Stillbirth labour pain still matters: an anaesthesiology call to action for parent-centred care.

Labor contractions play an important role in childbirth but can also cause severe pain in the lower back and abdominal area, radiating to the thighs. Appropriate efforts are needed to reduce the pain caused by these contractions. This quasi-experimental study aimed to determine the effect of using a peanut ball in a straddling position on pain levels during the first stage of labor. Before the intervention, most respondents experienced severe pain, whereas after the intervention, most reported a decrease in pain levels. The results showed a p-value of 0.001, which means that the use of a peanut ball in a straddling position is effective in reducing contraction pain during the first stage of labor.

Computerized gravimetric control of parenteral analgesic admixtures: A retrospective quality improvement study.

Neuraxial labor analgesia (NLA) has long been considered a risk factor for cesarean and vacuum delivery. We aim to investigate if, as suggested in the literature, these adverse outcomes are rather associated with a dystocic painful labor prompting an NLA request. This community-based cohort study was conducted from January 2010 to March 2023 in a Baby Friendly Hospital which supports physiological childbirth. Nulliparous women who received NLA (n = 1905) were divided into 2 groups according to whether they chose to request NLA a priori (before experiencing labor pain; AP group, n = 395) or in labor (after experiencing labor pain; IL group, n = 1510). A descriptive analysis of the sample was performed. The primary outcome was mode of delivery. A multinomial logistic regression model was used to assess in-labor request as a possible predictor of vacuum extraction and cesarean delivery, considering maternal age, height, and BMI as confounders. Groups differed in median maternal age (31 vs 30years AP vs IL, respectively P < 0.001) and neonatal weight (3195 vs 3270, P < 0.007). The risk of cesarean delivery was higher in the IL group (RRR 2.35; 95% CI 1.70 to 3.23; P < 0.001), while that of vacuum extraction was comparable between the two groups (RRR 0.81; 95% CI 0.53 to 1.21; P = 0.293). The higher incidence of cesarean delivery in the IL group compared to the AP group suggests that many women asking for NLA in labor have underlying risk factors for cesarean delivery: the relationship between NLA and cesarean delivery might not be causal. The association with vacuum remains less clear.

Approximately 30% of women experience low back pain when in labour. Large placebo-controlled trials conducted in high-resource settings have demonstrated the efficacy of sterile water injections (SWI) to manage back pain in labour. The procedure has also been endorsed by influential international clinical guidelines. However, the effectiveness and acceptability of the procedure amongst women in low-resource settings such as Ghana, where access to any analgesia may be limited, has not been explored. Investigating the clinical utility of SWI, assessing effectiveness and acceptability, is essential for determining its potential benefits for birthing women in this low- and middle-income country (LMIC). A non-randomised quasi-experimental study was conducted. Women in labour at term with self-reported back pain chose either a treatment with SWI or standard care. Participants in the SWI group received intradermal injections of sterile water, 0.1 mL, four points bordering the lumbo-sacral region (Michaelis' Rhomboid). Self-reported back pain scores using a Visual Analogue Scale (VAS) were obtained prior to and following treatment up to 120min after the injections for both groups. The difference in VAS score between groups was analysed using a multilevel repeated-measure analysis. Secondary endpoints included women's satisfaction with the intervention and maternal and neonatal birth outcomes. During the study period, 73 women were enrolled, 51 choosing SWI and 22 standard care. There was no difference between the two cohorts in self-reported back pain prior to treatment. Women who received SWI reported a significant reduction at 30min (95% Confidence Interval (CI) -98.29 to -88.60; p < .001) in VAS scores compared to women opting for standard care at all time points (10, 30, 60, 90, and 120min). The maternal satisfaction survey, conducted with the intervention group, indicated that over 90% of participants were satisfied with their treatment experience and were willing to recommend SWI to others. SWI was clinically effective and acceptable to women birthing in Ghana, who reported satisfaction and endorsement. There was a strong association between SWI and a reduction in labour back pain with no adverse effects recorded during the study period. This study was prospectively registered with the Pan African Clinical Trial Registry with the identification number PACTR202307748580298 on 28th July 2023. Prospectively registered.

Current research primarily concentrates on acute and chronic postpartum pain, while sub-acute pain after childbirth (SAPC) remains a significant but often under-recognized health concern. We determined if pain and psychological vulnerabilities, obstetric factors, and analgesic choices were associated with the development of SAPC. We included women with singleton pregnancy. Pain and psychological vulnerabilities were assessed using validated questionnaires (Angle Labor Pain Questionnaire (A-LPQ), Central Sensitization Inventory (CSI), Edinburgh Postnatal Depression Scale (EDPS), Fear Avoidance Components Scale (FACS), Pain Catastrophizing Scale (PCS), Perceived Stress Scale (PSS), State Trait Anxiety Inventory (STAI)). The primary outcome of SAPC, defined as having postpartum pain lasting for ≥4 weeks, was followed up at 6 to 10 weeks postpartum with online survey. Of the 881 patients recruited, 816 completed the postpartum follow-up, with 99 (12.1%) patients having developed SAPC. Having higher CSI score (adjusted odds ratio (aOR) 1.03, 95%CI 1.01-1.04), increased number of pain relief administrations (aOR 1.55, 95%CI 1.23-1.95), use of artificial rupture of membrane and oxytocic for labor induction (aOR 2.72, 95%CI 1.51-4.91), greater volume of blood loss during delivery (every 10-mL increase; aOR 1.02, 95%CI 1.01-1.03), having had third-degree tear during delivery (aOR 4.12, 95%CI 1.28-13.27) and greater infant weight (aOR 1.15, 95%CI 1.02-1.30) were independently associated with greater risk of SAPC. The use of prostin for labor induction was protective against the risk of SAPC (aOR 0.56, 95%CI 0.34-0.93) (Area under the curve (AUC) = 0.73). Our center's multivariable model demonstrates moderate predictive performance and may inform the future development and refinement of predictive tools to identify patients at increased risk of SAPC, thereby supporting more timely monitoring and early interventions for postpartum pain management. This study was registered on clinicaltrials.gov registry (NCT03167905) on 30/05/2017.

Awareness, attitude, and anticipated willingness to use labor analgesia: a single-center antenatal survey study from a tertiary referral center in Saudi Arabia (2024).

Auricular acupressure with five-element music therapy reduces labor pain and short-term postpartum depression: A randomized controlled trial.

Childbirth preparation classes aim to equip expectant parents with knowledge and skills for a smoother labor process. This study evaluated their effects on labor pain, duration, and neonatal outcomes. This retrospective cohort study involved 240 primiparous women, with 120 attending at least four classes and 120 not participating. The classes comprised eight sessions conducted by certified midwives at Ayatollah Rouhani Hospital in Iran (2018-2019). Data were collected through questionnaires, clinical observations, and medical examinations. Pain severity was assessed using the Visual Analogue Scale (VAS). The intervention group reported significantly lower pain intensity during the late first stage of labor (mean ± SD: 8.21 ± 2.36 vs. 8.69 ± 1.75; p < 0.001) and the second stage (7.69 ± 3.08 vs. 8.37 ± 2.36; p < 0.05). No significant differences were observed in the durations of the first (219.09 ± 131.46 vs. 235.03 ± 138.73 min; p = 0.36), second (37.00 ± 26.10 vs. 42.77 ± 31.82 min; p = 0.12), or third stages (6.58 ± 4.49 vs. 7.07 ± 4.54 min; p = 0.40). Neonatal outcomes showed no significant differences. Women in the control group had nearly Seven times higher odds of experiencing pain scores above 5 during late first-stage labor. Childbirth preparation classes effectively reduce labor pain but do not significantly impact labor duration or neonatal health. Given the importance of promoting natural delivery, expanding such educational programs is recommended to enhance maternal adaptation and overall labor experience.

Mapping fear of childbirth and the role of family support in pregnant women: A network approach.

Labor analgesia as stigma, uncertainty, and conditional privilege: a thematic analysis of online Q&A posts in Japan.

The effect of a brief audio-guided self-hypnosis intervention on fear of childbirth during normal delivery: A non-randomised controlled trial.

Median effective dose (ED50) of intrathecal ropivacaine for labor analgesia initiation in nulliparous vs. multiparous women: an up-down sequential allocation study.

Abstract Background: labor divided into three stage, stage one cervical dilated from ( 0-10cm), stage 2 the fetal head begin to descend causing perineal distention and activating somatic nociceptive pathway and stage three the delivery of the placenta, Pethidine is narcotic opioid analgesic pregnancy category C drugs. The aim of the study is to find out if pethidine has a significant role in the vaginal delivery (reducing pain and assistant cervical dilation). Method: prospective cohort study from Saad Abo Alella University Hospital and Soba University Hospital including 385 delivered women ,317 didn’t take pethidine and 68 took it. Results: the severity of labour pain reduced in group given pethidine. The number of contraction was increased comparing before and after pethidine, 56% (2 contractions per 10 minute before giving pethidine) and 74% (3 contractions per 10 minute after giving pethidine). The number of cases converted to section in group of pethidine was 21% compared to 11.7% in group without pethidine. Time consumed in stage 2; for group without pethidine 36.3% (8–20 min) and pethidine group 36.8% (21–45 min). Pain severity decreased significantly after pethidine administration (p &lt; 0.05), while the rate of cesarean section increased compared to placebo. Conclusion: pethidine reduce the severity of pain and increase the number of contraction but on the other hand increased the length of stage 2 compared to the group without pethidine and also increased the incidence of those referred to cesarean section.

Background: Epidural obstetric analgesia is the standard of care for labor pain relief; however, its impact on neonatal cerebral oximetry remains debated. Objective: We aimed to evaluate whether epidural analgesia modifies cerebral regional oxygen saturation (CrSO2), measured by near-infrared spectroscopy (NIRS), in term neonates from low-risk deliveries. Methods: We conducted a prospective comparative observational cohort study, including 48 term newborns: 25 delivered under epidural analgesia (EA) and 23 without epidural analgesia (NE). CrSO2 was monitored using NIRS (INVOS 5100C, Somanetics/Medtronic, Troy, MI, USA; OxyAlert NIRSensor Cerebral/Somatic Infant–Neonatal Sensor CNN/SNN) during the neonatal transition up to 15 min after birth (primary outcome), and its relationship with neonatal well-being parameters (umbilical cord pH, Apgar score, and other analytical and obstetric indicators) was explored. Results: Median CrSO2 at 15 min was 79.52 [76.40–82.64] in the EA group and 78.65 [74.21–83.09] in the NE group. Both groups exhibited a similar temporal pattern characterized by a progressive increase, a peak at 10 min, and stabilization by 15 min. Mean (SD) CrSO2 in EA/NE were: 2 min, 57.64 (14.8)/60.04 (14.4); 5 min, 79.56 (10.9)/79.39 (12.2); 10 min, 82.28 (8.1)/81.13 (9.7); 15 min, 79.52 (7.6)/78.65 (10.3). No significant between-group differences were detected at any time point using a linear mixed model (p-values: 2 min, 0.57; 5 min, 0.96; 10 min, 0.66; 15 min, 0.74). Conclusions: These findings indicate that epidural obstetric analgesia does not alter cerebral oximetry parameters in term neonates from low-risk deliveries during the early transitional period.

Effect of virtual reality on labor pain, comfort, and satisfaction: A randomized controlled trial.

Childbirth is a major life event with complex physical and psychosocial consequences. This study examined how women's childbirth experiences are constructed in Chinese social media narratives and identified key themes and emotional patterns across different modes of delivery. We conducted a cross-sectional content analysis of 17,783 childbirth-related posts from Weibo and REDnote. Latent Dirichlet allocation (LDA) was used to extract topics, and a pre-trained Chinese BERT model was fine-tuned for three-class, sentence-level sentiment classification; model performance was evaluated using accuracy, F1-score and AUC-ROC. LDA identified six main themes, with "vaginal birth process and pain experience" and "emotional meanings and family value of childbirth" accounting for the largest proportions. Negative emotions substantially outweighed positive ones and were particularly concentrated in vaginal birth narratives, whereas caesarean section and postpartum recovery posts were more neutral and informational. The integrated LDA-BERT approach achieved good performance (AUC-ROC = 0.89), supporting the robustness of sentiment estimates. Childbirth narratives on Chinese social media present a predominantly negative yet "bittersweet" emotional profile, with marked differences between vaginal and caesarean experiences. These findings underscore the need for tailored perinatal interventions, including individualized labour pain management, strengthened psychological support and more nuanced online health communication.

BACKGROUND Labor pain triggers robust hypothalamic-pituitary-adrenal-axis activation, releasing adrenocorticotropic hormone (ACTH)/cortisol that fuels systemic inflammation and predicts postpartum depression (PPD). Although epidural ropivacaine is standard in China, adding the κ-agonist butorphanol may synergistically block pain and restrain this neuroendocrine stress response, offering a novel strategy to protect maternal mental health. AIM To investigate the effects of the combined use of butorphanol and ropivacaine on the plasma levels of ACTH and cortisol in patients undergoing labor analgesia as well as the incidence of PPD. We also compared the incidence of adverse reactions between the two groups. This study aimed to evaluate the regulatory effects of drug combinations and their side effects on the stress response of pregnant women, providing a basis for clinical intervention. METHODS Between June 2020 and June 2023, 114 pregnant women were randomly divided into study and control groups, with 57 participants in each group. The research group received a combination therapy of butorphanol and ropivacaine, whereas the control group received a combination therapy of sufentanil and ropivacaine. All participants received combined spinal epidural anesthesia to alleviate delivery pain. The Visual Analog Scale was used to assess the pain levels at different timepoints. We compared the incidence of adverse reactions and evaluated the incidence of PPD in the delivery room at 2 hours, 1 day, and 7 days postpartum using the Edinburgh Postnatal Depression Scale. Venous blood samples were collected using a fully automated chemiluminescence analyzer to measure ACTH and cortisol. RESULTS The Visual Analog Scale scores of the study group were significantly lower than those of the control group at all timepoints (P &lt; 0.05). In addition, the Edinburgh Postnatal Depression Scale scores of the study group on days 1 and 7 postpartum were significantly lower than those of the control group (P &lt; 0.05), indicating a lower risk of PPD in the study group. There was no significant difference in 24-hour neonatal behavioral neurological assessment, 1-minute Apgar score, and total treatment cost between the two groups of newborns (P &gt; 0.05), and no respiratory depression was observed. The incidence rates of adverse reactions were 5.26% and 17.54% in the study and control groups, respectively. Two hours after delivery, both groups showed a decreasing trend in ACTH and cortisol; however, the levels in the study group were significantly lower than those in the control group (P &lt; 0.05). CONCLUSION The combination of butorphanol and ropivacaine for labor analgesia can significantly reduce pain scores in women and lower the risk of postpartum pain. Additionally, it reduces the incidence of adverse reactions without compromising the safety of both the mother and newborn. This effect may be attributed to the synergistic analgesic effects of the drugs, neuroendocrine regulation, and the improved psychological and physiological conditions of the mother.

Postpartum pain and urinary incontinence (UI) are the most common postpartum sequelae, which can lead to postpartum anxiety and depression when severe, and seriously affect the quality of life of postpartum mothers. Floating needle (FN) is one of the Chinese medical treatments of the latest in recent years, and studies have shown that FN for postpartum pain and stress urinary incontinence has a positive effect; this study aimed to comprehensively and critically evaluate the available evidence on the effectiveness of FN in managing postpartum pain and UI, and provide the first evidence-based medical evidence for FN intervention for postpartum sequela. Computerized retrieval of Chinese databases (CNKI, Wanfang, VIP, and CBM) and English databases (PubMed, Embase, Web of Science, and Cochrane Library) for randomized controlled trials on FN therapy for postpartum pain and UI was conducted up to December 20, 2023. Search terms included "floating needle," "urinary incontinence," and "labor pain." Data extraction and quality assessment were performed on eligible studies. Meta-analysis was conducted using RevMan 5.4, with mean differences (MDs) for continuous outcomes and risk ratios for dichotomous endpoints. A total of 1194 women were included in 8 articles in both Chinese and English, all of which were conducted in China; 6 of the articles were included in the meta-analysis. The FN is more effective in treating postpartum incontinence and pain than the control group (risk ratio = 1.33, 95% confidence interval [CI] = 1.18-1.5, P < .001), and significantly reduced the International Consultation on Incontinence Questionnaire-Short Form score (MD = 1.56, 95% CI = 0.78-2.35, P < .001); FN therapy can significantly reduce the amount of urine leakage in postpartum patients (MD = 1.79, 95% CI = 1.09-2.49, P < .001). Our results suggest that FN therapy could be encouraged as one of the routine treatments for postpartum sequelae.

Childbirth is a unique and significant experience in every woman's life. A negative childbirth experience, often due to difficult labor, can adversely affect a mother's feelings toward her baby and their subsequent relationship. Massage, a non-pharmacological pain relief method involving coordinated manipulation of soft tissues by hand, aims to alleviate pain and enhance comfort. This ancient technique is widely used during labor and has demonstrated effectiveness in reducing both the intensity and duration of labor pain. This study aimed to compare the effects of two massage methods-rotational effleurage massage and connective tissue massage (CTM)-on pain intensity and labor outcomes. The study subjects in the two intervention groups received effleurage massage and connective tissue massage, but the control group did not receive any intervention and only routine labor care was provided to them. This quasi-experimental, multicenter study was conducted on 90 pregnant women (gestational age 38-40 weeks) admitted in labor at three hospitals. Participants were selected through convenience sampling and randomly allocated into three groups of 30 using permuted block randomization within each center. Although random allocation was performed, due to the multicenter design and non-probability sampling, the study is more accurately classified as quasi-experimental. Written informed consent was obtained from all participants. Data collection tools included a demographic and obstetric questionnaire, the McGill Childbirth Satisfaction Questionnaire, a visual analogue scale for pain, and a labor evaluation checklist. Statistical analyses were performed using SPSS software version 22 (IBM Corp., Armonk, NY, USA). In this randomized clinical trial, 90 primiparous women were randomly assigned to three groups: effleurage massage, Connective tissue massage, and control. The interventions were performed during the active phase of labor (4-10cm cervical dilation). Pain intensity was measured using the Visual Analogue Scale at different dilation stages: 3-4cm, 5-6cm, 7-8cm, and 9-10cm). Pain intensity significantly decreased in both intervention groups compared to the control group at all stages of the active phase of labor (p < 0.001). At 7-8cm dilation, the mean pain scores were 6.13 ± 0.94 in the effleurage group, 6.23 ± 0.77 in the connective tissue massage group, and 7.87 ± 0.86 in the control group (p < 0.001). Effleurage massage demonstrated greater efficacy than connective tissue massage in reducing pain during the later stages of active labor (p < 0.05). Effleurage massage was more effective than connective tissue massage in reducing pain intensity during active labor. Integrating effleurage into maternity care as a non-pharmacological method may improve maternal comfort and support positive birth experiences.