Non-pharmacological Pain Relief Research Articles

'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.

Exploring Healthcare Providers' and Women's Perspectives of Labor Companionship during Childbirth: An Interpretative Phenomenological Analysis Study.

A labor companion of choice during childbirth is crucial for improving women's birth experience and confidence to give birth. Labor companions provide various benefits, including enhanced communication, emotional support, non-pharmacological pain relief, and better healthcare. However, little is known about the supportive actions of labor companions with respect to women's needs during labor and birth, as well as healthcare providers' perceptions of labor companions. Therefore, this study was conducted to explore the perceptions of healthcare providers and women regarding labor companions. The study utilized an interpretative phenomenology research design. Data collection involved conducting semi-structured interviews with 14 participants. The sample consisted of mothers, physicians, and nurses, ensuring a diverse range of perspectives. An interpretative phenomenological analysis was conducted for data analysis. Five themes were identified: (a) impact of companionship, (b) benefits for healthcare providers, (c) companion roles, (d) loneliness and alienation of mothers, and (e) challenges of implementation. The findings indicated that the presence of a companion reduces the need for unnecessary medical interventions and eases the workload of healthcare providers. Without a companion, mothers often feel lonely and disconnected during the birthing process. The presence of companions is often hindered by space limitations in delivery rooms, the absence of clear policies, and lack of childbirth education programs for companions. Clear policies, education programs, and adequate space are essential for implementing and promoting labor companionship during childbirth.

The comparison of the effect of non-pharmacological pain relief and pharmacological analgesia with remifentanil on fear of childbirth and postpartum depression: a randomized controlled clinical trial

IntroductionChildbirth may be associated with psychological, social, and emotional effects and provide the background for women’s health or illness throughout their life. This research aimed at comparing the impact of non-pharmacological pain relief and pharmacological analgesia with remifentanil on childbirth fear and postpartum depression.Materials and methodThis randomized clinical trial with two parallel arms was conducted on 66 women with term pregnancy referred to Taleghani Hospital in Tabriz for vaginal delivery during September 2022 to September 2023. First, all of the eligible participants were selected through Convenience Sampling. Then, they were randomly assigned into two groups of pharmacological analgesia with remifentanil and non-pharmacological analgesia with a ratio of 1:1 using stratified block randomization based on the number of births. Before the intervention, fear of childbirth (FOC) was measured using Delivery Fear Scale (DFS) between 4 and 6 cm cervical dilatation. Pain and fear during labor in dilatation of 8 cm were measured in both groups using VAS and DFS. After delivery, FOC was assessed using Delivery Fear Scale (W DEQ Version B) and postpartum depression using the Edinburgh’s postpartum depression scale (EPDS). Significance level was considered 0.05. Mean difference (MD) was compared with Independent T-test and ANCOVA pre and post intervention.ResultsThe mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after the intervention by controlling the effect of the baseline score (MD: -6.33, 95%, Confidence Interval (CI): -12.79 to -0.12, p = 0.04). In the postpartum period, the mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after controlling the effect of the baseline score (MD: -21.89; 95% CI: -35.12 to -8.66; p = 0.002). The mean score of postpartum depression in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group (MD: -1.93, 95% CI: -3.48 to -0.37, p = 0.01). Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N10. Date of registration: 05/07/2022 Date of first registration: 05/07/2022. URL: https://www.irct.ir/trial/61030; Date of recruitment start date05/07/2022.ConclusionThe study results indicated a reduction in FOC and postpartum depression among parturient women receiving non-pharmacological strategies with active participation in childbirth compared to women receiving pharmacological analgesia. Owing to the possible side effects of pharmacological methods for mother and fetus, non-pharmacological strategies with active participation of the mother in childbirth are recommended to reduce the FOC and postpartum depression.

Virtual reality for pain management in hospitalized patients with cancer: A randomized controlled trial.

Hospitalized patients with cancer often experience acute and/or chronic pain. Although virtual reality (VR) has been extensively studied across a wide range of clinical settings, no studies have yet evaluated potential impact on pain management in this patient population. Prospective randomized controlled trial at an urban academic hospital comparing VR against an active control to mitigate moderate-severe cancer disease and treatment-related pain. A total of 128 adult hospitalized patients with cancer (any tumor type) were randomized to 10 minutes of immersive VR distraction therapy or 10 minutes of two-dimensional guided imagery distraction therapy delivered by handheld tablet. Participants in the two arms were similar in age, sex, race, presence of metastatic disease, concurrent pain specialist consultation, and baseline opioid use. Although both groups experienced improved self-reported pain scores (primary outcome), those randomized to VR experienced significantly greater reduction in pain immediately after intervention compared with active control (p=.03). This difference was sustained for 24 hours as well (p=.004). Within-group analysis showed significant improvement in VR arm of pain bothersomeness (p=.05) and general distress (p=.03) as well. Among hospitalized adult patients with moderate-severe pain related to cancer and cancer therapies, VR provided more nonpharmacologic pain relief than active control and this benefit sustained long after conclusion of the intervention. Virtual reality (VR), a developing technology that immerses the user in new environments, has been shown to improve pain in different patient populations. To test the role of VR in improving pain in hospitalized patients with cancer who report moderate-severe pain, we compared the impact of a 10-minute immersive VR intervention to that of a 10-minute two-dimensional guided imagery experience to improve self-reported pain scores. We found that, although both interventions improved pain, VR did so significantly more. Moreover, participants assigned to VR had sustained improvement in pain 24 hours later.

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.

Electric massage chairs reduce labor pain in nulliparous patients: a randomized crossover trial

BACKGROUND: Labor pain varies significantly among pregnant women, ranging from mild to extremely distressing. Non-pharmacologic pain relief methods during vaginal birth are increasingly popular, either as a complement to pharmacologic agents or at times as the primary method of pain relief. Multiple trials have reported that manual or by-hand massage reduces labor pain. The effectiveness of full-body mechanical massage using electric massage chairs on labor pain remains unexplored.OBJECTIVE: To evaluate mechanical massage using electric massage chair on labor pain in nulliparous women.STUDY DESIGN: A randomized counterbalanced crossover trial was conducted in a university hospital in Malaysia from August 2022 to February 2023. Eligible nulliparas in labor with a minimum labor pain score of 5 (0-10 numerical rating scale) were enrolled. Participants were randomized to 30 minutes on the massage chair with mechanical massage followed by 30 minutes on the massage chair without mechanical massage, or the other way around in massage sequence. The primary outcome was change in pain score comparing pain with and without mechanical massage as a paired comparison for the entire trial participants. Secondary outcomes were across arms analyses of maternal and neonatal outcomes. The paired t-test, t test, Mann- Whitney U test, Chi square test and Fisher exact test were used as appropriate for the data.RESULTS: 208 women were randomized; 104 to each intervention. Data was available from 204 participants (103 randomized to massage first and 101 to no massage first). The primary outcome of change in labor pain score (0-10 Numerical Rating Scale, NRS) after massage and no massage (all participants included after crossover, paired t-test analysis) was mean±standard deviation 4.51±2.3 vs 5.38±2.1 mean difference - 0.87 (95% CI -1.14 to -0.59), p<0.001, a significant reduction in pain score after electric chair mechanical massage compared to no massage. On the across randomized arms secondary analyses, labor pain score after their first massage chair session was 4.35±2.52 (randomized to massage first, received massage as initial intervention) vs 5.66±1.73 p<0.001 (randomized to no massage first, received no massage as initial intervention) mean difference -1.31 (95% CI -1.91 to -0.748), a significant reduction after mechanical massage. Other distal maternal outcomes (mode of delivery, labor analgesia, duration of labor and maternal agreement that mechanical massage is effective for labor pain) and neonatal outcomes (Apgar score at 1 and 5 minutes, cord artery blood pH and base excess, and neonatal admission) were not different across randomized arms.CONCLUSION: Mechanical massage using an electric massage chair significantly reduces labor pain, offering a potential non-pharmacologic pain management option during labor.

Nonpharmacological pain relief for labour pain: knowledge, attitude, and barriers among obstetric care providers.

Labor pain is considered the worst pain in a woman's life. Hence, pain control should be essential to labor management at any level. There is scarce information, and there are gaps regarding the knowledge, attitude, and barriers to the utilization of nonpharmacological approaches for pain relief in Saudi Arabia. Therefore, the current study aims to evaluate nonpharmacological pain relief (NPPR)-related knowledge, attitudes, and barriers among obstetric care providers in Najran, Saudi Arabia. A cross-sectional analytical study was performed at maternity departments in Maternal and Children Hospital (MCH), Najran, Saudi Arabia, from April 1 to May 26 2023. The study involved 186 obstetric care providers (OPCs), physicians (19), nurses (144), and midwives (23). A structured self-reported questionnaire was used to collect data and involves five main sections: demographic data, work-related data, nonpharmacological pain relief-related attitude, perceived barriers, and knowledge quiz. The adjusted odds ratio (AOR) along with 95% CI was estimated to determine the factors associated with nonpharmacological pain relief-related knowledge and attitude using multivariate analysis in the binary logistic regression. Over three-quarters (79%) of obstetric care providers had adequate knowledge of nonpharmacological pain relief methods. The majority (85.5%) of the participants had a positive attitude toward NPPR in labour pain management, with the mean scores ranging from 3.55-4.23 for all sub-items. Obstetric care providers acknowledged that patient belief, lack of time, and workload were the strongest barriers to offering nonpharmacological pain relief methods for labour pain 67.6%, 64.5%, and 61.3%, respectively. In binary logistic regression analysis, the in-service training related to nonpharmacological pain relief (AOR = 5.871 (2.174-15.857), p=0.000), (AOR = 3.942 (1.926-11.380), p=0.013) and years of work experience (AOR = 1.678 (1.080-2.564), p=0.019), (AOR = 1.740 (1.188-2.548), p=0.003) were significantly associated with obstetric care providers' knowledge and attitudes regarding nonpharmacological pain relief (p≤0.05). Although most OPCs have adequate knowledge and a positive attitude regarding NPPR, they need motivational strategies to enhance their utilization. In addition, an effort should be made to decrease OPCs' workload to provide more time for NPPR application and patient education. Training courses and in-service training can play an important role in enhancing NPPR knowledge and attitude and, consequently, its application. Also, in each working unit, the policymakers should provide clear guidelines and policies that enhance and control the utilization of NPPR.

Maternal singing reduced pain indexes in 2-month-old infants and increased proximity during vaccinations.

Immunisation is a global health priority, but methods of non-pharmacological pain relief are not widely used in routine clinical practice. In this study, we set out to investigate the effects of maternal singing during the routine vaccination of infants. We recruited 67 mother-infant pairs at Health Centres in the Aosta Region of Italy. Infants aged 2-4 months were randomly allocated to a singing intervention group or to a control group whose injections were administered following standard practice. Pre- and post-immunisation pain was blindly assessed using the Modified Behavioural Pain Scale, and mother-infant proximity indexes were assigned based on muted video-tracks. When assessed for pain, the infants in the maternal singing group were assigned significantly lower movement indexes (p = 0.032) and marginally significantly lower cry indexes (p = 0.076). A higher frequency of mother-to-infant gaze (p < 0.005) was observed in the singing group dyads. Finally, the intervention group mothers' self-perceived ease in singing was correlated with their previous singing experience and with lower anxiety following the vaccination procedure (p < 0.05). Maternal singing during immunisation procedures benefits both mothers and babies. The practice of singing is a biologically rooted and adaptive form of intuitive parental communication that should be encouraged, especially in at-risk populations.

Temperature-Mediated Neural Interventions in Knee Osteoarthritis: a Review of Cryoneurolysis and Cooled Radiofrequency Ablation with Ultrasound Guidance.

Knee osteoarthritis is a debilitating chronic disease affecting nearly half of the world's population at some point in their lives. Treatment of pain and loss of function associated with this disease has been limited. In this review, we seek to explore how neural interventions with ultrasound guidance may be an emerging option for non-pharmacologic pain relief in patients with knee osteoarthritis. Cryoneurolysis techniques have been demonstrated to provide pain relief out to 150days post-treatment in knee osteoarthritis in select individuals. There have also been studies of cryoneurolysis pre-operatively to total knee replacement providing reduced pain, reduced opioid use post-operatively, and shorter hospital length of stay. Cooled radiofrequency ablation (CRFA) has been demonstrated to significantly reduce pain, improve functionality, and reduce pharmacologic needs in knee osteoarthritis out to 2years. Both interventions appear to have increased accuracy with ultrasound, and CRFA appears to be associated with improved patient outcomes. The research demonstrates the efficacy of both cryoneurolysis and cooled radiofrequency ablation in the treatment of knee osteoarthritis. Ultrasound guidance in neurolysis provides an additional tool with real-time, high-accuracy nerve localization. These therapies should be considered for certain patients to assist in pain management in the non-operative and post-operative phase of knee osteoarthritis management. Further research is needed to further define the long-term effects and the long-term utility of the techniques in knee pain.

Childbirth Preparation: Knowledge of the Use of Non-Pharmacological Pain Relief Methods during Childbirth in Tshwane District, South Africa: A Cross-Sectional Study.

Effective management of labour pain is an essential aspect of care provided to women during childbirth. The aim of this study was to assess pregnant women's knowledge of using non-pharmacological pain relief methods during childbirth. Methods: This quantitative descriptive cross-sectional study was conducted at four hospitals in the Tshwane District of South Africa. The sample consisted of 384 pregnant women. Results: The results show that (n = 200, 52.1%) pregnant women lack knowledge regarding non-pharmacological pain relief methods, while a minority (n = 101, 26.3%) had some knowledge, some (n = 73, 19%) were uncertain about these methods and others (n = 10, 2.6%) did not comment. Additionally, most respondents (n = 232, 60%) never received education about the various methods available to manage pain during labour at antenatal care, while others (n = 131, 34%) agreed that they received such education. A significant relationship between the level of education and knowledge about non-pharmacological pain relief methods was noted (p = 0.0082). In conclusion, respondents knew methods such as massage, breathing exercises, movements and birth positions. However, they lacked knowledge of birth companionship, acupuncture, transcutaneous electrical nerve stimulation (TENS), aromatherapy and music. The overall findings revealed that antenatal care services provided by midwives are not effectively preparing pregnant women for pain relief during childbirth.

Non-pharmacological pain relief interventions in preterm neonates undergoing screening for retinopathy of prematurity: a systematic review

ObjectiveThe objective of this review was to determine the efficacy of non-pharmacological interventions for pain management during retinopathy of prematurity (ROP) screening.Methods and analysisElectronic search of Ovid MEDLINE, PubMed, EMBASE,...

Women’s expectations about birth, requests for pain relief in labor and the subsequent development of birth dissonance and trauma

BackgroundBirth is a significant event in women’s lives. As Mansfield notes (2008) many women aim for a birth that avoids pharmacological pain relief because they are advised it is better for them and their baby. For women having their first baby, this may not be realistic as 3/4 of primiparous women in Australia will use pharmacological pain relief. This study examines the expectations that a group of women had regarding pain relief, how these expectations developed and what happened to requests for pain relief in labour.MethodsA longitudinal prospective study design was used to recruit 15 women who were having their first baby. Women having low risk pregnancies, hoping for a ‘natural birth’ (vaginal, no/minimal pharmacological pain relief) were eligible. A semi-structured interview tool was used across all three interviews that asked women about their expectations, then actual labour experience, pain management requests and how these were responded to by carers. Fifteen women were interviewed – at 36 weeks gestation; as soon after delivery of their baby as possible, then six months post-delivery (N = 43 interviews). Interviews were recorded and transcribed and coded by ES using NVivo software with hierarchical thematic analysis used.ResultsThe study found that women appear to experience a mismatch between expectations they had developed pre-birth, versus actual experience. This appears to cause a specific form of dissonance – which we have termed ‘birth dissonance’ leaving them feeling traumatised post birth. This is because what women expected to happen in birth was often not realised. In particular, some women requested pain relief in birth and felt that their request was not responded to as hoped, and also seemed to develop post-birth trauma. We proposed that this may have resulted from dissonance arising from their expectations about being able to birth without significant pain relief. Interventions and technology may also contribute to this sense of mismatch and post-birth trauma.ConclusionsLow risk birthing women birthing in a hospital may have to engage with higher levels of technology, intervention and pain relief than that which they expected pre-birth. This could possibly be avoided with four simple changes. Firstly, better pre-birth education for women about how painful labor is likely to be. Secondly, pre-birth education which includes a detailed explanation of the utility of pharmacological and non-pharmacological pain relief. Thirdly, more egalitarian decision-making during labour and finally delivering upon women’s requests for pain relief in labor, at the time that they ask for it. Further research is required to determine the extent of birth dissonance and how women making the transition to motherhood can avoid it.

Effect of audio-visual therapy on pain and anxiety in labor: A randomized controlled trial

BackgroundBirth pain affects women at a physical and psychological level. Pain is subjective, and perception will vary among individuals depending on their health status, pain tolerance, and psychological state. Labor pain can drastically affect the birth process and delivery outcomes if not managed well, ranging from poor maternal satisfaction and impaired maternal-newborn bonding to prolonged labor and fetal distress. Since pharmacological pain relief methods harm the fetus, non-pharmacological pain relief methods are gaining popularity among laboring women and healthcare professionals. ObjectivesThe study aimed to evaluate the effect of audio-visual therapy on labor pain and maternal anxiety. MethodsA randomized, controlled, open-label, single-center trial was conducted among 76 primigravida women with no obstetrical complications during the active phase of labor (4–8 cm cervical dilatation). The participants were randomly assigned to an experimental group receiving 50 min of virtual reality intervention or a control group receiving standard care using a computer-generated random sequence. The data related to pain and anxiety were collected using the personal information form, anxiety assessment scale for pregnant women in labor, present behavioral intensity scale, numerical pain rating scale, and post-delivery birth satisfaction checklist. ResultsGroups were homogenous in terms of demographic and obstetric variables. The virtual reality intervention reduced the experimental group's reported pain intensity and anxiety score. However, no statistically significant difference was noted in maternal vital signs and labor and neonatal outcomes between the groups. ConclusionThe virtual reality intervention reduced labor pain intensity and anxiety among laboring women compared to standard care.

Effectiveness of technology-based interventions compared with other non-pharmacological interventions for relieving procedural pain in hospitalized neonates: a systematic review.

The objective of this review was to evaluate the effectiveness of technology-based interventions for relieving procedural pain among hospitalized neonates compared with other non-pharmacological interventions. Neonates who require hospital care often experience acute pain during medical procedures. The current best practice for relieving pain in neonates is the use of non-pharmacological interventions, such as oral solutions or intervention-based human touch. Technological solutions (eg, games, eHealth applications, mechanical vibrators) have become more commonplace in pediatric pain management over recent years. However, there is a sizeable knowledge gap concerning how effective technology-based interventions are for relieving pain in neonates. This review considered experimental trials that include technology-based, non-pharmacological interventions for relieving procedural pain among hospitalized neonates. The primary outcomes of interest include pain response to a procedure measured by a pain assessment scale validated for neonates, behavioral indicators, and changes in physiological indicators. The search strategy aimed to identify both published and unpublished studies. PubMed MEDLINE (PubMed), CINAHL (EBSCOhost), Scopus, Cochrane Central Register of Controlled Trials, MedNar, and EBSCO Open Dissertations databases were searched for studies published in English, Finnish, or Swedish. Critical appraisal and data extraction were conducted by 2 independent researchers who adhered to JBI methodology. Meta-analysis could not be performed due to considerable heterogeneity in the studies; as a result, the findings are presented narratively. A total of 10 randomized controlled trials involving 618 children were included in the review. The staff members delivering the interventions and the outcome assessors were not blinded in all of the studies, which introduced a potential risk of bias. The presented technology-based interventions were diverse, including laser acupuncture, noninvasive electrical stimulation of acupuncture points, robot platform, vibratory stimulation, recorded maternal voice, and recorded intrauterine voice. In the studies, pain was measured using validated pain scales, behavioral indicators, and physiological variables. In the studies in which pain was assessed with a validated pain measure (N=8), technology-based pain relief was significantly more effective than the comparator in 2 studies, whereas no statistically significant differences were observed in 4 studies and the technology-based intervention was less effective than the comparator in 2 studies. The effectiveness of technology-based interventions in relieving neonatal pain, either as a standalone method or in combination with another non-pharmacological method, was mixed. Further research is needed to provide reliable evidence on which technology-based, non-pharmacological pain relief intervention is most effective for hospitalized neonates. [http://links.lww.com/SRX/A19].

Knowledge, Practices, and Attitudes of Nurses Regarding Non-Pharmacological Pain Management in the Midwifery Ward

Background and Objectives: Pregnant women are frequently worried about labor pain, and it is usually the most important problem for them and their relatives. Non-pharmacological pain relief methods provide several benefits, such as no harmful effects on the fetus or baby, no interruption of labor, and even being pleasurable for the mother and fetus. The aim of this study was to assess the nurse’s knowledge, practice, and attitude toward non-pharmacological pain management methods in the delivery room in Erbil Governorate. Method: The descriptive cross-sectional design was utilized to determine nurses' knowledge, practices, and attitudes about labor pain and non-pharmacological pain management, as well as to monitor nurses' practices in the delivery rooms during labor and delivery. A total of 78 nurses from public and private hospitals in Erbil Governorate participated in the study. Structured questionnaires and an observational checklist were used to collect data and used SPSS version 26 was used to analyze it. Result: Nurse’s knowledge (N=27, 50.0%), (N=9, 37.5%) in public and private hospitals was at a good level, and they had a positive attitude (N=32, 59.3%) in public hospitals and a positive attitude (N=14, 58.3%) in private hospitals. But had a fair practice (N=19, 35.18%) in public hospitals and good practice (N=10, 41.7%) in private hospitals towards labor pain and non-pharmacological pain management. This is due to the lack of time, inadequate staff and the great workload of the staff. Conclusion: This survey showed that the knowledge of most of the nurses was at a good level, but it was weak in items such as (cold therapy, acupuncture and acupressure technique), as well as majority of them do the following practices: relaxation technique, give psychological support and, ensure that women's relatives are there during the entire labor process; and they do not use other types of non-Pharmacological

Influence of the COVID-19 pandemic on labor and childbirth care practices in Brazil: a cross-sectional study

BackgroundIt has been hypothesized that the coronavirus disease 2019 (COVID-19) pandemic may have changed the conduct of obstetric practices at the time of labor, delivery, and birth. In Brazil, many practices lacking scientific evidence are implemented in this care, which is charcaterized by excessive use of unnecessary interventions. This scenario may have been worsened by the pandemic. Thus, we analyzed the effects of the pandemic on care during prenatal care and delivery by comparing the results of two surveys (one was administered before the pandemic and the other during the pandemic) in public hospitals in Belo Horizonte - Minas Gerais (MG), Brazil.MethodsThis cross-sectional and comparative study analyzed preliminary data from the study “Childbirth and breastfeeding in children of mothers infected with SARS-CoV-2”, which was conducted in three referral maternity hospitals in Belo Horizonte - MG during the pandemic in the first half of 2020 in Brazil. The final sample consisted of 1532 eligible women. These results were compared with data from 390 puerperae who gave birth in the three public hospitals in the study “Birth in Belo Horizonte: labor and birth survey”, conducted before the pandemic to investigate the changes in practices of labor and delivery care for the mother and her newborn, with or without COVID-19 infection, before and during the pandemic. In this research, “Birth in Belo Horizonte: labor and birth survey”, data collection was performed between November 2011 and March 2013 by previously trained nurses. Between study comparisons were performed using Pearson’s chi-square test, with a confidence level of 95%, and using Stata statistical program.ResultsWe found a significant increase in practices recommended by the World Health Organization during the pandemic including the following: diet offering (48.90 to 98.65%), non-pharmacological pain relief (43.84 to 67.57%), and breastfeeding in the newborn´s first hour of life (60.31 to 77.98%) (p < 0.001). We found a significant reduction of non-recommended interventions, such as routine use of episiotomy (15.73 to 2.09%), the Kristeller maneuver (16.55 to 0.94%), oxytocin infusion misused (45.55 to 28.07%), amniotomy (30.81 to 15.08%), and lithotomy position during labor (71.23 to 6.54%) (p < 0.001).ConclusionOur study revealed a statistically significant increase in the proportion of use of recommended practices and a reduction in non-recommended practices during labor and delivery. However, despite advances in the establishment of World Health Organization recommended practices in labor, delivery, and birth, the predominance of interventionist and medicalized practices persists, which is worsened by events, such as the pandemic.

The effect of using maternal voice, white noise, and holding combination interventions on the heel stick sampling

BackgroundHeel stick sampling, a common procedure in newborns, causes acute pain. AimsThis study aims to measure the outcome of five various non-pharmacologic pain relief groups; maternal voice, white noise, holding, maternal voice+holding, and white noise+holding. MethodsThe study is an open label, randomized controlled trial. A total of 178 newborns were included in this study. Newborns were randomly allocated to each group; white noise (n = 31), maternal voice (n = 31), holding (n = 30), white noise+holding (n = 29), maternal voice+holding (n = 28), and control (n = 29) interventions. Newborns' pain responses were evaluated using the Neonatal Infant Pain Scale (NIPS), and the Premature Infant Pain Profile (PIPP). The primary measured outcomes were the newborns' pain levels, while the secondary outcomes were the heart rate and changes in oxygen saturation. The mean values of pain in neonates between groups were evaluated one minute before (Phase1), during (Phase2), and one minute after (Phase3) the procedure. ResultsThe research results are given with comparisons in three time periods (Phase1, Phase2 and Phase3). White noise and white noise+holding were found to have the lowest mean NIPS and PIPP score (p < 0.001). The mean heart rate was found to be the lowest in the white noise+holding group (p < 0.001). There was no significant difference between the groups in terms of oxygen saturation score (p = 0.453). ConclusionThe white noise+holding applied to newborns during heel stick sampling were effective in pain reduction. Nurses and midwives can use white noise+holding method. Implications to practiceThese results contribute to the pain management of newborns.

Nonpharmacological Methods to Reduce Pain During Active Labor in A Real-life Setting.

To evaluate the association between pain intensity in the active phase of the first stage of labor with the use or not of nonpharmacological methods for pain relief in a real-life scenario. This was an observational cross-sectional study. The variables analyzed were obtained by a questionnaire with the mothers (up to 48 hours postpartum) to investigate the intensity of pain during labor using the visual analog scale (VAS). The nonpharmacological pain relief methods routinely used in obstetric practice were evaluated by consulting medical records. The patients were separated into two groups: Group I - patients who did not use nonpharmacological methods for pain relief and Group II -patients who used these methods. A total of 439 women who underwent vaginal delivery were included; 386 (87.9%) used at least 1 nonpharmacological method and 53 (12.1%) did not. The women who did not use nonpharmacological methods had significantly lower gestational age (37.2 versus 39.6 weeks, p < 0.001) and shorter duration of labor (24 versus 114 min, p < 0.001) than those who used the methods. There was no statistically significant difference in the pain scale score using the VAS between the group that used nonpharmacological methods and the group that did not (median 10 [minimum 2-maximum 10] versus 10 [minimum 6-maximum 10] p = 0.334). In a real-life setting, there was no difference in labor pain intensity between the patients who used nonpharmacological methods and those who did not use them during the active phase of labor.

Doula support among brazilian women who attended the senses of birth health education intervention – a cross sectional analysis

BackgroundWhile maternal health is a priority in international goals, maternal health outcomes remain poor in many regions of the world. In Brazil, maternal mortality has decreased over the past decades, but the country’s maternal mortality ratio is higher than over half of all countries at 59 deaths per 100,000 live births. The Brazilian maternal health care model facilitates high rates of medical interventions during labor and childbirth; 56% of births are by cesarean birth. Doula support is considered a potential strategy to reduce medically unnecessary interventions during childbirth that contribute to maternal mortality.MethodsThe cross-sectional study analyses associations with use of doula support and normal birth among Brazilian women who participated in a health education intervention named the Senses of Birth (SoB). The SoB intervention, implemented in five cities from 2015 to 2017, was developed to educate about normal birth and to evidence-based practices (EBP) reduce medically in childbirth. Chi-Square tests were performed to identify the relationship between doula support during childbirth and sociodemographic characteristics, childbirth information, perceived knowledge, and use of EBPs during labor. Logistic regression was performed to identify associations in adjusted analysis.ResultsControlling for covariates, doula support was associated with vaginal delivery (OR 2.47, 95% CI: 1.37–4.45.) Findings also suggest that women who had doula support were more likely to use non-pharmacological pain relief methods during labor (OR 9.68, 95% CI: 2.67–34.61), deliver in a public hospital (OR 2.02, 95% CI: 1.09–3.72), and be low and mid-level income compared to women with high income.ConclusionThis study’s findings suggest that doula support is significantly associated with vaginal birth. The results may be useful for advocating for changes to the childbirth care model in Brazil. Incorporating EBPs, such as doula support, for all women who desire may improve maternal and child outcomes.

Knowledge and Attitude Regarding Non-Pharmacological Pain Relief Methods during Labor among Midwives and Nurses at Madina

Background: Pain during labour is a complicated, multidimensional, and subjective issue that both the expecting mother and the maternity healthcare provider are concerned about. The aim was to assess knowledge and attitudes regarding non-pharmacological pain relief methods during labour among midwives and nurses at Madina. Subjects and Methods: The study employed a quantitative descriptive cross-sectional study design; 158 participants (midwives and nurses) were conveniently selected. The study was carried out in the Labour ward and Antenatal ward at Maternity at Medina and the Child Hospital at Medina hospital from January to February (2022). Data was collected through a self-administered questionnaire. Results: The study revealed that 51.9% of participants had adequate knowledge, while 48.1% had inadequate knowledge. In addition, 60.8% of them have a good attitude. Factors associated significantly with knowledge regarding non-pharmacological pain relief include education, working area, and the profession. In addition, the present study reflects that there is a positive correlation between participants' knowledge of non-pharmacological pain relief and their attitude. Recommendations: Nurses and midwives should be involved in several educational and training courses and attend different workshops, conferences, and seminars on non-pharmacological pain relief during labour. Nurses and midwives should utilize the methods of non-pharmacological pain relief during labour to alleviate the complications of pharmacological pain relief as much as possible. Further studies should be conducted by other researchers to investigate other factors that affect and enhance the level of non-pharmacological pain relief methods. Researchers can also incorporate the domain of practise within their future studies.