Pain Relief In Labour Research Articles

A Meta-analysis of the Effect of Aerobic Exercise during Pregnancy on Maternal Labor Pains

Objective: Systematically evaluate the effect of prenatal aerobic exercise on maternal labor pain.Methods: Systematic search: Cochrane Library, Embase, Web of science, PubMed, China Biomedical Database, China Knowledge Network (CNKI), Wanfang Data Knowledge Service Platform, Wipu.com, etc., and the time limit of the search was from the establishment of the library to June 2024, and randomized controlled trials (RCTs) related to the purpose of the study were collected and included by the after 2 researchers independently screened the literature, extracted information and evaluated the risk of bias of the included studies, RevMan5.3 software was applied to analyze the data. Results: A total of 10 RCTs were included, including 1144 cases of labor. Meta-analysis showed that prenatal aerobic exercise was effective in relieving labor pain level throughout the entire laboring process, with an MD [95% CI] of -1.80 [-2.75,-0.84], (P<0.05), when compared with the control group. However, the effect was not significant in relieving 3-4 cm of uterine opening and when the uterine opening was more than 4 cm. Conclusion: Current evidence suggests that prenatal aerobic exercise relieves labor pain levels throughout labor, but is not significantly effective in relieving uterine opening of 3-4 cm and 4 cm or more. Due to the limitations of the number and quality of included studies, the above conclusions need to be verified by more high-quality studies.

Effect of traditional Chinese medicine therapy on labor pain in patients with natural childbirth: A network meta-analysis.

This systematic review compared the efficacy of traditional Chinese medicine (TCM) treatments for outcomes of different stages and labor pain among pregnant women. Eight databases were electronically searched for TCM on labor pain between January 2012 and January 2022. The studies were recorded and screened according to inclusion criteria and subsequently entered in Note Express. The quality of the included studies was evaluated using the Cochrane risk of bias tool, and network meta-analysis was conducted with Stata 16.0. Forest plots and league tables were used to compare different treatment modalities' effect sizes. Additionally, the probabilities of various treatment modalities for each outcome under the cumulative ranking curve were determined. The protocol was registered in PROSPERO (CRD42022336091). This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Thirty articles encompassing 3277 participants were included in the network meta-analysis with 9 different treatment modalities. In terms of pain of labor at 30 minutes, acupuncture + autonomic nerve block was the most effective treatment modality. With regard to the 60-minute pain and the first stage of labor, acupressure + acupuncture therapy was most effective. In general, a combined treatment with acupressure and acupuncture is the most effective approach for relieving labor pain and shortening the duration of labor. Based on these data, we intend to explore further clinical TCM therapy for relieving maternal pain.

Knowledge Perception and Utilisation of Labour Analgesia Among Antenatal Clinic Attendees in a Tertiary Centre in Makurdi, North-Central Nigeria

Abstract Background: Labour pain management forms an integral part of modern obstetric practice. Despite the availability of various forms of obstetric analgesia in Nigeria, reports indicate poor knowledge, awareness, and utilisation of labour analgesia among the obstetric population. Objective: To determine the knowledge, perception, utilisation, and factors affecting utilisation of labour analgesia among antenatal clinic attendees at the Federal Medical Centre (FMC), Makurdi. Materials and Methods: This was an analytical cross-sectional study conducted among 421 consecutively consenting antenatal patients in the Department of Obstetrics and Gynaecology at the FMC, Makurdi, between March 1 to July 31, 2023. Data were collected using an interviewer-guided questionnaire, analysed using Statistical Package for Social Sciences (SPSS) version 20.0, and results were presented in textual form and tables. Results: About 47% (199) of the study participants perceived labour pain as the worst possible pain. Only 18.3% (77) of the study participants were knowledgeable about labour analgesia, while just 6.4% (27) of the study participants had ever used it. On multiple logistics regression, the knowledge of labour pain relief (adjusted odd’s ratio [aOR] 0.090, CI = 0.038−0.215, P < 0.001) and mode of previous delivery (aOR 0.292, CI = 0.114−0.750, P < 0.011) were the factors affecting the utilisation of labour analgesia among study participants. Conclusion: There is poor knowledge and utilisation of labour analgesia among antenatal patients. Incorporation of labour analgesia into existing protocols and enhancing health education on labour analgesia as part of antenatal health talks can create awareness of labour analgesia among antenatal patients.

Gonadotropins combined with and without 100mg Clomiphene Citrate drug on ovulation induction and role of epidural analgesia in pregnancy outcome of infertility women.

Successful ovulation induction can overcome the common condition of infertility associated with ovulatory dysfunction. Monotherapy of clomiphene citrate (CC) or combined with gonadotrophins are the best treatment modalities for ovulation induction with a successful outcome. We concentrated on evaluating the effects of 100 mg Clomiphene Citrate, both with and without gonadotrophins, on ovulation induction and the outcome of labor analgesia in women with infertility. This prospective cohort consists of 136 women with infertility who were medicated with 100 mg of clomiphene citrate alone and 100 mg of clomiphene citrate with gonadotropins. We recorded the endometrial thickness, details of the dominant follicle, and the incidence of a positive pregnancy rate. Women with positive pregnancy were managed with epidural labor with labor analgesia to relieve labor pain and evaluated the foetal outcome. In CC alone, the ovulation rate was 57%, while in CC with gonadotrophins, it was 81%. The mean dominant follicle size and endometrial thickness were high in CC with gonadotrophins (p < 0.05). The overall incidence of positive pregnancies was 28.98%. Levobupivacaine with dexmedetomidine significantly reduced the mean VAS score from baseline, resulting in a higher foetal body weight. Taking 100 mg of Clomiphene citrate with gonadotropins works better than taking Clomiphene citrate by itself at starting ovulation, increasing the size of the dominant follicle, and improving the thickness of the endometrium. With levobupivacaine plus dexmedetomidine, the labor analgesia showed better stability in hemodynamic parameters and effective control on labor pain scores.

Role of lumbar puncture level on the onset of epidural labor analgesia: a randomized controlled trial.

To compare the speed of achieving painless uterine contractions in parturients undergoing epidural analgesia at different lumbar puncture levels. This study is a randomized controlled trial at a tertiary A hospital with a history of over 80years in Sichuan Province, China. Parturients aged 22-40years old scheduled for vaginal delivery under epidural analgesia were recruited. Eligible patients were randomly allocated into lumbar 2-3 (L2-3) or lumbar 3-4 (L3-4) groups. Epidural analgesia was performed through the interspaces according to grouping. The primary outcome was the percentage of painless uterine contractions 15min after the initiation of analgesia. The secondary outcomes included the percentage of painless status at 5 and 10min, sensory block plane, motor block evaluation, adverse events of parturients, epidural analgesic consumption, Apgar score, and the parturients' evaluation of analgesia. Between April 2023 and August 2023, a total of 150 women were finally recruited, and 136 of them were analyzed (68 in each group). In comparison with the L3-4 groups, there was a significantly larger proportion of painless uterine contractions at 5, 10, and 15min after analgesia initiation in the L2-3 group (20.6% vs. 7.4%, 52.9% vs. 26.5%, and 80.9% vs. 64.7%, P = .026, .002, and .034, respectively). Similarly, the pain scores were lower in the L2-3 group at 5, 10, and 15min than that in the L3-4 group (5(4,7) vs. 6(5,7), 3(2,5) vs. 4(3,6), and 2(1,3) vs. 3(2,5), P = .006, .004, and .020, respectively). Furthermore, puncturing through the L2-3 interspace contributed to a higher evaluation of parturients to the analgesia procedure (9(8,9) vs. 8(8,9), P < .001). However, there was no significant difference in sensory block, motor block, or adverse events between the two groups. Puncturing through the L2-3 interspace is associated with faster pain relief and a better experience for parturients. These findings present a superior option for anesthesiologists when conducting epidural labor analgesia. Key messages What is already known on this topic? Epidural analgesia is an effective way to relieve labor pain. What this study adds? Puncturing via lumbar 2-3 interspace induces more rapid onset of epidural analgesia. How this study might affect research, practice or policy? Lumbar 2-3 interspace is a superior option in terms of the speed of pain relief and satisfaction of parturients when conducting epidural labor analgesia.

Effective Epidural Analgesia during Labor: A Feasible Method to Decrease Unnecessary Cesarean Deliveries in Thailand

Thailand has reported a high rate of cesarean delivery (45%–55%), prompting global concern about an increase in cesarean delivery rates. Fear of labor pains is one of the most common reasons pregnant women opt for cesarean delivery. Labor pain is associated with cervix dilation and fetal descent into the birth canal, which is exacerbated by ischemic pain caused by uterine contraction. Modern medical and non-medical techniques have demonstrated efficacy in reducing pain and ensuring safety during labor and delivery. Neuraxial labor analgesia is a highly effective medical pain relief method but has no effect on the rate of cesarean or assisted vaginal delivery. Medication administration for pain relief during labor, using a combination of a local anesthetic and an opioid, was observed to be transmitted across the placenta to the fetus, but had no significant effects on fetal outcomes in mothers who chose epidural analgesia. There are several techniques for administering neuraxial labor analgesia that can be customized for each pregnant woman. To achieve the most wonderful feasible labor and delivery experience, effective epidural labor analgesia is a crucial technique for reducing anxiety and suffering about labor pain. It is safe, widely used world-wide, and effective. Implementing a policy to increase public and medical providers awareness and acceptance of labor pain relief, as well as establishing a safe obstetric anesthesia service provided by obstetric anesthesiologists, could improve maternal and neonatal safety while significantly lowering the rate of unnecessary cesarean deliveries.

Effectivity of Walking Epidural Analgesia in Normal Labor to Reduce Labor Pain and Improve Neonatal Outcome

Background: In Indonesia itself, only 15% of 2,700 labor women felt the pain was tolerable, meanwhile 85% said the pain was moderate until unbearable. Usage of epidural anaesthesia for pain relief in labor is common but controversies still persist about its effect and side effect on labor process. Neuraxial block especially epidural also not yet well known in Indonesia.Objective: This research aims to study maternal visual analogue scale (VAS) score changes before and after walking epidural anesthesia (WELA) and fetal outcome after birth. Methods: This research is an experimental design with one pre-test and post-test group. Data was taken from Unggul Karsa Medika Hospital and Permata Hati Clinic medical records from 2017 until 2022. Ethical approval was approved by Unggul Karsa Medika Hospital Ethical Committee (003/KEP-LIT/III/2023). After that all of 450 patients’ data was then analyzed by Wilcoxon with IBM® SPSS Statistic 26th with α=0.05.Result: Statistical analysis shows there was significant decrease of pain severity with initial VAS 7.58 to 3.37 after WELA procedure (p 0.0001). APGAR scores of all the foetus were normal with no asphyxia present.Conclusion: Our findings demonstrate the benefit of WELA for both of mother and fetus. was significantly decrease in VAS score during labor. Fetal outcome was also notably great after labour process and usage of epidural could decrease the risk of fetal acidemia and distress which reduce caesarean section rate. Usage of WELA in Indonesia could be encourage and recommended as an alternative to elective caesarean section.

“…We never considered it important…”: a qualitative study on perceived barriers on use of non-pharmacological methods in management of labour pain by nurse-midwives in eastern Tanzania

BackgroundA significant number of women experience labour without effective pain management and thus suffer from unbearable labour pain to the extent they term labour as the most agonizing event in their lives. Unresolved labour pain can lead to stress, fear, and confusion, which may compromise placental perfusion and lead to birth asphyxia. Although various pharmacological and non-pharmacological labour pain management methods exist, the use of non-pharmacological methods (NPMs) to manage labour pain has remained low in low-resource settings. This paper explored the barriers for using NPMs to manage labour pain by nurse-midwives in eastern Tanzania.MethodsWe conducted an exploratory qualitative study with 18 nurse-midwives purposefully recruited from the labour wards of two selected district hospitals in eastern Tanzania. Qualitative content analysis guided the data analysis.ResultsTwo categories illustrating barriers to using NPMs were generated: individual-level and institutional-level barriers. Individual-level barriers include (i) limited competencies of nurse-midwives on the use of NPMs for managing labour pain, (ii) inadequate exposure to labour pain management practices, (iii) misconceptions about labour pain relief, and (iv) a lack of opportunities for knowledge acquisition. The institutional barriers include (i) a critical staff shortage amidst many clients and (ii) an unfavourable healthcare facility environment.ConclusionThe implementation of NPMs for labour pain management by nurse-midwives in eastern Tanzania faces several institutional and individual barriers. We recommend addressing both supply- and demand-side barriers. Strengthening nurse midwives’ competencies in NPMs adoption and use and improving the facility environment to ensure privacy during labour can be a starting point for addressing supply-side issues. We recommend dispelling myths and misconceptions through health promotion education to address demand-side barriers.

Education of Birth Ball Training as Therapy to Relieving Labor Pain

Labor pain arises because of the mother's physical and psychological response. Emotions become unstable due to anxiety and fear which worsen the condition of labor pain. The pain experienced by the mother during labor can give rise to fear which makes her anxious and often leads to panic attacks. This condition causes a physiological response that can disrupt the condition of the uterus when it contracts so that the impact of labor will last a long time. Usually, the mother who is about to give birth will find it difficult to adjust to the conditions of labor pain, so that uterine contractions cannot be controlled which causes the first stage to lengthen and the fetus to be disturbed. A prolonged labor process is a type of birth complication that is worrying, complicated, and unpredictable. A non-pharmacological method that can reduce labor pain is birth ball therapy. Research that has been conducted has found that birth ball exercises affect reducing labor pain. PkM is implemented through educational activities where there are 30 PkM participants. The results of the PkM implementation show that the PkM participants have been successfully educated through this PkM activity so that they can apply birth ball exercises to reduce labor pain in mothers. Due to the implementation of this PkM activity, it is hoped that there will be an increase in the knowledge of midwives who play a role in initial level services to provide appropriate steps in dealing with labor pain in mothers using complementary therapy, and birth ball exercises.

Comparative efficacy of opioid and non-opioid analgesics in labor pain management: A network meta-analysis.

Effective labor pain management is crucial for parturient well-being, as it can improve the delivery experience of pregnant women and reduce anxiety and tension. This systematic review and network meta-analysis compared the efficacy and safety of various analgesics, classified by drug category and individual treatment methods, for labor pain control. A comprehensive literature search was conducted in Pubmed, EMBASE, Cochrane Library, and Web of Science databases. All searches commenced from the database's inception to the date of the literature search (May 31, 2023). The Cochrane Risk of Bias 2 tool assessed study bias risk. Network meta-analyses using a random-effects model and odds ratios (ORs) with 95% confidence intervals (CIs) were performed. Fifteen randomized controlled trials evaluating analgesic interventions in ASA I or II parturients were included. Combination therapies (OR: 5.81; 95% CI, 3.76-7.84; probability: 60%) and non-opioid analgesics (OR: 5.61; 95% CI, 2.91-8.30; probability: 39.2%) were superior to placebo for labor pain relief. Specifically, dexmedetomidine/ropivacaine/sufentanil (OR: 7.32; 95% CI, 2.73-11.89; probability: 40.6%) and dexmedetomidine/ropivacaine (OR: 6.50; 95% CI, 2.51-10.33; probability: 11.9%) combinations, bupivacaine/fentanyl and ropivacaine/sufentanil combinations, and remifentanil monotherapy showed improved analgesic efficacy versus placebo. Dexmedetomidine/ropivacaine reduced parturient nausea and vomiting versus alternatives. Non-opioids, opioids and combinations thereof effectively relieved labor pain. In addition, dexmedetomidine/ropivacaine combination demonstrated analgesic efficacy and lower nausea and vomiting incidence.

'Giving birth on a beach': Women's experiences of using virtual reality in labour.

Birth is a normal physiological process, and many women want a natural birth. Women use a range of non-pharmacological pain relief methods to reduce labour pain intensity, to help manage labour pain and to induce relaxation. The purpose of this study was to explore the experiences of women using Virtual Reality as a non-pharmacological method of pain relief in labour. Virtual Reality has been shown to be an effective distraction technique in other acute pain settings which also reduces anxiety. This study conducted qualitative in-depth interviews postnatally with women who used Virtual Reality in labour. Thematic analysis was used to analyse the qualitative data. Nineteen women used Virtual Reality in labour. Results from interviews with nineteen women in the postnatal period identified three main themes: impact of virtual reality on experience of labour, managing the pain of labour and challenges of using virtual reality in labour. This study identified that Virtual Reality was effective as a relaxation technique and helped in pain management by the use of self-efficacy techniques. Women in this study also identified preferred virtual environments specifically to use during labour and birth. This study provides a unique and original contribution to the field of Virtual Reality in labour and birth. It also identifies Virtual Reality as an acceptable and positive experience in the management of anxiety and labour pain.

A community evaluation of post-partum quality of life using a locally adapted mother-generated-index: the Delhi Delivery Care (DELCARE) Survey (2009-2011)

ABSTRACT Post-partum quality of life is an inadequately studied and poorly understood outcome of delivery care, especially in low- and middle-income countries. Hence, we evaluated the postpartum quality of life and its clinic-demographic context as part of a 3-stage cluster randomized community survey (DECLARE; covered quality of care as primary outcome) conducted in 2009–2011 in Delhi. In stage 1 of participant selection(sampling), 20 wards (of 150; geographically defined administrative units) were selected using a probability-proportionate-to-size systematic method. In stage 2, one from each income stratum (high, middle, and low; multiple colonies within each ward) was selected from each ward by simple random sampling (total 60 colonies of 2311). In stage 3, a house-to-house survey was conducted to recruit ~1800 recently delivered women for the multidimensional work, which included quality-of-care, cost-of-care, and PPQOL. Among the participants, those with high school or above education were invited to administer the Mother-Generated Index and calculate the primary and secondary index scores (PIS and SIS). A total of 794 (of 857 eligible; 118846 households) women were administered MGI. The mean PIS was 4.6[95 percent CI 4.4–4.7] while the average SIS was 4.0[95 percent CI 3.8–4.2]. The PIS was worse for primiparous vs. multiparous mothers. On multivariate analysis, poorer psychological state, obstetric complications, and premature delivery correlated with poorer QOL scores, while better gestational weight gain, higher age, and labor-pain relief correlated with better QOL scores. The study benchmarks the poor status of post-partum quality-of-life and documents the spectrum, severity, and complexity of its key social, psychological, physical, and demographic determinants.

Method of non-drug pain relief during childbirth

In modern obstetrics it is possible to regulate pain perception during childbirth. There are methods of both drug and non-drug pain relief during childbirth. Up to 25–30 % of women characterize labor pain as severe and excessive. Adequate labor pain relief provides psychological comfort and eliminates stress caused by pain. After labor pain, many women experience depression, decide to terminate the next pregnancy, or (up to 30 %) request a caesarean section without medical indications. Pain relief during labor is one of the priorities in obstetric care.

USE OF STERILE WATER FOR INJECTION IN THE MANAGEMENT OF LABOR PAIN: A RANDOMIZED CONTROLLED TRIAL

Objectives: The objectives of the study are to assess the efficacy of sterile water for injection (SWI) in reducing labor pain, compare it with a saline procedure, and see which one is superior. Parameters assessed were pain relief based on the numeric pain rating scale (NPRS) and duration of labor from intervention to delivery associated with administration of subcutaneous SWI versus normal saline injection (NSI). Methods: This is a prospective randomized interventional hospital-based comparative study of mothers who were in active labor with back pain and undergoing treatment in the labor room of Eden Hospital, Medical College and Hospital, Kolkata. The study was conducted on 66 willing pregnant mothers, divided into two groups of 33 each with one injected with normal saline and the other with sterile water. Results: The NPRS score was almost equal in 2 groups at 15 min, but with an increase in duration, it was seen that the score was low in the sterile water group compared to the normal saline group. The association was statistically significant (p&lt;0.05). Conclusion: This study hypothesized that subcutaneous SWI for relieving labor pain is better than subcutaneous NSI. Based on this study, it is concluded that both the SWI and NSI reduce labor pain, but the SWI produced a significantly greater reduction of pain as measured by the numeric pain rating score and also better satisfaction. Therefore, SWI is a safe, simple, and cost-effective method and can be used as a pain-relieving method, especially in the absence of other pain-relieving options.

Dexmedetomidine improves mitophagy and pyroptosis through the ALKBH5/FUNDC1 axis during epidural-related maternal fever

PurposeEpidural analgesia has emerged as a commonly used method for relieving labor pain. However, epidural-related maternal fever (ERMF) is characterized by a high occurrence rate and can have detrimental consequences for the well-being of both the mother and the fetus. This study aimed to investigate the functional role and underlying mechanism of dexmedetomidine (DEX) in ERMF. Materials and methodsRopivacaine (ROP)-induced human umbilical vein endothelial cells (HUVECs) were treated with DEX and/or transfected with ALKBH5 or FUNDC1 overexpression plasmid. qPCR and Western blot were adopted for mitophagy and pyroptosis marker protein detection. Autophagosomes were observed through electron microscopy, Caspase-1/PI double-positive cells were determined using flow cytometry. Inflammation-related factors were quantified using ELISA. The N6-methyladenosine (m6A) modification of FUNDC1 mRNA was examined using methylated RNA immunoprecipitation (MeRIP) and the binding between ALKBH5 and FUNDC1 mRNA was confirmed by RNA immunoprecipitation (RIP). ResultsIn ROP-induced HUVECs, there was a significant upregulation in ALKBH5 and FUNDC1, resulting in a notable increase in inflammation, pyroptosis, and mitophagy. The administration of DEX demonstrated the ability to alleviate ROP-induced pyroptosis and promote protective mitophagy. Interestingly, DEX treatment significantly reduced the interaction between ALKBH5 and FUNDC1 mRNA, while simultaneously increasing the m6A level of FUNDC1 mRNA in ROP-treated cells. Moreover, the overexpression of FUNDC1 partially reversed the effects of ALKBH5 overexpression on mitophagy and pyroptosis in HUVECs. ConclusionsDEX can promote mitophagy and inhibit pyroptosis through the ALKBH5/FUNDC1 axis in ERMF, indicating its potential as a therapeutic strategy for clinical ERMF treatment.

Combined spinal-epidural analgesia for labour pain relief: a narrative review

Combined spinal-epidural analgesia for labour pain relief: a narrative review

Nitrous Oxide Use for Pain in Labor, Conversion to Neuraxial Analgesia, and Birth Outcome.

A variety of labor pain management options is essential to patients and their care providers. Inhaled, patient controlled nitrous oxide (N2O) is a valuable addition to these options. The purpose of this study was to examine laboring patient, newborn, and provider characteristics associated with N2O use for pain relief in labor and to examine the association between N2O, conversion to neuraxial analgesia, and cesarean birth. This was a retrospective observational cohort study of the first year of N2O use in one large academic medical center. Patients at least 37 weeks' gestation who were admitted for labor with intended vaginal birth from August 1, 2018, to June 30, 2019, were included (N = 2605). Laboring patient and newborn factors and their relationship to N2O use were calculated as unadjusted and adjusted relative risks (RRs). Poisson regression was used to model the association between N2O use and subsequent use of neuraxial analgesia and type of birth for both nulliparous and multiparous patients. Overall, 20.2% of patients used N2O during labor. Multiparous patients were 24% less likely to use N2O than nulliparous patients (RR, 0.76; 95% CI, 0.69-0.84). Use of N2O did not differ significantly between patients cared for by midwives compared with patients cared for by physicians (RR, 0.95; 95% CI, 0.90-1.00). In multivariable modeling, N2O use in multiparous patients was associated with a 17% decrease in use of neuraxial analgesia (RR, 0.83; 95% CI, 0.73-0.94). There was no association between N2O use and use of neuraxial analgesia in nulliparous patients (RR, 0.99; 95% CI, 0.93-1.06). N2O use was not associated with cesarean birth in either group. N2O is an important pain management option for laboring patients and those who care for them. Study results may assist midwives, physicians, and nurses in counseling patients about analgesia options.

Pain control and neonatal outcomes in 211 women under epidural anesthesia during childbirth at high altitude in Qinghai, China.

High altitudes are characterized by low-pressure oxygen deprivation. This is further exacerbated with increasing altitude. High altitudes can be associated with reduced oxygenation, which in turn, can affect labor, as well as maternal and fetal outcomes. Epidural anesthesia can significantly relieve labor pain. This study aimed to assess the effects of elevation gradient changes at high altitude on the analgesic effect of epidural anesthesia, labor duration, and neonatal outcomes. We divided 211 women who received epidural anesthesia into groups according to varying elevation of their residence (76 in Xining City, mean altitude 2,200 m; 63 in Haibei Prefecture, mean altitude 3,655 m; and 72 in Yushu Prefecture, mean altitude 4,493 m). The analgesic effect was assessed using a visual analog scale (VAS). Labor duration was objectively recorded. The neonatal outcome was assessed using Apgar scores and fetal umbilical artery blood pH. VAS scores among the three groups did not differ significantly (p > 0.05). The neonatal Apgar scores in descending order were: Xining group > Haibei group > Yushu group (p < 0.05). The stage of labor was similar among the three groups (p > 0.05). Fetal umbilical artery blood pH in descending order were: Xining group > Haibei group > Yushu group (p < 0.05). Elevation gradient changes in highland areas did not affect the efficacy of epidural anesthesia or labor duration. However, neonatal outcomes were affected.

The Benefits and Barriers of Providing Non-Pharmacological Pain Relief to Women in Labour during COVID-19: A Qualitative Study of Midwives in South Africa

Pregnancy is an exceptional event in a woman’s life. As a result of the intense pain associated with childbirth, women require encouragement and support during this crucial phase. Midwives play a crucial role in the maternal care paradigm, managing labour pain alongside ensuring the mother and baby’s safety during the labour process. This study explored midwives’ perspectives concerning the utilisation and barriers of non-pharmacological labour pain reduction methods during COVID-19 in Matjhabeng Municipality hospitals in South Africa’s Free State Province. Ten midwives participated in a semi-structured interview wherein the audio was recorded and transcribed verbatim. The data were analysed using Tesch’s approach for open-coding data analysis. Midwives’ experiences with non-pharmacological therapeutic options for relieving labour pain were varied. They used mobilisation techniques, warm bathing, deep breathing exercises, back massaging, and psychological support. Midwives affirmed that non-pharmacological labour pain interventions were poorly implemented because of staff shortages, heavy workload, and COVID-19 regulations at the time. In efforts to address the obstacles in managing labour pain and alleviate the pain of women during labour, midwives recommended the provision of education and advocacy, the employment of additional midwives and auxiliary staff, and improvement in hospital infrastructure. Due to staff shortages, heavy workloads, and COVID-19 restrictions that limit birth companions, non-pharmacological pain reduction methods are not properly implemented. Health education; employing additional midwives, professional doulas, and students; and improving health infrastructure are midwives’ concerns. Prioritising midwife training in non-pharmacological labour pain management is crucial for delivering the best possible care during childbirth.

Pharmacological labour pain interventions: South African midwives’ perspective

BackgroundWomen of childbearing age feel great about giving birth, but the pain could be excruciating depending on their pain tolerances. Midwives requires obstetrical knowledge and skills such as pain management during labour and safety. We explored midwives’ perspectives on the utilisation of pharmacological pain alleviation interventions during labour in selected hospitals in Matjhabeng Municipality, Free State province, South Africa. A qualitative study was undertaken, involving a sample of ten midwives, using a semi-structured interview guide. The interviews were audio-recorded and transcribed verbatim. Tesch’s open coding data analysis method was applied to analyse the data. The midwives were restricted to use Pethidine and Phenergan prescribed by doctors for labour pain relief, which disrupted labour pain management and obliged them either to wait for a physician or follow telephone instructions. According to the midwives, women taking Pethidine and Phenergan encountered adverse effects and discomfort. Midwives identified high workload, inadequate personnel, lack of skill and knowledge, lack of medication availability, and lack of infrastructure as the primary challenges of administering pharmacological methods to women in labour. The lack of standing orders, which delays the administration of medications pending a physician’s prescription, constituted an additional difficulty. In the instance that Pethidine and Phenergan were unavailable or ineffective for some women, the midwives recommended that women be administered alternative pharmacological pain relievers. They also advocated for institutionalization of pharmacological guidelines allowing them to use their discretion when treating labour pain. Midwives can only utilise a few standardised and regulated pharmacological medications for labour pain management. The midwives’ ability to administer pharmacological pain relief during labour was hampered by a high workload burden, insufficient staff, lack of skill and understanding, drug unavailability, and inadequate infrastructure. Midwives advocated for supported guidelines that would allow them to treat labour pain at their discretion. Intersectoral stakeholders are required to improve midwife skills and attitudes. Health facilities need to train and supply analgesics to midwives. Midwives ought to be familiar with pharmacological pain relievers.