Pain Relief In Labour Research Articles

Preliminary Findings and Outcomes Associated With the Use of a Continuous Spinal Protocol for Labor Pain Relief Following Accidental Dural Puncture

(Reg Anesth Pain Med. 2019;44:1098–1103) Anesthesiologists vary in their management of accidental dural puncture (ADP) and associated postdural puncture headache (PDPH). Possible interventions following ADP include the insertion of a spinal catheter or the administration of intrathecal normal saline. While each of these interventions has been studied alone, combining them into a single continuous spinal protocol for labor pain relief has not been evaluated. This study aimed to compare the outcomes after an ADP of using a standardized continuous spinal protocol versus resiting the epidural catheter.

Generalizability of Randomized Trials of the Programmed Intermittent Epidural Bolus Technique for Maintenance of Labor Analgesia: A Prospective Single-Centre Cohort Study

(Br J Anaesth. 2019;123:e434–e441) Neuraxial analgesia is the most widely used labor pain relief method, and patient-controlled epidural analgesia (PCEA) used in combination with a low-dose continuous epidural infusion has been shown to boost patient satisfaction while also increasing the volume of local anesthetics that are used. Researchers who have conducted randomized controlled trials (RCTs) have shown that substituting a programmed intermittent epidural bolus (PIEB) in place of PCEA can decrease local anesthetic consumption, but it is unclear if the maternal motor block in this method has a negative effect on labor progression. Because RCTs are almost always conducted on healthy nulliparous women, their results cannot easily be applied to the variety of patients seen in daily clinical practices. Gabriel and colleagues conducted their study on epidural labor analgesia data in order to compare the maternal motor function of RCT-eligible nulliparous women to parous women who are usually considered RCT-ineligible.

Importance of neuroaxial methods of analgesia in modern obstetric practice

The aim of the study is a comparative evaluation of the efficacy and safety of ultra-low-dose spinal analgesia, epidural and paravertebral analgesia to labor pain relief. Material and methods . Four groups of 40 women took part in the study: one group is 40 patients, the labor pain was relieved by epidural analgesia, The second group consisted of 40 women in labor, anesthesia was carried out with ultra-low-dose spinal analgesia, 3rd group is 40 women who were anesthetized with paravertebral analgesia.The control group is 40 patients without anesthesia. The parameters of central hemodynamics were monitored: heart rate, blood pressure, mean arterial pressure. The motor block was estimated on the Bromag escale. The dynamics of the opening of the cervix, the duration of the first and second stages of labor was estimated. Implications and negative influence of the anesthesia, the effect of analgesia on the fetus were also registered. Findings . Epidural analgesia showed high efficiency and safety, but the frequency of hypotension in this group was significantly higher than in other groups, an increase in the positivity of the exacerbation period was found. Ultra-low-dose spinal analgesia also had a sufficient analgesic effect in the first stage of labor. However, short-termeffect did not always provide effective analgesia of the second period of labor in comparison with other methods. In general the advantages of paravertebral analgesia in the form of a significant acceleration of cervical dilatation and a decrease in the time of delivery are revealed. There were no cases with score of ‘2’ of Bromagescale of a motor block with paravertebral analgesia, while in the epidural group and the ultra-low-dose spinal analgesia isolated cases with a score of ‘1’ and ‘2’ were encountered. Paravertebral analgesia does not result to hypotensionas against other neuro-axial methods of analgesia. Conclusion . Neuroaxialmethods provide a sufficient level of analgesia can reduce anomalies of labor and do not affect negatively the fetus. All presented methods of anesthesia have their place in obstetric anesthesiology. There is the possibility of choosing the most appropriate method of anesthesiain every obstetrical situation.

Cultural conceptions of Women's labor pain and labor pain management: A mixed-method analysis.

We assess American cultural beliefs about labor pain and labor pain management, including stereotypical and disparate beliefs about labor pain of women from different racial groups. Understanding cultural beliefs about labor pain is critical as these beliefs influence experience, interpretation, and treatment of labor pain. We used an online survey with quantitative and qualitative questions about American labor pain beliefs. Participants were recruited and compensated using TurkPrime's Panels during the first week in August 2017 and the last week in May 2018. The completion rate was 76.86 percent (n=214). After screening using quality control items, the final sample included 200 respondents. Qualitative results indicate that 56.5 percent (n=113) of respondents have an accurate understanding of nociceptive/sensory drivers of labor pain, and 55.8 percent (n=63) of those respondents focused on the second stage of labor. However, only two respondents (1%) mentioned non-sensory (i.e., psychological) causes of labor pain - reflecting a lack of cultural knowledge of the biopsychosocial nature of pain. Categorical responses indicate almost all respondents (95%; n=190) believe women have a right to labor pain relief, and the majority believe labor pain has value (68%; n=136) and should be treated medically (87%; n=174). Quantitative results document stereotypical beliefs that women of color experience less labor pain than white women. Belief that there is value in experiencing labor pain and that pain should not be treated medically were both associated with greater racial disparities in beliefs about labor pain severity. Beliefs were not related to respondent sociodemographic identity, suggesting they are American cultural constructs. Future consideration of the influence of dominant American cultural beliefs about labor pain - including misunderstanding of the nature of labor pain and racial bias in expectations of labor pain - on individuals, norms, and structures is expected to improve quality of patient care.

Aromatherapy intervention on anxiety and pain during first stage labour in nulliparous women: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to critically evaluate and summarise all available evidence derived from randomised clinical trials (RCTs) regarding aromatherapy’s effects on labour pain and anxiety relief. Literature search was performed in MEDLINE/PubMed, Cochrane library, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus since their respective inception to January 2019. Additionally, Google Scholar was also searched to explore citations of eligible final studies which were subsequently included in the systematic review. The search strategy used was: (pregnancy or pregnant or prenatal or antenatal or perinatal or maternal) AND (aromatherapy or essential oils or aroma therapy). Per inclusion and exclusion criteria established by the current study, nine RCTs were included in the systematic review. Results from the current study suggested that aromatherapy significantly decreased pain and anxiety in the first stage of labour. IMPACT STATEMENT What is already known on this subject? Several studies have shown aromatherapy’s effectiveness in relieving pain and anxiety for hospitalised patients and on relieving nausea and vomiting for women during pregnancy. Some results have further indicated that aromatherapy was effective in facilitating episiotomy healing and in reducing pain, fatigue and distress. Aromatherapy was also found to play a role in improving maternal moods; reducing post-caesarean pain; and preventing or mitigating stress, anxiety and depression after childbirth. Though most non-pharmaceutical pain management options were considered non-invasive and presumably safe for mothers and their foetuses, their exact efficacies remained unclear due to a lack of high quality evidence. What the results of this study add? This systematic review and meta-analysis summarises all evidence derived from RCTs wherein aromatherapy was performed as a supportive analgesic method during labour. Results of this meta-analysis identified more credible evidence validating that aromatherapy could significantly decrease labour pain both in early active and late active phases. What the implications are of these findings for clinical practice and/or further research? Availability of credible evidence supporting aromatherapy’s effectiveness on reducing physiological and psychological stress during pregnancy and childbirth would be useful, both theoretically and practically, for all stakeholders concerned, such as pregnant women, medicine and midwifery students, midwives, nurses, gynaecologists and health policymakers.

Effect of transcutaneous electrical acupoint stimulation on labor analgesia

To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on labor pain. A total of 151 primiparas who were vaginal delivery were randomized into a TEAS group (76 cases) and a peridural group (75 cases). In the peridural group, peridural blockage was applied to analgesia. In the TEAS group, TEAS was applied at Hegu (LI 4)，Neiguan (PC 6), Jiaji T10~L1 (EX-B 2) and Ciliao (BL 32), disperse-dense wave (2 Hz/100 Hz), 15-50 mA in current intensity. The analgesic time was from 3 cm to completely opening of cervix. The visual analogue scale (VAS) scores were observed before analgesia, after 30, 60, 120 min of analgesia in the two groups. The time of different stages of labor, usage rate of oxytocin, incidence rate of adverse reaction and amount of postpartum hemorrhage were recorded. The newborn's 1 and 5 min Apgar scores were evaluated. The VAS scores showed a downward trend in the two groups after analgesia (P<0.01), and the change of the TEAS group was less than the peridural group (P<0.01). The active phase on the first stage and second stage of labor in the TEAS group were shorter than the peridural group (P<0.01, P<0.05), there was no significant difference in the time of third stage of labor between the two groups (P>0.05). The usage rate of oxytocin and incidence rate of adverse reaction in the TEAS group were 9.2% (7/76) and 2.6% (2/76), which were lower than 34.7% (26/75) and 18.7% (14/75) in the peridural group (P<0.01). There was no significant difference in the amount of postpartum hemorrhage and newborn's 1 and 5 min Apgar scores between the two groups (P>0.05). The analgesic effect of TEAS is inferior to peridural blockage, but TEAS could relieve labor pain to the tolerance, shorten the time of active phase on the first stage and second stage of labor and reduce the use of oxytocin, has mild adverse reaction.

Perceived strategies to reduce traumatic childbirth amongst Iranian childbearing women: a qualitative study

BackgroundPsychological birth trauma (PBT), mainly due to overlooking maternal mental health, is a common and high prevalence public health problem in low-resource settings. Preventing PBT is a good indicator of the realization of human rights in healthcare. This work reports the results of a qualitative study that aimed to identify perceived strategies of PBT prevention among childbearing women in Iran.MethodsWe conducted semi-structured in-depth interviews with 22 mothers with history of traumatic childbirth, two mothers with positive childbirth experience, two spouses, and eight health professionals between April and June 2017. We used purposive sampling method to recruit traumatized mothers, while health experts were selected based on their relevant expertise and experience. Our initial literature review identified eight categories, using which we developed our interview guide and conducted the content analysis approach.ResultsWith the maximum possible purification, we reached 50 thematic codes. The strategies to prevent PBT are generally summarized in four major themes and 13 categories: 1) skill-builder knowledge [Birth preparedness, Mothers’ empowerment in maintaining mental health, Understanding the importance of mental care in maternity services], 2) responsible caregiving [Support loop, Good behavior of the caregivers, Deepening trust, Struggle with medicalization of childbirth, Labour pain relief, Special services for maternal mental health], 3) the alliance of prenatal and antenatal care [Continuity of care, Coordination of prenatal and antenatal caregivers], and 4) reconstruction of the structures [Efficient management, Rebuilding physical structures].ConclusionsThis is a comprehensive approach towards PBT prevention, which can guide future efforts to reduce PBT at the clinical level and open further avenues for future studies. We recommend policy makers to consider the integration of multilevel and multidimensional PBT prevention interventions, simultaneously within maternity care services packages for promotion of mental health.

Pengaruh Pemberian Parasetamol Intravena untuk Mengurangi Nyeri Persalinan Kala 1 Fase Aktif

Background: Labor was a physiological process, labor pain appeared from regularly uterine contraction, cervix distention and pressure to pelvic floor that stimulate free end nerves. Pain labor can influenced the mother, fetus and the progress of labor. There are various of effort to decrease pain labor by pharmacological or non pharmacological. The best therapy must be safe, effective, and minimal adverse effect to mother and fetus.Objective: To evaluate the effect of paracetamol intraveneous for pain relief in active labor versus saline water.Methods: In randomized controlled trial, with single blinded, 66 primigravid in active labor at RSUD Hj. ANNA LASMANAH Banjarnegara and RSUD Banyumas from November 2016 to January 2017. Sampels divided in two groups, paracetamol group (n=33) and normal saline group (n=33). The primary outcome was the efficacy of paracetamol to relief pain. Intensity of the pain measure by VAS (visual analogue scale), pain measured before drug administration, after 30 minutes, at 1, 2, 3, and 4 hours in both groups. The secondary outcomes include the adverse effect to the mother and baby in both group.Results: The reduction in pain score was significantly greater in paracetamol group than normal saline after 30 minutes, 1, 2, 3, and 4 hours after adiministration of the drug (p&lt;0.05). There was no adverse effect to mother and baby in both groups.Conclusion: Paracetamol intravenous statistically significant decreasing mean pain score than normal saline and safe in active labor.Keywords: Paracetamol, analgesia, active phase in labor

Barriers to effective painless labor in developing countries and the remedial measures

Childbirth has been the most controversial subject in the pain management since ages. While there are some proponents which argue that pain is pain, and it’s the physician’s responsibility to relieve it as he does for the kidney pain or even simple headache; while some argue that it is not a pathological process, and that pain associated with labor brings about a stronger and lasting bondage between mother and child. A religious argument has also been presented against it. The introduction of epidural anesthesia revitalized interest in offering pain relief in labor even for prolonged periods. In resource poor countries, it has been looked upon with guarded skepticism. The scarcity of resources and staff, coupled with lack of a nation-wide awareness campaign has been largely responsible for the low practice of this modality in SAARC countries. Apicare Journal has raised this issue at SAARC level with the association of representative bodies of the member countries. This editorial is an attempt to present some insight on the barriers to painless labor and remedial measures in our countries.&#x0D; Key words: Childbirth; Pain, labor; Pain relief; Epidural analgesia&#x0D; Citation: Ali L. Barriers to effective painless labor in developing countries and the remedial measures. Anaesth. pain intensive care 2020;24(6):__&#x0D; Received: 22 November 2020, Reviewed: 22 November 2020, Accepted: 30 November 2020

Knowledge, and use of labour pain relief methods and associated factors among obstetric caregivers at public health centers of East Gojjam\xa0zone, Amhara region, Ethiopia: a facility based cross- sectional study

BackgroundThe study was conducted in public health centers of East Gojjam Zone, Amhara region, Ethiopia. The purpose of this study was to assess knowledge, and use of labour pain relief methods and associated factors among obstetric caregivers in the study setting.MethodsA facility-based cross-sectional study design was conducted from March 1–30, 2018. The study was conducted among three hundred and nine sampled obstetric caregivers. Structured questionnaire was used to collect the data. The data were entered into Epi-data version 4.2 Software for cleaning and exported to SPSS version 23.0 for data analysis. Multivariate logistic regression was carried out for variables with a p-value < 0.25 in bivariate logistic regression to determine significant relationships between the dependent and independent variables. Statistical significance was determined at 95% confidence interval (CI) and p-value below 0.05.ResultThe overall use of labour pain relief methods reported was 34.4%, (30.4% non-pharmacological and 8.4 pharmacological, respectively). More than half of the study participants (54.2%) had adequate knowledge about labour pain relief methods. In multivariate analysis, being a midwifery profession [AOR =2.814, 95% CI = (1.574–5.031)], having positive attitude [AOR = 4.370, 95% CI = (2.523–7.567)], and professionals with a medium level of education [AOR = 3.450, 95% CI = (1.993–5.971)] were factors significantly associated with knowledge of obstetric caregivers about labour pain relief methods. In multivariate analysis, knowledge of obstetric caregivers [AOR = 3.821, 95% CI = (2.091–6.980)], positive attitude of obstetric caregivers [AOR = 2.455, 95% CI = ((1.358–4.436))] and experience of obstetric caregivers [AOR = 2.56, 95% CI = (1.350–4.845) were factors significantly associated with the use of labour pain relief methods.ConclusionIn this study, the overall use of labour pain relief methods by obstetric caregivers was low. Systemic opioid (Pethdine) was reportedly one of the most known pharmacological pain relief methods in this study. Providers’ knowledge, attitude and work experience had shown statistical significance with the use of labour pain relief methods. Task-oriented in- service training is required to fortify obstetric caregivers’ knowledge and attitude towards the use of labour pain relief methods.

Remifentanil patient-controlled versus epidural analgesia on intrapartum maternal fever: a systematic review and meta-analysis

BackgroundIntravenous remifentanil patient-controlled analgesia (RPCA) is an alternative for epidural analgesia (EA) in labor pain relief. However, it remains unknown whether RPCA is superior to EA in decreasing the risk of intrapartum maternal fever during labor.MethodsAccording to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was performed by searching PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from inception to April 2019. All randomized controlled trials (RCTs) investigating the risk of intrapartum maternal fever with RPCA compared with EA alone or EA in combination with spinal analgesia during labor were included.ResultsA total of 825 studies were screened, and 6 RCTs including 3341 patients were identified. Compared with EA, RPCA was associated with a significantly lower incidence of intrapartum maternal fever (risk ratio [RR] 0.48, P = 0.02, I2 = 49%) during labor analgesia. After excluding 2 trials via the heterogeneity analysis, there was no difference in the incidence of intrapartum fever between patients receiving RPCA and those receiving EA. Satisfaction with pain relief during labor was lower in the RPCA group than that in the EA group (− 10.6 [13.87, − 7.44], P < 0.00001, I2 = 0%). The incidence of respiratory depression was significantly greater in the RPCA group than that in the EA group (risk ratio 2.86 [1.65, 4.96], P = 0.0002, I2 = 58%). The incidence of Apgar scores < 7 at 5 min in the RPCA group was equivalent to that in the EA group.ConclusionThere is no solid evidence to illustrate that the incidence of intrapartum maternal fever is lower in patients receiving intravenous RPCA than in patients receiving EA.

Pain management during labor and vaginal birth.

Neuraxial analgesia provides excellent pain relief in labor. Optimizing initiation and maintenance of neuraxial labor analgesia requires different strategies. Combined spinal-epidurals or dural puncture epidurals may offer advantages over traditional epidurals. Ultrasound is useful in certain patients. Maintenance of analgesia is best achieved with a background regimen (either programmed intermittent boluses or a continuous epidural infusion) supplemented with patient-controlled epidural analgesia and using dilute local anesthetics combined with opioids such as fentanyl. Nitrous oxide and systemic opioids are also used for pain relief. Nitrous oxide may improve satisfaction despite variable effects on pain. Systemic opioids can be administered by healthcare providers or using patient-controlled analgesia. Appropriate choice of drug should take into account the stage and progression of labor, local safety protocols, and maternal and fetal/neonatal side effects. Pain in labor is complex, and women should fully participate in the decision-making process before any one modality is selected.

Pharmacologic labour analgesia and its relationship to postpartum psychiatric disorders: a scoping review.

This scoping review aimed to summarize the current literature on postpartum psychiatric disorders (e.g., postpartum depression, postpartum anxiety, postpartum post-traumatic stress disorder) and the possible relationship of these disorders to the use of pharmacologic labour analgesia (e.g., epidural analgesia, nitrous oxide, parenteral opioids) to identify knowledge gaps that may aid in the planning of future research. PubMed, PsycINFO, CINAHL, and EMBASE were searched from inception to November 9, 2018 for studies that included both labour analgesia and the postpartum psychiatric disorders specified above. Two reviewers assessed the studies and extracted the data. Of the 990 identified citations, 17 studies were included for analysis. Existing studies have small sample sizes and are observational cohorts in design. Patient psychiatric risk factors, method of delivery, and type of labour analgesia received were inconsistent among studies. Most studies relied on screening tests for diagnosing postpartum psychiatric illness and did not assess the impact of labour analgesia on postpartum psychiatric illness as the primary study objective. Future studies should correlate screen-positive findings with clinical diagnosis; consider adjusting the timing of screening to include the antepartum period, early postpartum, and late postpartum periods; and consider the degree of labour pain relief and the specific pharmacologic labour analgesia used when evaluating postpartum psychiatric disorders.

Oxycodone for pain management in the latent phase of labour - A pragmatic trial.

Parenteral opioids are used for pain relief in labour but there are little data for oxycodone in this context. The aim of this study was to evaluate the efficacy, foetal exposure and safety of subcutaneous oxycodone in the latent phase of labour. This pragmatic trial included 76 parturients, who received subcutaneous oxycodone for pain relief in the latent phase of labour according to the hospital protocol: an initial dose 0.1mg/kg, and a second dose, 0.05mg/kg, could be administered four hours later. Pain intensity and pain relief were assessed using a numerical rating scale of 0-10. After delivery, blood samples from the maternal and umbilical veins were collected, and plasma concentrations of oxycodone and its main metabolites were quantified using UPLC-MS/MS. The Apgar scores and maternal and neonatal adverse effects were recorded. The foetal exposure at birth was low, the median oxycodone and oxymorphone umbilical vein plasma concentrations were 1.2ng/mL (range 0.21-7.8) and 0.14ng/mL (0-0.26), respectively. Pain scores decreased substantially, from a median pain score of 7/10 before oxycodone to median scores of 5/10 at 30minutes after administration, 5/10 at 60minutes and 6/10 at 120minutes. The median Apgar score was 9 (range 2-10) at 1minute and 9 (6-10) at 5minutes. Maternal adverse effects were mild, and there were no oxycodone-related neonatal adverse effects. Subcutaneous oxycodone provided effective analgesia during the latent phase of labour. Newborn exposure at birth was low, and oxycodone was well-tolerated.

Fentanyl concentration in maternal and umbilical cord plasma following intranasal or subcutaneous administration in labour

BackgroundThe effect that the route of maternal fentanyl administration has on placental transfer of drug to the neonate is not well studied. Plasma concentration ratios are an indicator of fetal exposure, relative to the mother. MethodsA cohort study (n=30) was conducted to measure fentanyl concentrations in maternal plasma, and arterial and venous cord blood, among women administered either intranasal or subcutaneous fentanyl for labour pain relief. Maternal and cord blood samples were collected within 30 min of birth to determine the fentanyl plasma concentration and to assess relative neonatal exposure. Neonatal outcomes were assessed by Apgar scores, need for resuscitation and nursery admission. ResultsThirty paired samples were obtained from healthy parturients with uncomplicated term pregnancies. Highest observed umbilical venous and arterial concentrations were 0.71 ng/mL and 0.56 ng/mL, respectively, and fetal to maternal fentanyl plasma concentration ratios ranged between 0.23 and 0.73, indicating low fetal exposure. While the total intranasal fentanyl dose administered was significantly higher than the subcutaneous fentanyl dose, this did not result in a higher fetal to maternal ratio. All neonates in both groups had 5-min Apgar scores >7, two neonates required short-term stimulation and oxygen (unrelated to fentanyl) and no neonate was admitted to the nursery. ConclusionThis study is the first to examine fetal and maternal fentanyl concentrations after subcutaneous administration. This research supports the safe use of fentanyl for labour analgesia for women.

Sufentanil versus fentanyl for pain relief in labor involving combined spinal-epidural analgesia: a systematic review and meta-analysis of randomized controlled trials

To systematically compare the efficacy and safety of sufentanil versus fentanyl for pain relief in labor involving combined spinal-epidural analgesia (CSEA), a systematic review and meta-analysis of randomized controlled trials targeting parturients requesting labor analgesia was conducted. The primary outcome measure was visual analog scale scores assessed at 10, 15, 30, and 60 min after intrathecal injection. Secondary outcomes included duration of spinal analgesia, incidence of side effects in parturients, and neonatal Apgar scores. Twelve randomized controlled trials, including data from 881 patients fulfilled the inclusion criteria. No clinically meaningful differences in pain reduction after intrathecal injection were found between the two analgesics. Sufentanil extended the duration of spinal analgesia by 25.40 min (95% CI 21.82 to 28.98min; p < 0.00001) compared with fentanyl. The risk for pruritus, nausea, and vomiting among parturients was 82% for those using sufentanil (relative risk 0.82 [95% CI 0.67-0.99]; p = 0.04) and 48% for those using fentanyl (relative risk 0.48 [95% CI 0.29-0.80]; p = 0.005). Both the synthesis results and sensitivity analysis demonstrated no differences in the risk for respiratory depression between parturients using sufentanil versus fentanyl. The neonates in sufentanil group exhibited higher Apgar scores than the fentanyl group 5 min after delivery (weighted mean difference 0.10 [95% CI 0.05-0.16]; p = 0.0002). Existing evidence suggests that compared with fentanyl, sufentanil used for analgesia in combined spinal-epidural during labor is more effective in extending the duration of spinal analgesia, and may be safer for the infant. There was overall low clinical and statistical heterogeneity among the included studies. For all outcomes, variations caused by heterogeneity across trials were acceptable. Thus the findings of this meta-analysis may provide additional evidence for future clinical practices of pain relief in labor involving CSEA. Stronger evidence supporting this conclusion will require data from more high-quality and multicenter randomized controlled trials.

The Effect of Simultaneous Application of Transcutaneous Electrical Nerve Stimulation (TENS) on Specific Lumbar and Acupuncture Points on Labour Pain Relief: A Randomised Clinical Trial

Introduction: Labour pain is among the most challenging experiences a woman could face during life. Non Pharmacological modalities like Transcutaneous Electrical Nerve Stimulation (TENS) are rather new methods, introduced for relieving this pain. Aim: To investigate the effect of concurrent use of TENS application on the labour pain relief. Materials and Methods: This is a double-blind randomised clinical trial study where, a total of 104 eligible pregnant women qualified for normal vaginal delivery. They were randomly divided into four groups treated with Lumbar-TENS or Acupuncture points-TENS as A: both inactive (placebo group), B: Active Acupuncture points TENS, C: Active Lumbar TENS and D: both active. TENS was applied on four points of toraco-lumbo sacral, while Acupuncture points-TENS was applied on Hegu and Sanyinjiao points. The pain scores were evaluated by Visual Analogue Scale (VAS) criteria, four times during the study for each individual. A questionnaire was used to evaluate the final impression of the subjects about the TENS method. The groups were compared using chi-square or Kruskal Wallis test. The trend of pain score over the study time points were assessed using Generalised Estimating Equation (GEE). Results: The mean age of the women were 27.86±5.92 years. There were no significant differences between the groups based on the pain scores over the study periods (p-value=0.588). There was a statistically significant difference between groups for satisfaction about the procedure and the placebo group had the lowest rate of tendency to reuse TENS at the future Labour (74%) compared to the other three groups (93-100%) (p-value=0.046). Conclusion: Lumbar or Acupuncture points-TENS had no significant relieving effects on Labour pain among the participants.

Knowledge and attitude towards pain relief in labor among final year midwifery students: A cross-sectional study

BackgroundPoor attitudes and lack of knowledge about labor pain has long been demonstrated to burden the health professionals, as well as the women. In developing countries, labor analgesia practice is not well established and undermined. Therefore, the aim of this study was to explore final year midwifery students' knowledge and attitudes towards pain relief during labor. MethodsA cross-sectional study was conducted among final year undergraduate midwifery students using structured, and self-administered questionnaire (N = 130). Descriptive statistics were performed. Results were presented using narrations, means and standard deviations, percentage, figure and tables. Univariate analysis was used to assess the association between demographic variables with poor knowledge and attitudes. Resultsof 130 students participated, the majority, 88% of respondents understood that women can feel moderate to severe pain during labor. However, only less than half of the participants had knowledge of labor pain should be relieved. The majority, 70% of students did not have awareness about the methods of labor analgesia. ConclusionsAlthough the majority of final year midwifery students were agreed with women can feel moderate to severe labor pain, almost more than half of the students were not aware of the painless labor in the hospital. Most of the students believed that pharmacological methods of labor analgesia will affect the labor, baby, and mother. Therefore, considerable attention in preservice teaching and training about labor pain and analgesia for midwifery students is recommended.

Effect of epidural labor analgesia on fetal heart rate and neonatal outcome

Introduction: Epidural analgesia does not affect the neonatal outcome as shown in this study by the similar APGAR scores and neonatal intensive care unit (NICU) admissions when compared with normal delivery without epidural analgesia. Aims: This study aims to find the fetal heart rate variability and neonatal outcome in women, who are opting for epidural anesthesia in comparison to women without any pain reliving modality. Subjects and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology at Datta Meghe Institute of Medical Sciences, Wardha, over period of 2 years from September 2017 to August 2019 after taking approval from Institutional Ethical Committee. One hundred women who fulfilled the inclusion criteria were included in the study, 50 women received epidural analgesia for relief of labor pain at =4 cm and 50 women were left for spontaneous delivery. The factors studied were fetal heart rate (FHR) variability and NICU admissions in both the groups. Statistical Analysis Used: SPSS version 19; Chi-square test and Student's t-test. Results: Epidural analgesia was associated with transient fetal heart variability which however was not statistically significant and was comparable with nonepidural group. Conclusions: Epidural analgesia is an effective method of pain relief and it must be an option available to all laboring women. There are no significant effects on FHR variability and does not affect neonatal outcome.

The Safety and Efficacy of Transcutaneous Nerve Stimulation (TENS) in Reducing Vaginal Delivery Labor Pain: Randomized Controlled Clinical Trial

Background: Labor analgesia remains the center of interest for both obstetricians and women. The safety of the traditional pharmacologic analgesics remains questionable due to their potential fetal and maternal complications. Therefore, several non-pharmacological modalities were evaluated for their safety and efficacy to relieve labor pain. Among these methods, transcutaneous nerve stimulation (TENS) gained much concern due to ease of use, low cost and high capacity for women self-titration. The study aims to investigate the efficacy of TENS in reducing labor pain associated with vaginal deliveries, and to determine the factors controlling the response to TENS. Methods: The study was a randomized, controlled clinical trial. A total of 390 women candidates for vaginal delivery were randomly allocated to 3 groups of intervention: paracetamol infusion, TENS, and intramuscular pethidine (130 women per group). The primary endpoint was pain intensity assessed on 10-point VAS scale and women satisfaction. Secondary endpoints included maternal or fetal complications. Results: VAS scores recorded during vaginal deliveries demonstrated a statistically significant reduction in TENS group compared to paracetamol at 15, 30 minutes, 1 and 2 hours, while pethidine arm demonstrated lower scores than TENS group (p Conclusion: TENS is a reliable labor pain analgesic with comparable efficacy and superior safety relative to pethidine. Clinicians should personalize TENS therapy according to women’s BMI and education level for optimized pain control.