The research design used was one group comparison pretest–posttest design to test the intensity of pain intensity using Shapiro–Wilk.From the results of the study obtained the normality test obtained p = 0.039 and 0.069 which showed the data did not normally distribute, the difference between before and after being given Murotal Al-Quran 0.30 with p = 0.008 showed that there was a difference in pain scale before and after therapy Murotal Al-Quran, for the anxiety of the difference between before and after being given therapeutic Murotal Al-Quran 0.021 with p = 0.025 which shows that there are differences in pain scale before and after the Murotal Al-Quran is concluded.It can be concluded that Murotal Al-Quran can reduce pain and anxiety in maternity when I was an active phase. It is expected that midwives can improve services through the development of midwifery care, especially for women who experience severe pain.

Effects of the Spouse's Aromatherapy Massage on Labor Pain, Anxiety and Childbirth Satisfaction for Laboring Women.

The purpose of this study was to determine the effects of the spouse's aromatherapy massage on labor pain, anxiety during labor and childbirth satisfaction for laboring women. The subjects of this study were laboring women who didn't have any complication during pregnancy and who have admitted for childbirth with their spouse to E. hospital in D city. This study was carried out from June to November in 2007. The subjects were allocated into three groups: spouse's aromatherapy massage group, spouse's carrier oil massage group and control group. Aromatherapy massage and carrier oil massage was applied for ten minutes every hour after the cervix dilated 5cm. The subjects in the control group were with their spouse during labor. The labor pain by VAS was significantly different among the three groups (Kruskal-Wallis chi2=7.09 p=.029) in the deceleration phase. The anxiety during labor by VAS were significantly different among the three groups (Kruskal-Wallis chi2=6.77 p=.034) in the deceleration phase. There was no significant difference in childbirth satisfaction among the three groups. The spouse's aromatherapy massage using Lavender, Clary sage, Frankincense and Neroli could be effective in decreasing labor pain and decreasing anxiety level during labor.

Effects of Yoga during Pregnancy on Weight Gain, Delivery Experience and Infant's Birth Weight

Purpose: The purpose of this study was to examine the effect of the yoga during pregnancy on the maternal weight, delivery experience and infant birth weight. Met hod: The nonequivalent control group pre test-post test design was used. The participants were the healthy pregnant women, whose pre-pregnancy BMI was normal, gestational period was more than 20 weeks. The final sample consisted of 21 mother-infant dyads for experimental group and 20 dyads for control group and who agreed to participate in this study. Data were collected from February 1st to December 15th, 2006. The Qi exercise prenatal program was carried out for 90 minutes a day, 2 times a week for 12 weeks. The data were analyzed using SPSS 16.0 Program. Result: The degree of maternal weight gain(p<.001), labor pain(p<.001), discomfort after delivery(p<.001) and infant's birth weight(p<.001) were significantly different between two groups. Conclusion: The yoga during pregnancy managed weight gain of mothers. Therefore, this study suggests that yoga during pregnancy to promotes stabilization can be beneficial for maintaining healthy weight, decreasing labor pain and discomfort after delivery for pregnant women and increasing infant's birth weight.

A Comparison of Massage Effects on Labor Pain Using the McGill Pain Questionnaire

The purpose of this study was to describe the characteristics of pain during labor with and without massage. Sixty primiparas in labor were randomly assigned to either a massage or control group and tested using the self-reported Short-Form McGill Pain Questionnaire (SF-MPQ) at 3 phases of cervical dilation: phase 1 dilation (3-4 cm), phase 2 dilation (5-7 cm), and phase 3 dilation (8-10 cm). The massage group received standard nursing care and massage intervention, whereas the control group received standard nursing care only. The results of this study showed: (1) In both groups, as cervical dilation increased, there were significant increases in pain intensity as measured by SF-MPQ; (2) massage lessened pain intensity at phase 1 and phase 2, but there were no significant differences between the groups at phase 3; (3) the most frequently selected five sensory words chosen by both groups were similar at phases 1 and 2- (a) sore, (b) sharp, (c) heavy, (d) throbbing, and (e) cramping, while of the 4 affective classes, "fearful" and "tiring-exhausting" were the most used by participants to describe the affective dimension. The results of this study indicate that, although massage cannot change the characteristics of pain experienced by women in labor, it can effectively decrease labor pain intensity at phase 1 and phase 2 of cervical dilation during labor. Nurses and caregivers could consider using massage to help laboring women through the labor pain.

Effects of Aromatherapy on Labor Pain &amp; Perception of Childbirth Experience

Purpose: The purposes of this study were to verify the effects of aromatherapy on labor pain and perception of the childbirth experience. Methods: This study was a nonequivalent control group pretestposttest design. The subjects of this experiment consisted of forty eight primiparas without problems during the gestation period. Twenty four primiparas in the experimental group were given general obstetric nursing care with aromatherapy every two hours. Twenty four primiparas in the control group were given general obstetric nursing care only. Data was collected for labor pain measured by a labor pain expression scale, uterine contraction activity measured by Montevideo units in the latent phase, active phase, and transition phase and the perception of childbirth experience 24hours after birth. Data was analyzed by t-test, and repeated measures of ANOVA with an SPSS program. Results: No significant group effects were found, but significant time effects were found for labor pain, and uterine contraction activity. There was no significant difference in postpartum mothers' perception about childbirth. Conclusion: In this study, effects of aromtherapy decreasing labor pain expression, and increasing the perception of childbirth was not found.

Effects of SP6 Acupressure on Labor Pain and Length of Delivery Time in Women During Labor

The purpose of this study was to evaluate the effects of SP6 acupressure on labor pain and delivery time in women in labor. Randomized clinical trial. Delivery room in a university hospital. Seventy-five (75) women in labor were randomly assigned to either the SP6 acupressure (n = 36) or SP6 touch control (n = 39) group. The participants were matched according to parity, cervical dilation, labor stage, rupture of amniotic membrane, and husband's presence during labor. There were no additional oxytocin augmentation or administration of analgesics during the study period. The 30-minute acupressure or touch on SP6 acupoint was performed. Labor pain was measured four times using a structured questionnaire, a subjective labor pain scale (visual-analogue scale [VAS]): before intervention, immediately after the intervention, and 30 and 60 minutes after the intervention. Length of delivery time was calculated in two stages: from 3 cm cervical dilation to full cervical dilatation, and full cervical dilatation to the delivery. There were significant differences between the groups in subjective labor pain scores at all time points following the intervention: immediately after the intervention (p = 0.012); 30 minutes after the intervention (p = 0.021); and 60 minutes after the intervention (p = 0.012). The total labor time (3 cm dilatation to delivery) was significantly shorter in the SP6 acupressure intervention group than in the control group (p = 0.006). These findings showed that SP6 acupressure was effective for decreasing labor pain and shortening the length of delivery time. SP6 acupressure can be an effective nursing management for women in labor.

Effects of one-to-one Labor Support on Labor Pain, Labor Stress Response, Childbirth Experience and Neonatal Status for Primipara

This study was designed to investigate the effect of one-to-one labor support on labor pain, labor stress response, childbirth experience and neonatal status for primipara by a quasi experiment (nonequivalent control group pretest-posttest design), from April 30, 1999 to February 20, 2000.The subjects of this experiment consisted of eighty two primipara with single gestation, full term, uncomplicated pregnancies. Forty one were in the experimental group and forty one in the control group. Their mean age was 25.95 years, their mean gestation period was 39.9 weeks.A caring package of one-to-one labor support had three components. Physical support consisted of massage, back pressure, touch. Emotional support was provided by a continuous nurse's presence, acceptance and encouragement. Informational support involved teaching breathing skills, relaxation skills and knowledge about the labor process.Data assessed labor pain, pulse rate and blood pressure to measure labor stress response. Also, in measuring the value of labor stress response, plasma epinephrine, plasma norepinephrine and serum cortisol were measured. In the 24 hours after birth, the data for the postpartum mother's childbirth experiences was collected. Umbilical cord arterial blood pH, one minute and five minute Apgar score were measured after birth.Data was analyzed by t-test, Chi-square-test, repeated measures ANOVA, ANCOVA with SAS Program.The results were as follows; 1. Labor pain was significantly low in the experimental group(P=.016).2. No significant group effects were found, but significant time effects were found for plasma epinephrine, norepinephrine, serum cortisol, pulse rate and blood pressure.3. The childbirth experience of the experimental group was significantly more positive than the control group (P =.005).4. The umbilical cord arterial blood pH of the experimental group was significantly higher than the control group(P=.014). There was no significant difference between the two groups in neonatal one minute and five minute Apgar scores.In conclusion, these findings indicate that one-to-one labor support could be effective in decreasing labor pain, and increasing positive childbirth experiences, also increasing the neonatal umbilical cord arterial blood pH for primipara. So, one-to-one labor support could be applied as an effective nursing treatment for primipara.

Clinical Aspects, Vaginal Discharge, Vaginitis and Pruritus Vulvae

Childbirth is a physiological event in every development of a woman to become a mother. This event can cause trauma because of the pain she experienced. The main factors in labor are passage, passager and power, psychological (psychological factors) and childbirth helpers. A woman needs physical, emotional, psychosexual and psychosocial maturity before marriage and becomes pregnant. Feelings of anxiety, fear of pain will make women uneasy facing pregnancy, childbirth and childbirth, non-pharmacological therapy that can be given in various ways, namely; acupressure, acupuncture, cold compresses, warm compresses, hydrotherapy, hypnotherapy, endorphin massage, relaxation and distraction techniques. The effectiveness of giving murotal Al-Quran audio will increase the power of faith and provide peace of mind.The purpose of this study is to determine the effectiveness of Murotal Al Quran Therapy on Decreasing Labor Pain and Anxiety in Maternity in the First Phase in Maternity Clinic Ar-Rahmah Indralaya Ogan Ilir. The population of this research was maternity inpartu when I was an active phase which amounted to 20 people.The type of research used in this study was quasi-experiment. The research design used was one group comparison pretest–posttest design to test the intensity of pain intensity using Shapiro–Wilk.From the results of the study obtained the normality test obtained p = 0.039 and 0.069 which showed the data did not normally distribute, the difference between before and after being given Murotal Al-Quran 0.30 with p = 0.008 showed that there was a difference in pain scale before and after therapy Murotal Al-Quran, for the anxiety of the difference between before and after being given therapeutic Murotal Al-Quran 0.021 with p = 0.025 which shows that there are differences in pain scale before and after the Murotal Al-Quran is concluded.It can be concluded that Murotal Al-Quran can reduce pain and anxiety in maternity when I was an active phase. It is expected that midwives can improve services through the development of midwifery care, especially for women who experience severe pain.