ArticleLiterature Review

Complementary and alternative therapies for pain management in labour (Review)

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Abstract

Acupuncture and hypnosis may help relieve pain during labour, but more research is needed on these and other complementary therapies The pain of labour can be intense, with tension, anxiety and fear making it worse. Many women would like to cope without using drugs during labour. Many alternative ways are tried to help, including acupuncture, mind-body techniques, massage, reflexology, herbal medicines or homoeopathy, hypnosis, music and magnets (covered by another Cochrane review) may be used to manage pain. We found evidence that acupuncture and hypnosis may help relieve labour pain. There is insufficient evidence about the benefits of music, white noise, aromatherapy or biofeedback, and no evidence about the effectiveness of massage or other complementary therapies.

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... Bu durum doğum ağrısının yönetiminde TAT kullanımını arttırmaktadır. 13 Bu sistematik inceleme çalışmasında doğum ağrısının yönetiminde non-farmakolojik tekniklerin kullanıldığı 57 araştırmanın bulguları özetlendi. Çalışmada doğum ağrısı yönetiminde yardımcı olabilecek non-farmakolojik teknikler belirlendi. ...
... 2006 yılında yayınlanan bir Cochrane sistematik inceleme araştırmasında akupresürün doğum ağrısının yönetiminde etkinliği hakkında yeterli kanıt olmadığı vurgulanmaktadır. 13 2012 yılında yayınlanan doğum eyleminde ağrı yönetimi konulu ve 2011 yılında yayınlanan doğum ağrısının yönetiminde akupunktur ve akupresür konulu iki Cochrane sistematik inceleme araştırmasında ağrı şiddetinin akupresür grubunda azaldığı ifade edilmektedir. 3,18 Başka bir sistematik inceleme araştırmasında da doğum ağrısını gidermede etkili olduğu belirtilmektedir. ...
... 3,18 Başka bir Cochrane sistematik inceleme araştırmasında akupunkturun doğum sırasında ağrı yönetimi için yardımcı bir teknik olabileceği belirtilmektedir. 13 Bir meta analiz araştırması bulgularına göre akupunktur doğum eyleminde anne memnuniyetini arttırmakta ve epidural analjezi kullanı-mını azaltmaktadır. 21 Akupunktur tekniğinde iğnenin tutulma süresi, akupunktur noktalarının sayısı, iğneleme derinliği gibi geniş bir varyasyon görülmektedir. ...
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ABSTRACT Objective: To summarise the evidence on the efficacy of non-pharmacological interventions to manage pain in labour. Material and Methods: We searched the EBSCOHOST, MEDLINE- Pubmed, ScienceDirect, Wiley Online Library to identify all relevant article of pain management in labour. Total of 2489 full text and 711 abstract related to subject under investigation were reached and of them, 57 were evaluated as part of the study according to inclusion criteria. Results: We included 57 trials with data reporting on 1 025 016 participant. Pain intensity was reduced in the heat-cold therapy, acupressure, massage, TENS, birth ball exercise, sterile water injection, aromatherapy group. There was no significant evidence for pain relief in acupuncture, waterbirth, immersion in water, hypnosis, music therapy, antenatal birth education/class, self-efficacy education and guided imagery techniques group. Conclusion: Non-pharmacological interventions may effective for reducing pain and increasing satisfaction with pain management. Further research is needed on the non-pharmacological interventions for pain management in labour.
... Cualquiera que sea la tipología del bloque obstétrico, las unidades de hospitalización convencional obstétrica se ubicarán preferentemente en el área de hospitalización y tendrán condiciones similares a las unidades polivalentes, si bien se configurarán de forma que, siempre que sea posible, se facilite el cumplimiento de las recomendaciones sobre contacto precoz madre-RN y prácticas posnatales de la "Estrategia de atención al parto normal en el Sistema Nacional de Salud" , especialmente la erradicación de las salas-nido de los hospitales (54). ...
... El bloque obstétrico debe estar bien señalizado y con fácil acceso desde el exterior, tanto para las usuarias y sus acompañantes como para el personal sanitario y los suministros y servicios de soporte, y bien comunicado con las unidades de hospitalización obstétrica y neonatología, así como con las principales áreas de diagnóstico. (54) La utilización de camas de hospitalización con cunas acopladas o sidecar permiten un contacto óptimo y seguro, garantizan la máxima interacción madre-hijo/a y facilitan el establecimiento de la lactancia. ...
... A continuación se incluye una descripción de las principales características estructurales y funcionales de las áreas físicas en que se desarrollan estas actividades, basada en la circulación idónea de las usuarias y en la secuencia de actos realizados en cada uno de los modelos considerados (55) . Este concepto secuencial, esquematizado en los diagramas que se muestran a continuación, deberá ser la directriz del diseño arquitectónico de la unidad, si bien éste, obviamente, se adaptará a las estructuras previas de las que se parta, pero observando en la medida de lo posible los flujos de circulación, que constituyen la base de una unidad bien planificada: (54) Los programas funcionales que aquí se desarrollan incorporan las recomendaciones enunciadas en el epígrafe anterior: ...
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El parto es la causa más frecuente de ingreso en los hospitales españoles. Los 463.249 partos registrados en 2005 en España, representan el 9,1% de las altas hospitalarias. En 2008, la dotación de paritorios en los hospitales españoles era de 742, lo que supone disponer de 1,6 por cada mil partos. La atención hospitalaria al parto se articula alrededor de la maternidad hospitalaria que se define, desde el punto de vista estructural y organizativo, como el espacio en el que se ofrece asistencia multidisciplinar a la mujer, al recién nacido y a la familia en el parto y nacimiento, con locales, instalaciones y equipamiento necesarios para la activi-dad estimada, por parte del equipo multiprofesional, garantizando las condiciones adecuadas de seguridad, calidad y eficiencia, para realizar la actividad. Este documento recoge recomendaciones sobre derechos y seguridad del paciente qui-rúrgico, criterios organizativos y de gestión de la maternidad hospitalaria, elaboradas desde la Agencia de Calidad del Sistema Nacional de Salud con el apoyo de expertos vinculados con asociaciones científicas y al Sistema Nacional de Salud, y en el marco establecido a través de la estrategia del parto normal aprobada en 2007. Estas reco-mendaciones no tienen carácter normativo y su objetivo es poner a disposición de las administraciones públicas sanitarias, gestores, públicos y privados, y profesionales, todos aquellos elementos que contribuyen a la mejora en las condiciones de seguridad y calidad de la maternidad hospitalaria. www.msc.es
... To the best of our knowledge, this is the first systematic review with meta-analysis discussing the effect of music intervention for primiparous women during labour. Our review procedure was based on the guidelines of Preferred reporting items for systematic reviews and meta-analyses (Moher, Liberati, Tetzlaff, & Altman, 2009 Although previous trials have recommended that music intervention may be effective in labour pain, other alternative therapies for labour pain relief such as massage therapy, antenatal education, group prenatal care, acupuncture, mindfulness-based intervention were also proposed (Smith, Collins, Cyna, & Crowther, 2006). The lack of network meta-analysis to verify the efficacy of these alternative therapies challenges the music recommendation. ...
Article
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Aims To determine the effect of music on the management of pain and anxiety in primiparous women during labour. Background Music is cost‐effective intervention in clinical practice to reduce pain, stress and anxiety. However, a systematic review with meta‐analysis for investigating its effects during labour is still lacking. Design A systematic review with meta‐analysis. Data sources MEDLINE, EMBASE and CINAHL databases. Review methods Randomized controlled trials or quasi‐experimental trials concerning the effects of music among primiparous women who were expected to give normal spontaneous delivery were searched and screened up to 31 July 2017. The recruited trials for this review were compliant with the standards of the Cochrane Handbook for Systematic Reviews of Interventions. Results A total of 392 primiparous pregnant women (197 in the music intervention group and 195 in the routine care group) from 5 studies were included in this review. Music as an intervention seemed to lower the pain scores for primiparous women during labour, but the effect was not statistically significant. However, there was a significant benefit of music intervention compared with routine care for primiparous women during labour. In the sensitivity analysis, music intervention showed significant effect on the improvement of pain and anxiety for primiparous women during labour. Conclusion Music intervention may be an effective intervention for the management of pain and anxiety for primiparous women during labour. This article is protected by copyright. All rights reserved.
... As a traditional treatment technique inherited thousands of years, acupuncture has been used for various diseases around the world. Previous meta-analyses and systematic reviews revealed that acupuncture was an effective therapy in treating pain disorders, such as tension-type headache [1], lateral elbow pain [7], labour pain [8], low back pain [9], migraine prophylaxis [10], shoulder pain [11], and peripheral joint osteoarthritis [12]. e systematic reviews from the Cochrane Library conclude that acupuncture is a valuable nonpharmacological tool in patients with frequent episodic or chronic TTH [1,13], and it appears to be effective and safe for TTH [14,15]. ...
Article
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Objectives: This study aimed to explore the characteristics and principles of acupoints, which were applied for treating tension-type headache (TTH). Methods: Four databases were searched for the literature studies of treating TTH with acupuncture and moxibustion up to September 1, 2020. Titles, journals, authors, key words, interventions, main acupoints, and outcomes of the included literature studies were extracted and inputted into the self-established Data Excavation Platform of Acupoint Specificity for analysis. Results: In total, 128 papers containing 137 prescriptions, 89 meridian acupoints, and 7 extraordinary acupoints of treating TTH with acupuncture and moxibustion were included. The total frequency of acupoints' application was 763 times. Fengchi (GB20), Baihui (GV20), Taiyang (EX-HN5), Hegu (LI4), and Taichong (LR3) were used most frequently. The acupoints in Yang meridians were utilized more than those in Yin meridians (66.1% vs. 17.8%), and the acupoints in the Gallbladder Meridian of Foot Shaoyang were applied most commonly. 59.9% (457/763) of the applied acupoints were on the head, face, and neck, and 31.7% (242/763) were on the four limbs. Additionally, the proportion of specific acupoints' application was 78.2% (597/763). Conclusions: The prescription of Fengchi (GB20), Baihui (GV20), Taiyang (EX-HN5), Hegu (LI4), and Taichong (LR3) might be relatively reasonable in clinical practices of treating TTH with acupuncture, which should be verified in further studies.
... In addition, massage is now quite popular among complementary initiatives as it is a low-cost, easy-toapply and effective method that does not require equipment and that does not demand excessive amounts of time for the nurse. Massage is used during labor to provide relaxation, to decrease pain and suffering, to shorten the labor process and to increase the ability of the woman to cope with labor pain Smith, Collins, Cyna, & Crowther, 2006). The results of our study support what is shown in the literature. ...
Article
Aim: Nonpharmacologic pain control methods, which are increasingly becoming widespread in coping with labor pain, are the methods that allow women to completely relax without using any medication and direct them to perceive the pain at the lowest level. This study was conducted to determine the effect of sacral massage on labor pain and anxiety. Methods: This study was conducted as a randomized controlled experimental study at Bağcılar Hospital, Obstetrics and Gynecology Clinic between March and October 2016. In all, 60 women, 30 of whom were in the control group and 30 of whom were in the experimental group, constituted the research sample. The women in the experimental group were administered a massage to the sacral region for 30 min. The questionnaire form, birth action follow-up form, postpartum interview form, visual analog scale (VAS) and state-trait anxiety inventory were used to collect data in the study. Results: The latent phase VAS averages (3.57 ± 1.43), active phase VAS averages (7.03 ± 1.5) and transition phase VAS averages (8.83 ± 1.78) of the experimental group were found to be statistically significantly lower than those of the control group (P < .05). Conclusion: It was concluded that sacral massage applied during labor reduced women's labor pain, lowered the levels of concern and anxiety, led to greater feelings of satisfaction among pregnant women in terms of labor, positively affected the perception of labor and had no fetal side effects.
... 5 One of the violent pain that could be experienced by women is labor, which illustrates both psychological and physiological challenge for women . 6 The most effective method of preparing pain relief during labor or/and delivery in comparison with no analgesia methods and regional analgesic techniques are mainly admitted to be the best usual pain relief methods in such situations. 7 In spite the side effects of aforementioned techniques are generally known, they have internationally applied as they are considered to have an excellence profile of risk/benefit in the absence of alternatives. ...
Article
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Hypnosis in obstetrics is available for more than one hundred years, but the development of inhalational anesthetic and chemotherapy agents and anesthesia drugs pending the 19th century induced the decrement of its application. However, experimental assessment of this type of intervention on labor and delivery in not high yet. For this reason, evaluation of hypnotic techniques in preparing childbirth should be carried out. One of the main unified mind-body healing practices, which has a great remedial potential in different applications of health care like labor and delivery. Assessment of effectiveness of this procedure in various administered trials is not easy, due to methodologic challenges, like normalizing trial conditions and picking up sufficient sizes of sample. Applying techniques of hypnosis for childbirth within hospital settings makes women to easily overcome barriers associated with institutional policies or caregiver resistance. Potential analgesic and anxiolytic clinical hypnosis effects for childbirth deserve more clinical trials. In this regard, nurses who manage women pending labor and delivery could easily enhance their skills and related understandings for contributing to techniques of hypnotherapy.
... It is necessary to minimize the pain caused by the episiotomy and to enable the mother to confront the challenges of motherhood with confidence [6]. The pain after episiotomy is often poorly treated, with insufficient evidence supporting an optimal course of treatment and over 50% of patients reporting pain-related issues after the procedure [7]. Pharmacological treatment is frequently used, but the number of drugs that can be used during lactation is limited because of possible adverse drug reactions in neonates. ...
Article
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Purpose Previously, pain treatment following episiotomy has relied on non-steroid anti-inflammatory drugs as analgesics, whose use during breastfeeding remains controversial due of their transfer to the child. Methods This was a pilot randomized parallel single-center study aiming to evaluate the effects of auricular acupuncture on pain relief after episiotomy. The primary outcome was reduction of pain intensity using visual analogue scale (VAS) scores during the first three postpartum days. The patients were allocated to either of the groups by using a heads–tails binary result coin toss method and the allocation was not masked. The study was completed after including 60 healthy women that underwent mediolateral episiotomy performed during vaginal delivery, with 29 receiving acupuncture therapy and 31 not receiving acupuncture therapy for pain relief. Oral analgesic therapy was made available per request for all patients. Results This study showed that subjective experience of pain was significantly reduced in the acupuncture group on the second and third postpartum days (P = 0.004, P = 0.005, P = 0.22). There were no adverse effects of acupuncture noted. Conclusions Our findings confirm that auricular acupuncture therapy may be a valuable adjunct to analgesic therapy in patients undergoing episiotomy during vaginal delivery. The results prompt a question whether our current ‘best practice’ may yet be improved.
... Cold therapy or cryotherapy as a non-pharmacological intervention has a range of surface application of deep massage with ice on the back, chest, rectum and perineum to reduce labor pain. This method, in addition to relieving pain has a healing effect on muscle spasms, reduces inflammation, and helps to improve tissue edema during labor (12,(21)(22)(23). ...
Article
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Abstract Background: Pain is a common and unavoidable phenomenon in childbirth, and in terms of severity, childbirth pain is among the most severe pains in human. Objectives: The current study aimed at investigating the effect of localized heat and cold therapy on pain intensity, duration of phases of labor, and birth outcomes among primiparous females. Satisfaction was also compared in the two intervention groups. Methods: The current randomized, controlled trial was conducted on 120 primiparous females in three groups (heat/ cold therapy, and control) from September 2015 to January 2016. Intensity of pain, duration of phases of labor, and birth outcomes were measured before and after intervention in the three groups. Satisfaction with localized heat and cold therapy was compared in the two intervention groups. No intervention was conducted in the control group. Data were analyzed using the Fisher exact, Chi-square, the Kruskal-Wallis, and ANOVA tests with SPSS version 19. Results: After intervention, statistically significant difference was found in the average pain severity respectively among the heat therapy, cold therapy, and control groups in dilations of 5 - 6 cm (3.25 � 0.91, 3.57 � 1.14, 4.00 � 1.37) 7 - 8 cm (4.08 � 0.91, 4.88 � 1.05, 4.97�1.17), and 9 - 10 cm (6.00�1.35, 6.40�1.09, 7.80�1.18) in the first and second phase of the labor (6.22�1.13, 7.37�1.08, 7.94�1.08). There was a statistically significant differences in the average duration of first phase of labor, respectively among heat therapy, cold therapy, and control groups (293.70 � 68.97, 368.57 � 79.82, 400.86 � 77.43) and second phases of labor respectively among heat therapy, cold therapy, and control groups (42.85�13.60, 51.71�12.24, 46.85�13.67), but there was no statistically significant difference among the three groups in terms of the average duration of labor in the third phase. No significant difference was observed between heat and cold therapy groups in terms of satisfaction. No significant difference was observed among the three groups in birth outcomes, including the mean first and fifth Apgar scores, time of cuddling newborn, and the first breastfeeding of newborn. Conclusions: Localized heat and cold therapy are non-pharmacological, non-invasive, satisfactory for the primiparous females, and effective methods to control and relieve pain during labor without adverse effects on maternal and fetal outcomes. Keywords: Heat Therapy, Cold Therapy, Pain Intensity, Labor
... 4 Since current pharmacological methods of pain relief do not meet the above-mentioned qualifications, the use of alternative complementary therapies such as massage, music, hypnosis, herbal medicine, relaxation, acupuncture, and acupressure have received special attention. 5 A core tenet of acupuncture and acupressure is that a person's health depends on the balance of energy in the body and the overall energy levels. The hypothesis is that the body's energy flows in channels, called meridians, and these techniques can restore energy balance through the manipulation of these meridians. ...
... objectivent à nouveau une décroissance de la nécessité de soulager la douleur dans les groupes acupuncture (RR=0,70 avec IC à 95% : 0,49 à 1,00 dans 2 ECR de 288 femmes). Cependant, comme Lee et coll., même si les auteurs classent les ECR comme de bonne qualité méthodologique malgré l'absence d'insu non aveugle, ils réclament d'autres études avec une plus grande population et la nécessité d'avoir des essais contrôlés randomisés en double aveugle [10]. D'autres ECR satisfaisant partiellement à ces critères sont parus à partir de 2007 permettant d'avoir une opinion de l'efficacité de l'analgésie dans l'accouchement davantage factuelle. ...
Article
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Résumé : Une des grandes indications de l’acupuncture est l’analgésie. En obstétrique, l’analgésie durant l’accouchement peut être une bonne indication. Mais peut-on la recommander à la lumière de l’acupuncture factuelle ? L’état des lieux des essais contrôlés randomisés de l’acupuncture obstétricale analgésique durant l’accouchement permet de déterminer que l’acupuncture peut être raisonnablement indiquée avec un grade B (présomption scientifique) selon le niveau des recommandations de la Haute Autorité de Santé Française. Mots clés : obstétrique - travail - acupuncture - antalgie - analgésie - ECR - recommandations. Summary: One of the big indications of the acupuncture is the analgesia. In obstetrics, the analgesia during the delivery can be a good indication. But can we recommend it in the light of the evidence-based acupuncture? The inventory of fixtures of randomized controlled trials by the analgesic obstetric acupuncture during the delivery allows to determine that the acupuncture can be reasonably indicated with a grade B (scientific presumption) according to the level of the recommendations of the High Authority of French Health. Keywords: obstetrics - labor - acupuncture - pain relief - analgesia - RTC - recommendations.
... The frequently used descriptive treatment modalities for labour pain can be listed as yoga, meditation, hypnosis, relaxation, imagery and breathing exercises [8]. Rather than being a technique, hypnobirthing can be called a labour philosophy that prepares the pregnant for delivery physically and psychologically. ...
Thesis
maç: Bu çalışmanın amacı, doğum öncesi dönemde verilen hipnoz ile doğum eğitiminin, doğum ağrısı ve korkusu üzerine etkisini belirlemektir. Yöntem: Yarı Deneysel (Tek Gruplu Ön Test-Son Test Tasarımlı) Eğitsel Müdahaleli Çalışma olarak planlanan çalışmanın evrenini; 1 Temmuz- 1 Eylül 2016 tarihleri arasında Eskişehir Devlet Hastanesi Kadın Doğum Polikliniği'ne başvuran 24.-26. gebelik haftaları arasında olan gebeler, örneklemi ise; polikliniğe gelen ve araştırma kriterlerine uyan çalışmaya katılmayı kabul eden gebeler oluşturmuştur. Eğitim grubu için program en az 5 en fazla 10 kişinin katılımı sağlandıktan sonra başlatılmıştır. Eğitim öncesi ve sonrası, eğitimin etkinliğini değerlendirebilmek için ölçek ve soru formları uygulanmıştır. Eğitimini tamamlayıp doğumunu yapan gebeler ile ilk 24 saat içerisinde iletişime geçilmiş ve veri formları uygulanmıştır. Çalışmadan elde edilen verilerin çözümlenmesi; SPSS 22 paket programı aracılığı ile gerçekleştirilmiştir. Bu çalışmada %95 güven ve 0,5 etki büyüklüğü ile 30 gebe ile çalışılması durumunda %100 teorik power değerine ulaşılmıştır (t değeri 2.04523 ve testin gücü (1-β) 1.000 bulunmuştur ). Bulgular: Çalışmaya katılan gebelerin (n=35) yaşları ortalaması 27,43±4,09 yıl (min:20 yıl, max:38 yıl) olarak bulunmuştur. Gebelerin; %14,3'ü hipnozla doğumu duyduklarını belirmişlerdir. Eğitim öncesi gebelerin %48,6'sı hypnobirthing konusunda yetersiz bilgiye, %51,4'ü (n=18) yeterli bilgiye sahip olduklarını göstermişlerdir. Eğitimi tamamlayan bütün gebelerin hypnobirthing bilgi yeterliliği için belirlenen 12,5 puanlık cutt off değerinin üzerinde puan alarak yeterli oldukları belirlenmiştir. Eğitime katılan gebelerin %37,1'i doğuma ilişkin endişeli olduklarını belirtmişlerdir. Endişeli olan gebelerin %53,8'i doğumun riskli olacağı endişesi taşıdığını, %23,1'i doğumhanede neler olacağına dair bilinmezlik yaşadıklarını, %7,7'si bebeğime bakabilecek miyim kaygısı yaşadığını, % 7,7'si erken doğum riski olabilir mi endişesi ve %7,7'si ise ilk gebeliği ile arada uzun süre olmasından endişe duyduğunu belirtmiştir. Eğitime katılan gebeler (n=35) eğitim öncesi doğumhane hakkında; sırasıyla %42,9'u kalabalık, %34,3'ü korkutucu ve %11,4'ü gürültülü olduğunu düşündüklerini belirtmişlerdir. Gebelerin tamamı sırasıyla doğumda yanlarında olmasını istediği kişi olarak; % 62,9'u eşlerini, % 20'si annesi, %11,4'ü abla/kardeşini istemiştir, yalnızca %5,7'si yanında hiç kimseyi istemediğini belirtmiştir. Doğum yapan kadınların %96,7'si hypnobirthing eğitiminin; doğum ağrısı üzerine tamamen etkili olduğunu, doğumda uygulayabildiğini ve rahatlamaya yardımcı olduğunu, %76,7'si huzur ve güven verdiğini, %66,7'si ortama uyum sağlamaya yardımcı olduğunu belirtmişlerdir. "Hypnobirthing'i yakınlarınıza çevrenizdeki kişilere önerir misiniz?" sorununa tamamı evet demişlerdir ve önerme nedenleri olarak sırasıyla; %30'u huzurlu ve bilinçli bir doğum yaptığını, %23,3'si doğumda nefes kontrolünü sağladığını, %20'si rahatlama sağladığını ve %13,3'ü ise ağrılarını azalttığını ifade etmişlerdir. Sonuç: Hypnobirthing konusunda yeterli bilgiye sahip olmak ( ≥12,5 puan); beklenen (WDEQ-A) ve deneyimlenen (WDEQ-B) doğum korkusunu azaltmıştır (p<0,05). Ancak eğitim sonunda yeterli bilgi düzeyine sahip olmak ile doğum memnuniyeti ve doğum ağrısı konusunda anlamlı ilişkiye rastlanmamıştır. Anahtar Kelimeler: Hypnobirthing, doğum ağrısı, ebe, gebelik, tokofobi Aim: The purpose of this study is to determine the effect of prenatal hypnobirthing education, labor pain and fear. Material and Method: This study was planned as Semi-Experimental (Single-Group Pre-Test-Final Test Design) Educational Intervention. The universe of study; Between 1 July - 1 September 2016, Eskişehir State Hospital Obstetrics and Gynecology Clinic, 24-26. pregnancies between the weeks of pregnancy, the sample is; who came to the polyclinic and complied with the research criteria, agreed to participate in the study. For the training group, the program was initiated after a minimum of 5 and a maximum of 10 participants were involved. Scales and questionnaires were applied before and after the training to evaluate the effectiveness of the training. Within the first 24 hours, communication was completed and data forms were applied to the pregnant women who completed their education and gave birth. Analysis of data obtained without working; was carried out in the computer environment via the SPSS 22 package program. In this study, when working with 30 pregnant women with 95% confidence and 0,5 effect size, 100% theoretical power value was reached (t value 2.04523 and test power (1 - β) 1,000) Findings: The mean age of the pregnancies participating in the study (n = 35) was found as 27.43 ± 4.09 years. 14,3% of the pregnant women had heard of birth with hypnosis. 48.6% of pre-education pregnancies showed insufficient knowledge about hypnobirthing, 51.4% (n = 18) had sufficient knowledge. It was determined that all pregnant women who completed the training were more than 12.5 points cut-off value for hypnobarthing competence. 37.1% of pregnant women participating in education stated that they were worried about birth. Of the worried pregnancies, 53.8% thought that they had anxiety about birth, 23.1% had no knowledge about what would happen in the birth room, 7.72% had worry about whether they could take care of their baby, 7.7% (n = 1) worried about the risk of premature birth, and 7,7% worried that it would be too long with the first gestation. Pregnant women participating in the training (n = 35); 42.9% are crowded, 34.3% are scary and 11.4% are loud. As the person to whom the pregnancies want to be in their births respectively; 62.9% wanted their husbands, 20% their mothers and 11.4% siblings / siblings. Only 5.7% stated that they did not want anybody. Of the women who gave birth, 96.7% had hypnobirthing training; that it is completely effective on birth pain, that it can be delivered at birth and helps to relieve, 76.7% gives peace and trust, and 66.7% helps to maintain fit. They said yes to the question "Are you proposing Hypnobirthing to the people in your circle?" and as reasons for proposing, respectively; 30% had a peaceful and conscious birth, 23,3% gave breath control at birth, 20% had relief and 13,3% had "decreased my pain". Results: Having enough knowledge about hypnobirthing ( ≥12,5 score); has reduced the expected (WDEQ-A) and experienced (WDEQ-B) fear of birth (p <0.05). However, at the end of the training, there was no significant relationship between having adequate knowledge level and birth satisfaction and birth pain. Key words: Hypnobirthing, labor pain, midwife, pregnancy, tocophobia.
... The full text of 128 articles was analyzed, of which 109 clinical trials were excluded (see supporting information on TableS1), so a total of 19 reviews were evaluated. Six were excluded for the following reasons: one included studies that only evaluated music in combination with other interventions (18), four did not include music listening studies (19)(20)(21)(22), and one was published before 2004 (23). A final sample of 13 reviews (6,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) was included for quality assessment and analysis (see figure 1). ...
Article
Aim: This study aims to analyze and describe the effects of music listening in the management of pain in adult patients, as reported in systematic reviews and meta-analysis. Methods: A search of articles published between 2004 and 2017 was conducted on Pubmed, ScienceDirect, Scopus, SCIELO, SpringerLink, Global Health Library, Cochrane, EMBASE and LILACS. Search, quality assessment, and data extraction was done independently by two researchers. Results: Most of reviews found a significant effect of music on pain. All analyses had a high heterogeneity, and only acute pain and music delivered under general anesthesia had moderate heterogeneity. No differences were found when music was chosen by the patient. Music type and its characteristics are scantly described and in terms that lack validity. Conclusions: More focused trials and reviews, objective language for music, and trials with music chosen by its characteristics are required.
... Autonomic nervous system controlled the cortisol secretion in massage therapy therefore women experienced significantly less pain when compared with non massage group women. 75 A study was conducted to assess the effect of massage during labour. The study reported that massage during labour can reduce labour pain. ...
... Other methods include a variety of complementary therapies, physiotherapy techniques, the use of herbal medicine, homeopathy, aromatherapy, hypnosis, and music therapy (Sanders and Lamb, 2017;Smith, Collins, Cyna, and Crowther, 2006;Smith et al., 2018). Various physiotherapy methods have been used to relieve labor pain such as relaxation techniques, breathing techniques, electrical stimulation, electroacupuncture, and acupressure (Polden, Mantle, Barton, and Haslam, 2004;Sanders and Lamb, 2017). ...
Article
Background With the global prevalence of COVID-19, general fear has increased along with misinformation and rumors that could affect a pregnant woman's psyche, and her sexual function. Objective This study was conducted to determine the prevalence of sexual dysfunction and related factors in pregnant women during the COVID-19 pandemic. Methods This cross-sectional study was performed on 205 pregnant women. Data collection tools included a sociodemographic characteristics questionnaire and the FSFI, both of which were completed online. Results The mean (SD) of the overall score of sexual function was 21.54 (8.37), and 80% of participants suffered from sexual dysfunction. The results of the adjusted general linear model showed that the variables of spouse's age and occupation, place of residence, and marital satisfaction were significantly statistically correlated with sexual function score. In women whose husbands were under 30 years of age compared with those over 35 years of age, in women living in their parents' homes compared to those living in private homes, and in women with high or extremely high marital satisfaction compared to moderate satisfaction, the sexual function score was higher. Conversely, women whose husbands were blue-collar workers had lower sexual function scores than those whose husbands were white-collar workers. Conclusion It is necessary to consider socio-demographic factors in the treatment and prevention of this sexual function disorders. It is recommended that the appropriate solutions be provided and implemented by the relevant authorities, taking into account the effective modifying factors, in order to further improve this dimension of married life.
... The removal of fear results in the removal of or decrease in tension, and in turn, the removal of tension results in the removal of or decrease in pain. Different diagnostic treatment methods have been used for labor pain (Smith, Collins, Cyna, & Crowther, 2006). One of these methods, hypnobirthing, is named as an international birth philosophy focused on the person's own development and freedom from their fears, is based on deep relaxation and is used for easy, healthy, peaceful, and conscious birth. ...
Article
Full-text available
PURPOSE To determine the effectiveness of antenatal period hypnobirthing education for childbirth fear and labor pain management during labor. STUDY DESIGN A quasi-experimental methodological study to assess the education of hypnobirthing. Women were recruited from Eskişehir State Hospital Obstetrics and Gynecology Clinic in Turkey between 24 and 26 pregnancy weeks and July 1–September 1, 2016 and the hypnobirthing education was given 5 weeks in the antenatal period. Participants; 30 Turkish-speaking pregnant women. Following labor, questionnaires were completed in hospital by women in order to assess the mother and infant after birth and determine the effect of education first 24 hours after birth. FINDINGS It was determined that hypnobirthing knowledge scores after education of the participating pregnancies decreased significantly, Wijma Delivery Expectancy/Experience Questionnaire-Version B (WDEQ-B) scale score decreased significantly ( p = 0.002). Participating laborers; ( p = 0.448), but there was also no significant relationship between birth satisfaction scores ( p = 0.540) and posttraining hypnobirthing information status scores and Visual Analogue Scale (VAS) scores. MAIN CONCLUSION Hypnobirthing training has an effect on fear of childbirth but has no effect on birth satisfaction and labor pain.
... 2. Técnicas de respiración: son las diferentes modalidades de efectuar la oxigenación pulmonar, lo que a su vez mejora la oxigenación en la paciente y el bebé, dependiendo del momento y la necesidad de la paciente, con lo cual logrará también mayor comodidad y tranquilidad, facilitando la relajación y control de las molestias propias de cada fase de la gestación o trabajo de parto. Una de las técnicas más populares es el método de Lamaze: [10][11][12] a. Respirar profundo y lento es el método más efectivo. Pero la mejor forma de hacerlo es como la paciente se sienta más cómoda. ...
Article
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Scientific and technological advances in the past two decades have allowed the development and application of several strategies to initiate, accelerate and regulate the physiological process of labor, always attempting to improve perinatal results. However, despite all said advances the concept of “normal” labor has not been standardized. Obstetric psychoprophylaxis is a type of labor women can freely choose, if medical and obstetrical history allow it, and the patient as well as her partner receive adequate training throughout the pregnancy period. In our country several private centers offer psychoprophylactic labor, unfortunately this option is not as common in public institutions. The objective of this paper is to review current concepts on obstetric psychoprophylaxis, and serve as a support tool for the development of new programs both private and public hospitals.
... In addition, some studies reported an association between epidural use and prolonged labor, increased use of instrumental deliveries, increased use of Caesarean sections, [11][12][13] and increased utilization of hospital resources [14]. Many caregivers are currently searching for non-pharmacological methods to control pain during labor, [15][16][17][18] and a major report from the World Health Organization has encouraged this approach [19]. Non-pharmacologic approaches to pain management include a wide variety of techniques that aim to reduce the physical sensations of pain and to prevent suffering by addressing the psychoemotional and spiritual components of care. ...
Article
Full-text available
Background: Epidural analgesia during labor can provide effective pain relief, but can also lead to adverse effects. The practice of moderate exercise during pregnancy is associated with an increased level of endorphins in the blood, and this could also provide pain relief during labor. Aerobic water exercises, rather than other forms of exercise, do not negatively impact articulations, reduce edema, blood pressure, and back pain, and increase diuresis. We propose a randomized controlled trial (RCT) to evaluate the effectiveness and safety of a moderate water exercise program during pregnancy on the need for epidural analgesia during labor. Methods: A multi-center, parallel, randomized, evaluator blinded, controlled trial in a primary care setting. We will randomised 320 pregnant women (14 to 20 weeks gestation) who have low risk of complications to a moderate water exercise program or usual care. Discussion: The findings of this research will contribute toward understanding of the effects of a physical exercise program on pain and the need for analgesia during labor. Trial registration: ISRCTN Registry identifier: 14097513 register on 04 September 2017. Retrospectively registered.
... [7][8][9][10][11][12] Some authors promote non-medical births, and some have a positive attitude towards pharmacological treatment, but with main focus on the effectiveness of reducing the actual pain, not the overall satisfaction. [13][14][15][16] A secondary outcome in studies with a non-medical focus is often an aim to decrease the use of pharmacological pain relief, [17][18][19][20][21] introducing a bias that makes it difficult to evaluate a possible positive effect from medical pain treatment. The World Health Organisation (WHO) makes an important statement in its recommendations for "Intrapartum care for a positive childbirth experience" from 2018, 22 concluding that labouring women have the right to pain relief when giving birth. ...
Preprint
Background: There is an increasing interest in health care systems worldwide for maternal satisfaction with childbirth experience. The WHO launched a recommendation in 2018 regarding women’s right to equal intrapartum care, where the importance of pharmacological pain relief was highlighted. Objectives: To assess the current knowledge regarding the impact of obstetric pharmacological pain relief on maternal satisfaction with childbirth. Search strategy: Pub Med, Cochrane, EMBASE and CINAHL were searched for studies in English language, published after 1999 that investigated the effect of pharmacological pain relief on women’s birth satisfaction after vaginal delivery. Selection criteria: Studies reporting assessments of subjective satisfaction with childbirth in women planned for vaginal delivery Data Collection and Analysis: Results were summarised qualitatively. A forest plot is presented for the five studies where comparable association measures were available. Due to the heterogeneity between studies and indirectness of measuring instruments, no meta-analyses were performed. Main Results: In total, 8,847 women were included from 11 studies: one randomised controlled study, ten observational studies, all with moderate or high risk of bias. Inconsistent methods were used to measure outcome; consequently, no conclusion could be drawn regarding a possible correlation between pharmacological pain relief and birth satisfaction. Conclusions: This systematic review could not show a correlation between pharmacological pain relief and women’s experiences of childbirth, mainly because a large heterogeneity between the studies. In order to evaluate pain relief during labour and improve women’s childbirth experiences, high quality research is urgently needed.
... At present, there are several CFTR-modulator drug combinations and exciting new next-generation CFTR modulators under study for the clinical treatment of CF patients with the Phe508del mutation 7,15 (see Fig. 1). The most important will be addressed below. ...
... Many CAM methods are available to manage labor. The most commonly cited methods are acupuncture, herbal medicine, homoeopathy, massage, acupressure, aromatherapy, hydrotherapy, hypnosis, and relaxation therapy [4,5,[11][12][13]. ...
Article
wufjhjdkf Background Traditional Persian Medicine (TPM) is an ancient medical system that provides suggestions to improve the health of mothers and children during pregnancy and labor. Persian physicians believed that these instructions made labor easier, safer, and less painful. Methods The present randomized clinical trial was conducted among women at 33–38 weeks of pregnancy in Tehran, Iran. TPM instructions consisted of diet, bathing, and application of oil from the 38th week of pregnancy to the onset of labor. The primary outcome was the duration of the active phase of labor. Results The mean duration of the active phase was 331.60 ± 151.48 min for the intervention group and 344.40 ± 271.46 min for the control groups, but it was not statistically significant. The active phase was significantly shorter in women who had better compliance (p=0.03). The need for oxytocin augmentation was 53.3% in the control group and 38.5% in the intervention group (p=0.17). The rate of perineal infection was 13% in the control group and 0% in the intervention group (p=0.11). Conclusions The active phase was not different in the intervention and control groups, but it was shorter in compliant women. It is possible that prolonged use of these recommendations in combination with a sitz baths and a larger sample size could result in more significant outcomes.
... Hasil analisis diperoleh nilai p=0,000 dengan kata lain p<0,05. Namun, hasil tersebut berbeda dengan penelitian Kelly (2012) dengan judul "Hypnosis for pain management during labour and childbirth" menyatakan bahwa Tidak ada perbedaan yang signifikan antara wanita dalam kelompok hipnosis dan kelompok yang berada di dalam Kelompok kontrol ditemukan untuk hasil utama: penggunaan penghilang rasa sakit farmakologis (rasio risiko rarata (RR) 0,63, kepercayaan 95% Interval (CI) 0,39 sampai 1,01, kelahiran spontan (rata-rata RR 1,35, 95% CI 0,93 sampai 1,96. Namun dalam penelitian ini, ada beberapa bukti manfaat bagi wanita dalam kelompok hipnosis dibandingkan dengan kelompok kontrol intensitas nyeri, lama persalinan dan tinggal di rumah sakit ibu, walaupun temuan ini didasarkan pada studi tunggal dengan jumlah kecil perempuan. ...
Article
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Latar Belakang : Persalinan secara Sectio Caesarea memberikan dampak bagi ibuterutama terkait dengan kenyamanan. Manajemen nyeri yang buruk akan mengakibatkan menurunnya kualitas hidup dan memperpanjang waktu hospitalisasi. Salah satu upaya mengatasi nyeri pada ibu post Sectio Caesarea dengan manajemen nonfarmakologi yaitu terapi hipnosis 5 jari. Tujuan : Untuk mengetahui pengaruh hipnosis 5 jari terhadap nyeri post Sectio Caesarea di RSUD Tidar Kota Magelang. Metode : penelitian menggunakan kuasi eksperimen dengan two group pretest and posttest with control group design. Sampel yang digunakan sebanyak 44 responden ibu post Sectio Caesarea dengan teknik consecutive sampling. Pengukuran nyeri menggunakan VDS (Verbal Descriptor Scale). Uji statistik yang digunakan adalah Uji Wilcoxon dan Mann Whitney dengan tingkat signifikansi p = 0,000 (p<0,05). Hasil : Ada pengaruh antara nyeri sebelum dan sesudah dilakukan hipnosis 5 jari dengan p value 0,000. Kesimpulan : Terdapat pengaruh hipnosis 5 jari pada penurunan nyeri post Sectio Caesarea. Oleh karena itu, metode ini dapat diterapkan sebagai bentuk intervensi keperawatan berupa terapi nonfarmakologi untuk mengurangi nyeri pada ibu post Sectio Caesarea.
... Other methods include a variety of complementary therapies, physiotherapy techniques, the use of herbal medicine, homeopathy, aromatherapy, hypnosis, and music therapy (Sanders and Lamb, 2017;Smith, Collins, Cyna, and Crowther, 2006;Smith et al., 2018). Various physiotherapy methods have been used to relieve labor pain such as relaxation techniques, breathing techniques, electrical stimulation, electroacupuncture, and acupressure (Polden, Mantle, Barton, and Haslam, 2004;Sanders and Lamb, 2017). ...
Article
Background: Labor pain is one of the most severe pains experienced by a woman during her life. Interferential current (IFC) is a type of transcutaneous electrical stimulation that can reduce pain, especially deep ones. Objective: This randomized controlled clinical trial (RCT) aimed to study the effects of quadripolar IFC on pain and the duration of the active phase of labor in primiparous women. Method: In this RCT, 60 primiparous women were randomized into two groups of IFC and sham IFC. The IFC group received IFC in two periods. The sham group received sham IFC. Primary outcomes were labor pain in different times of active phase and duration of active phase, and secondary outcomes were delivery satisfaction; the number of infants transferred to neonatal intensive care units (NICUs), fetal heart rate (FHR) disorders, Apgar score, partograph variables, and adverse side effects were recorded. Result: Between-group changes showed a significant decrease in labor pain during the active phase in the IFC group compared to the sham IFC group (mean difference (MD) = -0.95; 95% confidence interval (95% CI) = -1.35 to -0.55; P < .001). The mean of active phase duration was significantly shorter in the IFC group than in the sham IFC group (MD = -38.25; 95% CI = -62.84 to -13.67; P = .003). Conclusion: This study showed the effectiveness of interferential electrical stimulation during labor to reduce pain and duration of the active phase, which can be valuable in improving the quality of care and encouraging natural childbirth.
... 43 Strategies to reduce cesarean births have been studied. 1,11,12,13,14,15,16,17 Similar to our results, the history of a previous cesarean birth is a well-known risk factor for a repeat cesarean 44,45 and clinical consensuses have addressed strategies to avoid a primary cesarean as an intervention to reduce the burden of unnecessary surgeries. 46 Besides this well-known risk factor, our study identified that the lack of use of nonpharmacological labor pain management methods proved to be the second strongest risk factor for cesarean births. ...
Article
Full-text available
Background: Nonpharmacological labor pain management methods (NPLPMM) are noninvasive, low-cost practices that may play a role in reducing the rates of unnecessary cesarean birth. We aimed to evaluate whether the NPLPMM is associated with the mode of birth. Methods: We conducted a retrospective cohort study with clinical records of all women admitted for birth from January 2013 to December 2017. Records of women who had spontaneous labor or received induction or augmentation of labor during hospitalization were eligible for the study. We estimated the risk ratios for cesarean birth in general linear models using the Poisson regression with adjustments for the following variables: age, ethnicity, schooling, parity, gestational age, previous cesarean birth, spontaneous labor before admission, or induction/augmentation of labor. Results: Within the total of 3,391 medical records, 40.1% had the use of a nonpharmacological labor pain management method registered. Cesarean rate among the study population was 44.2%. The use of NPLPMM decreased the risk of cesarean birth by 78% (OR = 0.22; 95% CI 0.19-0.26). History of a previous cesarean birth (RR = 2.63; 95% CI 2.35-2.64), the lack of use of NPLPMM (RR = 2.46; 95% CI 2.22-2.72), and primiparity (RR = 2.09; 95% CI 1.86-2.34) were the strongest risk factors for cesarean birth in the cohort. Discussion: The use of NPLPMM may be an effective strategy to reduce unnecessary cesarean birth. Further studies to identify the efficacy of each method may help health professionals to offer more appropriate methods at different stages of labor.
... Výsledky poukázali, že hypnóza a akupunktúra môžu bolesť pri pôrode zmierniť (sledovaný súbor bol ale malý). Pri ostatných metódach nie je dostatok dôkazov o ich účinku na zmiernenie bolesti (Smith, Collins, Cyna, Crowther, 2006). ...
... The frequently used descriptive treatment modalities for labour pain can be listed as yoga, meditation, hypnosis, relaxation, imagery and breathing exercises [8]. Rather than being a technique, hypnobirthing can be called a labour philosophy that prepares the pregnant for delivery physically and psychologically. ...
... Non-pharmacological therapies have the potential to reduce labour pain while causing little or no harm to the mother, foetus, or labour progress, and are straightforward and costeffective [4]. Pain in labour is a nearly universal experience for child bearing women and it can be intense with tension, anxiety and fear making it worse. ...
Article
During labour and childbirth, comfort techniques that give natural pain relief can be quite beneficial. The purpose of this study was to analyse pregnant women's awareness about non-pharmacological therapies in Bhopal's designated hospitals. This study was conducted using a descriptive research approach. The study's target population was pregnant women, and the sample method was purposive sampling. A total of 50 people were included in the study. The knowledge of pregnant women on non-pharmacological therapies was assessed using a self-structured questionnaire, and the study findings indicated that their understanding was insufficient.
Chapter
This chapter explores the options of obstetric analgesia and anesthesia specifically for women with inherited bleeding disorders and discusses strategies for a safe delivery of these options. A wide variety of non‐pharmacological methods have been used to help women cope with the pain of childbirth. The primary concern when using any pharmacological method in women with inherited bleeding disorders lies in the potential risks of bleeding complications in the mother and newborn. The use of systemic opioid analgesia to cope with labor pain is documented in ancient Chinese writings. Paracervical block is used to relieve pain during the first stage of labor and involves the injection of local anesthetic around the cervix. Pudendal block is used to relieve pain during the second stage of labor and involves the injection of local anesthetic solution into the bilateral pudendal nerves in the pelvis, through a transvaginal or a transperineal approach.
Chapter
Schwangerschaft und Geburt erfordern vom mütterlichen Organismus eine besondere Adaptation an die sich verändernden Bedürfnisse. Mechanische, hormonelle und metabolische Veränderungen greifen hierbei ineinander. Alle anästhesiologischen Maßnahmen wirken nicht nur auf den mütterlichen Organismus, sondern beeinflussen auch den Zustand des Fetus bzw. Neugeborenen. Für eine optimale anästhesiologische Versorgung schwangerer Patientinnen ist die Kenntnis dieser Prozesse Voraussetzung.
Article
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Background Although integrative medicine is gaining increasing attention and is claiming more and more its place in modern health care, it still plays a marginal role in conventional maternity care. The present study aims to examine the patterns of Complementary and Alternative Medicine (CAM) use and the demand for integrative therapies, including CAM, relaxation therapies, nutritional counseling, and psychological assistance, among women in pregnancy and childbed. Methods The survey was conducted from April 2017 to July 2017 by means of a pseudo-anonymous 38-item questionnaire at the Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich. Eligible participants were women hospitalized due to pregnancy related complications and women in childbed. Descriptive statistics were generated to determine patterns of CAM use and demand for integrative therapeutic approaches. Univariate analysis was used to detect associations between patients’ characteristics and their interest in the different integrative therapies. Furthermore, binary logistic regression was used to estimate the odds ratio of demand for CAM. ResultsA total of 394 out of 503 patients participated in the survey (78%). 60% declared using CAM in general, 45% specifically in relation to their pregnancy or childbed. Most commonly used modalities were vitamins (31% of all patients), yoga (24%), and herbal supplements (23%). Most popular sources of recommendation of CAM use were midwives and gynecologists. Integrative therapy options patients would have wanted alongside conventional maternity care were CAM (64%), relaxation therapies (44%), dietary counseling (28%), and psychological counseling (15%). Furthermore, associations between patients’ sociodemographic characteristics and their demand for integrative therapies were identified. Conclusions The results of this study demonstrate that there is a considerable demand for integrative medicine and widespread use of CAM among women during pregnancy and childbed in Germany. Maternity health care providers should be aware of these findings in order to be able to better address patients’ needs and wishes. Our study findings should be interpreted with regard to patients in an hospital setting.
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Background: Labor is one of the most painful experiences to women throughout life. This study aimed to compare the effect of ice cold massage and acupressure on reducing labor pain intensity and labor duration in primigravida women. Methods: Design: Randomized controlled trial. Setting: This study was conducted at labor and delivery unit, maternity university hospital, Cairo University, Egypt. Sample: Three hundred laboring women were recruited randomly and allocated to the study and the control groups (ice massage group; acupressure group: and control group. Each group consisted of 100 women. Intervention was exerted in cervical dilatation of 3-4 cm on LI-4 acupoint and intervention period lasted for 20 minutes. Labor pain in the three groups was assessed by VAS and partograph. Labor pain intensity and labor duration were compared in the three groups. Results: There was a significant decrease in pain intensity immediately and 30 minutes after intervention in ice massage and acupressure groups in comparison to the control group (P≤0/003; p<0/002). Moreover the length of first and second stage of labor was significantly reduced (P≤0/003; P≤0/04) in comparison with the control group. Conclusion: Both ice massage and acupressure reduced labor pain intensity and duration of labor in primigravida women, and the ice massage appeared to be more effective in pain reduction.
Article
Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. The second part of this guideline presents recommendations and statements on care during the dilation and expulsion stages as well as during the placental/postnatal stage. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG190 guideline “Intrapartum care for healthy women and babies”. Other international guidelines were also consulted in individual cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions where necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline, and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.
Article
Introduction and hypothesis With the increasingly extensive application of epidural analgesia, its effect on pelvic floor function outcomes has received growing attention. The aim of the study is to determine the possible effect of epidural analgesia on pelvic floor muscle (PFM) endurance and strength and the prevalence of urinary incontinence (UI) and stress urinary incontinence (SUI) at 6 weeks postpartum. Methods This is a retrospective cohort study of 333 primiparous women after vaginal delivery. At 6 weeks postpartum, a vaginal balloon connected to a high-precision pressure transducer was used to measure PFM strength and endurance. SUI/UI was determined using the verified Chinese International Classification of Urinary Incontinence Short Form (ICIQ-UI-SF) questionnaire. Statistical analysis was performed using binary logistic regression and multiple linear regression analysis. Results Women in the epidural analgesia group experienced longer first and second stages of labor (p < 0.05). There were no statistically significant differences in the rates of perineal lacerations, forceps assistance or episiotomy between women with or without epidural analgesia (p > 0.05). No statistically significant differences were found in PFM endurance (B: 0.933, 95% CI confidence interval: −1.413 to 3.278, p: 0.435) or PFM strength (B: 0.044, 95% CI: −3.204 to 3.291, p:0.979) between these two groups. In addition, the prevalence of UI (30.77% vs. 26.87%) and SUI (21.54% vs. 16.42%) in women with or without epidural analgesia was not statistically significant (p > 0.05). Conclusions PFM function and UI prevalence at 6 weeks postpartum are not significantly affected by epidural analgesia.
Article
Background: Urinary incontinence (UI) is the involuntary loss of urine and can be caused by several different conditions. The common types of UI are stress (SUI), urgency (UUI) and mixed (MUI). A wide range of interventions can be delivered to reduce the symptoms of UI in women. Conservative interventions are generally recommended as the first line of treatment. Objectives: To summarise Cochrane Reviews that assessed the effects of conservative interventions for treating UI in women. Methods: We searched the Cochrane Library to January 2021 (CDSR; 2021, Issue 1) and included any Cochrane Review that included studies with women aged 18 years or older with a clinical diagnosis of SUI, UUI or MUI, and investigating a conservative intervention aimed at improving or curing UI. We included reviews that compared a conservative intervention with 'control' (which included placebo, no treatment or usual care), another conservative intervention or another active, but non-conservative, intervention. A stakeholder group informed the selection and synthesis of evidence. Two overview authors independently applied the inclusion criteria, extracted data and judged review quality, resolving disagreements through discussion. Primary outcomes of interest were patient-reported cure or improvement and condition-specific quality of life. We judged the risk of bias in included reviews using the ROBIS tool. We judged the certainty of evidence within the reviews based on the GRADE approach. Evidence relating to SUI, UUI or all types of UI combined (AUI) were synthesised separately. The AUI group included evidence relating to participants with MUI, as well as from studies that combined women with different diagnoses (i.e. SUI, UUI and MUI) and studies in which the type of UI was unclear. Main results: We included 29 relevant Cochrane Reviews. Seven focused on physical therapies; five on education, behavioural and lifestyle advice; one on mechanical devices; one on acupuncture and one on yoga. Fourteen focused on non-conservative interventions but had a comparison with a conservative intervention. No reviews synthesised evidence relating to psychological therapies. There were 112 unique trials (including 8975 women) that had primary outcome data included in at least one analysis. Stress urinary incontinence (14 reviews) Conservative intervention versus control: there was moderate or high certainty evidence that pelvic floor muscle training (PFMT), PFMT plus biofeedback and cones were more beneficial than control for curing or improving UI. PFMT and intravaginal devices improved quality of life compared to control. One conservative intervention versus another conservative intervention: for cure and improvement of UI, there was moderate or high certainty evidence that: continence pessary plus PFMT was more beneficial than continence pessary alone; PFMT plus educational intervention was more beneficial than cones; more-intensive PFMT was more beneficial than less-intensive PFMT; and PFMT plus an adherence strategy was more beneficial than PFMT alone. There was no moderate or high certainty evidence for quality of life. Urgency urinary incontinence (five reviews) Conservative intervention versus control: there was moderate to high-certainty evidence demonstrating that PFMT plus feedback, PFMT plus biofeedback, electrical stimulation and bladder training were more beneficial than control for curing or improving UI. Women using electrical stimulation plus PFMT had higher quality of life than women in the control group. One conservative intervention versus another conservative intervention: for cure or improvement, there was moderate certainty evidence that electrical stimulation was more effective than laseropuncture. There was high or moderate certainty evidence that PFMT resulted in higher quality of life than electrical stimulation and electrical stimulation plus PFMT resulted in better cure or improvement and higher quality of life than PFMT alone. All types of urinary incontinence (13 reviews) Conservative intervention versus control: there was moderate to high certainty evidence of better cure or improvement with PFMT, electrical stimulation, weight loss and cones compared to control. There was moderate certainty evidence of improved quality of life with PFMT compared to control. One conservative intervention versus another conservative intervention: there was moderate or high certainty evidence of better cure or improvement for PFMT with bladder training than bladder training alone. Likewise, PFMT with more individual health professional supervision was more effective than less contact/supervision and more-intensive PFMT was more beneficial than less-intensive PFMT. There was moderate certainty evidence that PFMT plus bladder training resulted in higher quality of life than bladder training alone. Authors' conclusions: There is high certainty that PFMT is more beneficial than control for all types of UI for outcomes of cure or improvement and quality of life. We are moderately certain that, if PFMT is more intense, more frequent, with individual supervision, with/without combined with behavioural interventions with/without an adherence strategy, effectiveness is improved. We are highly certain that, for cure or improvement, cones are more beneficial than control (but not PFMT) for women with SUI, electrical stimulation is beneficial for women with UUI, and weight loss results in more cure and improvement than control for women with AUI. Most evidence within the included Cochrane Reviews is of low certainty. It is important that future new and updated Cochrane Reviews develop questions that are more clinically useful, avoid multiple overlapping reviews and consult women with UI to further identify outcomes of importance.
Article
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BACKGROUND AND OBJECTIVE: Nowadays, for pain relief in labor, there are pharmacological and nonpharmacological methods which are used in obstetric field. One of these methods is irritation of painful area by painful stimulus which is seemed that release local endorphin and act base on gate theory. So, this study was carried out to evaluate the effect of normal saline and distilled water injection in painful sacrum on back pain in first stage of labor. METHODS: This randomized clinical trial study was done on 140 volunteers who were selected by simple sampling method and then randomly allocated to two groups, 70 participants in case and 70 participants in control. Four areas selected on sacrum for injection of distilled water (0.1 cc) and saline normal (0.1 cc). Then, in the 10th, 30th, 45th, 90th minutes of post injections, pain was estimated in both groups by VAS method which is a standard scale. Data was analyzed by paired t- test, X2 and t–student. FINDINGS: Mean pain was not significant in 2 groups in the 10th, 30th minutes. Mean of preinjection of saline normal was 54.5±34.1 which showed a significant difference with post injection in the 45th minute (61.1±29.5, p=0.02) and, in the 90th minute (65.3±32.1, p=0.01). Mean of preinjection of distilled water was 54.5±33.2 which was significant with post injection in the 45th minute (58.2±29.5, p=0.02) and in the 90th minute (64.1±30.9, p=0.006). CONCLUSION: Data showed that subcutaneous injection of distilled water and normal saline in sacral area did not increase and decrease pain significantly up to 30 minutes, but after 30 minutes, the pain in both two groups increased that the injection frequency may cause a better results. KEY WORDS: Distilled water, Pain gate theory, Labor pain, Normal saline
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The demand on obstetric anaesthetists is ever increasing, with the majority of women being cared for within hospital delivery areas, requiring their services. Caring for obstetric patients is very different compared to caring for patients in other surgical settings. Obstetric anaesthetists will frequently administer neuraxial anaesthesia for surgical procedures while women are awake for their operation. They must also take into consideration the effects of anaesthesia on the fetus. The types of obstetric surgical interventions are distinct compared to the routine caseload encountered by junior anaesthetists in the main operating areas of hospital facilities. As well as these differences, the majority of surgery that occurs within the delivery area is emergent in nature and requires prompt anaesthetic input. All of these factors can lead to uncertainty for novice obstetric anaesthetists, and covering delivery wards can be a daunting prospect for many anaesthetic trainees. Quick Hits in Obstetric Anesthesia is not only aimed at novice obstetric anaesthetists but is also intended for use as a quick reference guide by all grades of anaesthetist. Information is clearly presented and summarises the management of emergency situations and common problems which are encountered while working with pregnant patients. Different anaesthetic ‘recipes’ and management strategies are presented for common obstetric procedures in addition to trouble-shooting chapters and ‘what to do lists’ for frequently encountered dilemmas. Quick Hits in Obstetric Anaesthesia includes chapters which are written by leading international experts in the field of obstetric anaesthesia, covering a spectrum of antenatal and postpartum situations when the input of obstetric anaesthetists to multidisciplinary team working is key to ensuring excellent patient outcomes.
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Labour analgesia can be broadly categorised as those where an anaesthetist is involved in the delivery of pain relief, and those which can be administered by Midwives or Nurses, without the input of an anaesthetist.
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Labor pain is a complex phenomenon with both sensory and emotional components. Research shows that fear of childbirth is associated with maternal anxiety, dyadic adjustment, higher insecurity in attachment relationships, and requests for cesarean delivery. Fears related to pregnancy and childbirth are related to the process of labor, fetal well-being, maternity staff competence, physical capabilities and reactions during childbirth, and others. Coping methods and the maintenance of control are important factors in maternal anticipatory management of labor. In this chapter, maternal attitudes are assessed for loss of control over the body and loss of control over emotions. The mother’s ability to trust the medical/nursing staff, and her attitude toward being awake and aware and the use of medication during labor are discussed. Childbirth education encourages the development of techniques of control during labor. Fears of loss of control are mitigated by maternal confidence in oneself, trust in others, and anticipation of reward (the newborn baby). We found that greater prenatal fears regarding well-being of self and baby, and fears of pain, helplessness, and loss of control were associated with greater pain and distress. A desire to be awake and aware during childbirth is related to confidence in one’s ability to manage labor, relative confidence regarding loss of control and helplessness in labor, and a wish to enjoy the excitement of delivery. Coping strategies employed by women in labor include complementary and alternative therapies, such as hypnosis, acupressure and acupuncture, and music therapy, which have been found to be effective in reducing anxiety, pain perception, and/or medication usage. Psychoeducation programs and short psychotherapy interventions are also effective in reducing maternal anxiety in labor. Emerging research on paternal conceptions and experiences of childbirth show that paternal role formulation and satisfaction, and paternal supportive measures of the mother influence maternal preparation for and responses in labor. Fathers’ involvement in childbirth, and being engaged in support and care for their partner, has been found to be fulfilling for both partners.
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Schwangerschaft und Geburt erfordern vom mütterlichen Organismus eine besondere Adaptation an die sich verändernden Bedürfnisse. Mechanische, hormonelle und metabolische Veränderungen greifen hierbei ineinander. Alle anästhesiologischen Maßnahmen wirken nicht nur auf den mütterlichen Organismus, sondern beeinflussen auch den Zustand des Fetus bzw. Neugeborenen. Für eine optimale anästhesiologische Versorgung schwangerer Patientinnen ist die Kenntnis dieser Prozesse Voraussetzung.
Article
Objective Virtual reality (VR) represents a potential method for easing labor pain and in nonpregnant patients has been shown to achieve similar or greater analgesia than hydromorphone. Few studies of VR have been performed in pregnant women. The aim of this randomized controlled trial (RCT) is to evaluate whether VR is effective in reducing pain in laboring women. Study Design An open-label, RCT of nulliparous, term women in labor in a tertiary care hospital. We included women with a pain score level of 4 to 7 having regular contractions at least every 5 minutes. We excluded women who had received any pharmacologic pain relief including neuraxial analgesia and those with contraindications to VR. Participants were randomized to up to 30 minutes of either VR or the control arm (no additional intervention). Our primary outcome was the difference in differences from pre- to postintervention pain score. Prespecified secondary outcomes included postintervention pain scores, duration of intervention use, pharmacologic analgesia use, maternal vitals, and obstetric outcomes. Results From March 2018 to February 2019, 40 subjects were enrolled, randomized, and completed the study; 19 were randomized to control and 21 to the VR arm. Most baseline characteristics were similar between groups. For the primary outcome, those assigned to the control arm had a statistically significant increase in pain of +0.58, while the VR arm had a significant reduction in pain of −0.52 (p = 0.03). There was also a difference in the proportion who had a minimum clinically important difference in pain (0% control and 23.8% VR; p = 0.049). Postintervention maternal heart rate was higher in the control arm (86.8 vs. 76.3, p = 0.01). Most other secondary outcomes did not differ. Conclusion In our study, we found that VR was effective for reducing pain in women in labor as compared with those receiving no intervention. Key Points
Article
BACKGROUND Latent threats, such as prolonged labor duration and postpartum hemorrhage, endanger women and newborns during and post childbirth, which produce burdens on natal care and public health expenditures. Acupuncture, a traditional Chinese medical practice, has increasingly been used for labor delivery in various countries to cope with these problems. METHOD This narrative review searched 29 English and Chinese electronic databases. Thirty-one empirical studies, carried out in Asia, America, Africa, the Middle East, Europe, and Australia were reviewed according to inclusion and exclusion criteria. RESULTS Acupuncture is adopted with positive signs toward labor pain relief, delivery mode, labor duration, postpartum hemorrhage, APGAR score (an evaluation for a neonatal evaluation), and birth weight. DISCUSSION With support of earlier studies, the satisfactory effects of acupuncture on labor delivery reviewed in this research have been noted by obstetric researchers and scholars, physicians, nurses, and midwives. CONCLUSION This review recommends the use of acupuncture in obstetric profession with respect to maternal-related healthcare.
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In light of new recommendations for intrapartum care, this fully updated second edition offers a review of best practice in all aspects of labour and delivery. This authoritative guide incorporates revised recommendations from the latest MBRRACE-UK Report, NICE guidelines, Cochrane Reviews and RCOG Green-top Guidelines to provide advice that is in line with the latest research and practice. New chapters cover the aspects of non-technical skills, ranging from leadership and team work to situational awareness and decision making. This edition also emphasises the problem of adherent placenta and discusses how it should be managed. With its modern, evidence-based approach, Best Practice in Labour and Delivery is the ideal textbook for those training in labour ward practice and studying for postgraduate examinations. Offering clear and practical guidance, this comprehensive book will help all obstetricians, obstetric anaesthetists, midwives and nurse practitioners to understand and deliver the best clinical care to patients.
Article
Background and purpose: Postpartum pain affects quality of life. Clinicians are increasingly using acupuncture for management of pain. Evidence based strategies that incorporate acupuncture for postpartum pain are lacking. Methods: We performed an exploratory, randomized clinical trial of Battlefield Auricular Acupuncture (BFA) plus standard analgesia versus standard analgesia alone for reduction of pain in the immediate postpartum period. Results: The mean time to 50% sustained reduction of initial pain in the standard analgesia group (n = 33) was 6 days compared to 5 days in the standard analgesia plus BFA (n = 37) group (p = 0.35). The mean total morphine equivalent units (MEUs) in the standard group compared to standard plus BFA group were 88 mg and 82 mg respectively (p = 0.45). Conclusions: This exploratory comparison suggests that BFA may not provide additional benefit to standard analgesia for immediate postpartum pain; however, the trend toward faster reduction in pain indicates that a larger definitive study may be required.
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The massage is the first therapy that every child comes in contact after its born, every mammal after its born. It is the first touch from the mother that mimics and conveys positive energy. Viewed from today's distance, during the study for the effects of the massage as a therapy,when we get the information we formed the mosaic called massage. This publication is dedicated to all supporters of physical therapy and rehabilitation that our experiences can check in their patients, as we have shared with many, around the world. Publication like this one was missing not only in our country, but in general at all. While we were writing this publication we checked ourselves, and now we will share it with everyone who will read it as a professional literature.
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A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990. To document trends in alternative medicine use in the United States between 1990 and 1997. Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively. A total of 1539 adults in 1991 and 2055 in 1997. Prevalence, estimated costs, and disclosure of alternative therapies to physicians. Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services. Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
Article
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We undertook a randomised trial to evaluate the effect of selfhypnosis on pain relief, satisfaction, and analgesic requirements for women in their first labour.
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There are few studies on acupuncture in childbirth despite the generally established analgesic effect of acupuncture treatment. The analgesic effect of acupuncture during childbirth was assessed by comparing the need for other pain treatments (epidural analgesia using bupivacaine, pudendal nerve block, intramuscular meperidine, nitrous oxide/oxygen, intracutaneous sterile water injections) in 90 women given acupuncture (acupuncture group) with that in 90 women not given acupuncture (control group). 52 women (58%) in the acupuncture group and 13 (14%) in the control group managed their deliveries without further pain treatment (p < 0.001). The groups were similar with respect to age, pariety, duration of delivery, use of oxytocine and incidence of Caesarean section. Acupuncture treatment was found to have no major side effects, and 85 women (94%) given acupuncture reported that they would reconsider acupuncture in future deliveries. Acupuncture reduces the need for other methods of analgesia in childbirth.
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Scientific Bases of Acupuncture summarizes the major scientific advances from 1976 - 1988 on the mechanisms of acupuncture. Outstanding researchers from Western countries, Japan and China report their findings in the format of review articles. The individual reviews summarize each author's personal research while also referring to the overall literature in the field of acupuncture and TENS.
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The pain and stress of labor is known to increase maternal levels of plasma beta-endorphin. Various forms of analgesia have been shown to block this increase. Electroacupuncture also provides pain relief and a tranquilizing effect in mothers during active labor. Plasma beta-endorphin levels were determined in 13 women receiving no analgesia. The control group that received no analgesia showed the expected rise in beta-endorphin levels. No increase in beta-endorphin levels was seen in women receiving electroacupuncture. These results may suggest that the electroacupuncture effect is not mediated by an increase in plasma beta-endorphin levels or that women in labor are resistant to the releasing effects of stimulation because the endogenous opioid system is already activated.
Article
OBJECTIVE: To determine the effects of breathing and tactile stimulation techniques that performed by nurse on pain perception of pregnant women during labor. STUDY DESIGN: The investigation was conducted among nulliparous women who had been admitted to the SSK Bakirköy Maternity Hospital between January 1st, 2000 and September 1st, 2000. Subjects were selected among volunteers by random sampling; who were in 38th to 42nd gestational weeks; have not any risk regarding complicated pregnancy and were expected to have spontaneous delivery. It is an experimental study included 40 cases, 20 of them compromising the study group and others, the control group. Investigational data were obtained by Visual Analouge scale, Inspection Form, Observation Form and Postnatal Interwiew Form which were based on verbal expression of pain sourced from delivery. RESULT(s): There was no significant difference between the two groups in terms of the parameters of age, attendance rate of pregnancy education programs, knowledge levels about delivery. 75% of study group and 90% of control group were primiparous (p<0.05). We found statistically significant increase in terms of negative impressions related to the expected labor pain, negative behavioural and mood changes during labor and sense of pain during the latent and active phase of labor in control groups (p<0,05). CONCLUSION(s): The study results demonstrated that nursing support and education during labor and nonpharmacological pain control methods (e.g. breathing and tactile stimulation techniques) provided in latent phase of labor for pregnant women those were not primed before delivery were effective in terms of reducing the perception of pain, adapting them to delivery and experiencing a more satisfied birth.
Article
Aromatherapy and massage have gained wide popularity amongst nurses in their clinical practice in recent years. The intensive care setting offers a challenge to nurses to meet the psychological and physical needs of the patient within a highly technological environment. A randomised controlled trial was conducted to assess the effects of aromatherapy and massage on post-cardiac surgery patients. Foot massage given over 20 min, with or without the essential oil of neroli, on day 1 postoperatively showed that a statistically significant psychological benefit was derived from both the groups receiving massage, compared to controls; however, significant physiological differences were limited to respiratory rate as an immediate effect of massage with or without the essential oil. A further follow-up questionnaire on day 5 post surgery indicated a trend towards greater and more lasting psychological benefit from the massage with the neroli oil compared to the plain vegetable oil.
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This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness of the use of biofeedback in prenatal lessons for managing pain during labour. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Background: The use of herbal and alternative medical therapies has been increasing rapidly across the United States over the past 10 years. Women of reproductive age often are users of herbs. The use of herbal and alternative medical therapies among pregnant women is important but poorly studied to date.Objective: To determine the frequency of use of herbal and alternative medicine by women during pregnancy.Methods: Two hundred fifty pregnant women attending antepartum visits were prospectively enrolled in a cross-sectional survey about use of herbal and alternative medical therapies.Results: Two hundred forty-two women completed surveys (97%). Of the respondents, 9.1% reported use of herbal supplements during the current pregnancy, 7.5% using these agents at least weekly. The most commonly used herbs during pregnancy were garlic, aloe, chamomile, peppermint, ginger, echinacea, pumpkin seeds, and ginseng. Herb use during pregnancy was strongly associated with prior use of herbal supplements (25.6% versus 1.2%, P <0.001). There were trends toward greater use among white women (11.4% versus 6.1% in other racial groups) and in women with at least college-level education (10.1% versus 7.6% for high school or less). No association was found between herb use during pregnancy and age or income level. Alternative medical therapies were used by 13.3% of pregnant women. The therapies included aromatherapy, meditation/relaxation, chiropractic, yoga, acupressure, therapeutic touch, homeopathy, acupuncture, and reflexotherapy.Conclusion: Herbal and alternative medicine use is common among pregnant women. Pregnant women should be asked about their use of these therapies. Further research is needed to clarify the safety and effectiveness of these therapies during pregnancy.
Article
The application of music in pain management has become popular in the past two decades. This article describes the responses of primiparas to the use of music therapy during the births of their children. Eleven women who attended childbirth education classes in Brantford, Ontario, Canada, volunteered to participate in a music therapy exercise. During pregnancy each participant selected preferred music, listened to it daily, and received instruction about focused listening. Within 72 hours after birth they were interviewed about their use of music as a coping strategy during labor. Women selected the combination of music and labor support as a helpful coping strategy during labor. All women used the music during labor to help distract them from the pain or their current situation. The planned use of music by mothers and caregivers can be an aid to prenatal preparation and an important adjunct in pain and stress management during labor and birth.
Article
Background: The aim of the present study was to describe the distribution of regional cerebral blood flow during the hypnotic state (HS) in humans, using positron-emission tomography (PET) and statistical parametric mapping. Methods: The hypnotic state relied on revivification of pleasant autobiographical memories and was compared to imaging autobiographical material in "normal alertness." A group of 9 subjects under polygraphic monitoring received six H215O infusions and was scanned in the following order: alert-HS-HS-HS with color hallucination-HS with color hallucination-alert. PET data were analyzed using statistical parametric mapping (SPM95). Results: The group analysis showed that hypnotic state is related to the activation of a widespread, mainly left-sided, set of cortical areas involving occipital, parietal, precentral, premotor, and ventrolateral prefrontal cortices and a few right-sided regions: occipital and anterior cingulate cortices. Conclusions: The pattern of activation during hypnotic state differs from those induced in normal subjects by the simple evocation of autobiographical memories. It shares many similarities with mental imagery, from which it differs by the relative deactivation of precuneus.
Article
Two studies were conducted to examine the effects of music on analogued labor pain using volunteer nulliparous subjects who were randomly assigned to treatment groups (n = 10 per group). Assessments of the treatments were made in a 1-hour session involving twenty 80-second exposures to a laboratory pain stimulus patterned to resemble labor contractions. In the first experiment, it was hypothesized that subjects listening to easy-listening music would report lower pain ratings and cardiovascular responses than subjects listening to rock music, self-selected music, or a dissertation (placebo-attention) and subjects in a no-treatment control group. No significant group effects were found; significant time effects were found for heart rate, systolic and diastolic blood pressure. Subjects spontaneously reported using imagery as a pain reduction technique. In the second study a combination of music and imagery was examined by randomly assigning subjects to one of five groups: self-generated imagery with music (SIM), guided imagery with music (GIM), self-generated imagery without music (SI), guided imagery without music (GI), or no-treatment control. Again, no significant group effects were obtained. Significant time effects were obtained for heart rate, systolic and diastolic blood pressure.
Article
A study of the effects of biofeedback on the pain of childbirth was conducted. Forty primigravidae were randomly assigned to either an experimental group or a control group. The experimental group was given a series of training sessions in biofeedback and used biofeedback equipment during labor. All subjects were monitored during the labor and delivery period for their reports of pain using a visual analogue scale (VAS) and a verbal descriptor scale (VDS). Results showed that women using biofeedback during childbirth reported significantly lower pain: from admission to labor and delivery (p less than 0.05:VDS; p less than 0.01:VAS), at delivery (p less than 0.005:VDS), and 24-hr postpartum (p less than 0.01:VDS). Also, women in the biofeedback group labored an average of 2 hr less and used 30% fewer medications. The results of this study suggest that EMG biofeedback may be effective in reducing levels of acute pain experienced by childbearing women.
Article
The addition of self-selected music as a conditioning aid during prepared childbirth education and subsequent family performance in labor within a musical environment were examined. Thirty primigravida couples received the same psychoprophylactic instruction, with 15 randomly selected couples receiving the added musical conditioning aid. Medication use remained minimal, without significant difference, for couples who did and couples who did not use music. However, the value of music to both the family and the health care staff is felt to be of enough subjective significance to warrant its use as a normal component of prepared childbirth education.
Article
Contradictory opinions and poorly controlled studies appear in the literature on the use of hypnosis in labor. A group of non-volunteer, untrained patients were individually hypnotized during active labor and compared with a control group selected by the same criteria and receiving the same obstetrical treatment. Hypnotized patient required less medication and obtained greater relief of pain than the control group The time involved in induction of hypnosis was only 20 minutes, and the total time added by hypnotic procedures was only 45 minutes longer that the regular care of the control patient group. It was conclude that hypnosis can be used easily on non volunteer, untrained patient in active labor, even in a noisy environment without any serious sequelae.
Article
In eight patients with intense chronic cutaneous pain, sensory nerves or roots. supplying the painful area were stimulated. Square-wave 0.1-millisecond pulses at 100 cycles per second were applied, and the voltage was raised until the patient reported tingling in the area. During this stimulation, pressure on previously sensitive areas failed to evoke pain. Four patients, who had diseases of their peripheral nerves, experienced relief of their pain for more than half an hour after stimulation for 2 minutes.
Article
Maternal satisfaction with the experience of childbirth was investigated in 1000 women having a vaginal delivery of a live child. Effective pain relief did not ensure a satisfactory birth experience. Epidural block produced the most effective analgesia but there were more dissatisfied women among the epidural patients than among those who did not receive this analgesia (p less than 0.05). Bad experience scores were evaluated one year later and were clearly related to a forceps delivery and long labour, both of which were more common in the epidural group. The desirability of an "epidural on demand" service should be tested against an "epidural when necessary" service.
Article
. Self-controlled relaxation in childbirth is claimed to relieve pain and speed labour. A comparative study of two methods of relaxation training based on biofeedback techniques has shown that electromyographic (muscular) relaxation can readily be taught at antenatal classes, while skin-conductance (autonomic) relaxation cannot. The techniques were of some use in early labour but did not postpone the onset of severe pain nor help women to cope with painful uterine contractions. There were no differences in the outcome of labour between women using biofeedback and the women in the control groups.
Article
The purposes of this study were to determine factors affecting the use of music by women during childbirth and to compare the frequency of actual music use during childbirth by women who heard music during prenatal labor rehearsal vs those who did not hear music in rehearsal. Fifty-four women attending Lamaze childbirth classes were randomly assigned to music-rehearsal or nonmusic-rehearsal groups. After delivery, all subjects completed questionnaires about music use and subjective responses to music. Eleven factors involved in determination of actual music use were identified. No significant differences in music use by rehearsal group assignment were found. Results demonstrate that music provides an adjunct to childbirth that is highly desirable for some women, while unappealing or inconvenient for others. Suggestions for utilization of findings by maternity care providers are presented.
Article
Matched groups of primigravid women received one of three antenatal training programmes: normal antenatal classes, normal classes plus electromyography biofeedback relaxation training, or normal classes plus skin-conductance biofeedback relaxation training. Myographic training was found to be effective within conventional antenatal constraints, whereas skin-conductance training was not. The women reported use of biofeedback training and related skills to be of some benefit during early labour. However, no difference between effectively trained electromyographic, ineffectively trained skin-conductance and control groups was found on labour and delivery performance measures.
Article
Twenty-eight women were recruited from prenatal classes and randomly assigned to receive massage in addition to coaching in breathing from their partners during labor, or to receive coaching in breathing alone (a technique learned during prenatal classes). The massaged mothers reported a decrease in depressed mood, anxiety and pain, and showed less agitated activity and anxiety and more positive affect following the first massage during labor. In addition, the massaged mothers had significantly shorter labors, a shorter hospital stay and less postpartum depression.
Article
To investigate the effect of psychological suggestion therapy on the birth process, a specially designed, prospective study of psychological suggestion ("insubstantial comfort") was undertaken in 120 healthy, full-term primipara with singleton pregnancy and cephalic presentation. All cases were randomly divided into 2 groups, the birth processes and final modes of delivery were analyzed in 60 cases interfered with the psychological suggestion therapy and 60 cases with spontaneous birth processes as control group. The results showed that a significant shorter time of the first and second stages of labor in the study group than that in the control group (P < 0.01). Based on this study, it is suggested that the conversation concerning about the evaluation of individual birth process between the mother-to-be and nurse should be controlled carefully for the purpose of advancing of birth process. The nurse should apply the psychological suggestion therapy during the birth process, specially when answering the question raised by mother-to-be about the quantity of the cervical dilataion. It is also suggested that the purpose of the rectal examination taking during the first stage of labor should be given some kind of meaning of psychotherapy.
Article
Studies suggest that between 30% and 50% of the adult population in industrialized nations use some form of complementary and/or alternative medicine (CAM) to prevent or treat a variety of health-related problems. A comprehensive literature search identified 25 surveys conducted between 1982 and 1995 that examined the practices and beliefs of conventional physicians with regard to 5 of the more prominent CAM therapies: acupuncture, chiropractic, homeopathy, herbal medicine, and massage. Six studies were excluded owing to their methodological limitations. Across surveys, acupuncture had the highest rate of physician referral (43%) among the 5 CAM therapies, followed by chiropractic (40%) and massage (21%). Rates of CAM practice by conventional physicians varied from a low of 9% for homeopathy to a high of 19% for chiropractic and massage therapy. Approximately half of the surveyed physicians believed in the efficacy of acupuncture (51%), chiropractic (53%), and massage (48%), while fewer believed in the value of homeopathy (26%) and herbal approaches (13%). This review suggests that large numbers of physicians are either referring to or practicing some of the more prominent and well-known forms of CAM and that many physicians believe that these therapies are useful or efficacious. These data vary considerably across surveys, most likely because of regional differences and sampling methods, suggesting the need for more rigorous surveys using national, representative samples. Finally, outcomes studies are needed so that physicians can make decisions about the use of CAM based on scientific evidence of efficacy rather than on regional economics and cultural norms.
Article
To determine the prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in North Carolina. Surveys were sent to all 120 licensed certified nurse-midwives in North Carolina requesting information concerning their recommendations for use of complementary and alternative medicine for their pregnant or postpartum patients. Eighty-two responses were received (68.3%). Seventy-seven (93.9%) reported recommending complementary and alternative medicine to their pregnant patients in the past year. Forty-seven (57.3%) reported recommending complementary and alternative medicine to more than 10% of patients. The percentage of nurse-midwives who recommended each type of complementary and alternative medicine was as follows: herbal therapy (73.2%), massage therapy (67.1%), chiropractic (57.3%), acupressure (52.4%), mind-body interventions (48.8%), aromatherapy (32.9%), homeopathy (30.5%), spiritual healing (23.2%), acupuncture (19.5%), and bioelectric or magnetic applications (14.6%). The 60 respondents who reported prescribing herbal therapies gave them for the following indications: nausea and vomiting, labor stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labor, postpartum hemorrhage, labor analgesia, and malpresentation. Complementary and alternative medicine, especially herbal therapy, is commonly prescribed to pregnant women by nurse-midwives in North Carolina.
Article
The neural mechanisms underlying the modulation of pain perception by hypnosis remain obscure. In this study, we used positron emission tomography in 11 healthy volunteers to identify the brain areas in which hypnosis modulates cerebral responses to a noxious stimulus. The protocol used a factorial design with two factors: state (hypnotic state, resting state, mental imagery) and stimulation (warm non-noxious vs. hot noxious stimuli applied to right thenar eminence). Two cerebral blood flow scans were obtained with the 15O-water technique during each condition. After each scan, the subject was asked to rate pain sensation and unpleasantness. Statistical parametric mapping was used to determine the main effects of noxious stimulation and hypnotic state as well as state-by-stimulation interactions (i.e., brain areas that would be more or less activated in hypnosis than in control conditions, under noxious stimulation). Hypnosis decreased both pain sensation and the unpleasantness of noxious stimuli. Noxious stimulation caused an increase in regional cerebral blood flow in the thalamic nuclei and anterior cingulate and insular cortices. The hypnotic state induced a significant activation of a right-sided extrastriate area and the anterior cingulate cortex. The interaction analysis showed that the activity in the anterior (mid-)cingulate cortex was related to pain perception and unpleasantness differently in the hypnotic state than in control situations. Both intensity and unpleasantness of the noxious stimuli are reduced during the hypnotic state. In addition, hypnotic modulation of pain is mediated by the anterior cingulate cortex.
Article
Pethidine is the most widely used intra-muscular opioid for the relief of labour pain. However concerns have been raised about its effectiveness and the possibility of depressing respiration in newborns. The objective of this review was to assess the effects of different opioids (and different doses of the same opioid) administered intra-muscularly in labour. We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register (Cochrane Library, issue 4, 1997) and reference lists of articles. Randomised trials comparing the effects of different currently used opioids (and different doses of the same opioid) administered intramuscularly in labour for women who request systemic analgesia. Two reviewers assessed trial quality and extracted data. Analysis was based on the groups as randomly allocated. Sixteen trials were included. There were problems with methodological quality of some of the trials, and lack of consistency in the way various outcomes were reported. There was no evidence of a difference between pethidine and tramadol in terms of pain relief, interval to delivery, or instrumental or operative delivery. There appeared to be more adverse effects such as nausea and vomiting and drowsiness with pethidine. Maternal pain relief seemed almost identical between the meptazinol and pethidine groups, whether assessed as maternal satisfaction with pain relief, visual analogue scales, or use of other pain relief, but meptazinol gave rise to slightly more side effects. Maternal satisfaction with pain relief appeared similar for pentazocine and pethidine, with more frequent nausea and vomiting with pethidine. There is not enough evidence to evaluate the comparative efficacy and safety of the various opioids used for analgesia in labour.
Article
Epidural analgesia is effective in reducing labour pain, but the possible adverse effects are not clear. The objective of this review was to assess the effects of epidural analgesia on pain relief and adverse effects in labour. The Cochrane Pregnancy and Childbirth Group trials register was searched. Randomised trials comparing epidural analgesia with other forms of analgesia not involving regional blockade, or no intervention. Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information. Eleven studies involving 3157 women were included. Epidural analgesia was associated with greater pain relief than non-epidural methods, but also with longer first and second stages of labour, an increased incidence of fetal malposition, and increased use of oxytocin and instrumental vaginal deliveries. With new trial data included, no statistically significant effect on caesarean section rates could be identified. Epidural analgesia appears to be very effective in reducing pain during labour, although there appear to be some potentially adverse effects. Further research is needed to investigate adverse effects and to evaluate the different techniques used in epidural analgesia.
Article
Immersion in warm water may help with relaxation, pain relief and increased elasticity of the birth canal. On the other hand, there may be risks associated with decreased mobility and inhalation of water by the baby, as well as increased risk of maternal infection. The objective of this review was to assess the effects of immersion in water during pregnancy, labour or birth on maternal, fetal, neonatal and caregiver outcomes. The Cochrane Pregnancy and Childbirth Group trials register was searched and study authors were contacted. Adequately controlled trials comparing the use of any kind of bath tub which allows immersion of the abdomen in water compared with non-immersion during pregnancy, labour or birth. Trials were assessed for inclusion and quality by the reviewer and a colleague. Three trials involving 988 women were included. No statistically significant differences between immersion and no immersion were detected for use of pain relief, augmentation and duration of first stage of labour, meconium stained liquor and perineal trauma. Neonatal outcomes such as Apgar scores, umbilical arterial pH values and neonatal infection rates also showed no differences. There is not enough evidence to evaluate the use of immersion in water during labour.
Article
Hypnosis has been used in obstetrics for more than a century with little empiric evaluation of the effects of this type of intervention on labor and delivery. We evaluated how childbirth preparation incorporating hypnotic techniques affected the labor processes and birth outcomes of pregnant adolescents. The study included 42 teenaged patients receiving prenatal treatment at a county public health department before their 24th week of pregnancy. They were randomly assigned to either a treatment group receiving a childbirth preparation protocol under hypnosis or a control group receiving supportive counseling. When labor and delivery outcome measures were compared in the 2 groups, significant differences favoring the hypnosis intervention group were found in the number of complicated deliveries, surgical procedures, and length of hospital stay. Larger studies in different populations are needed.
Article
To investigate the effects of massage on pain reaction and anxiety during labour. Labour pain is a challenging issue for nurses designing intervention protocols. Massage is an ancient technique that has been widely employed during labour, however, relatively little study has been undertaken examining the effects of massage on women in labour. A randomized controlled study was conducted between September 1999 and January 2000. Sixty primiparous women expected to have a normal childbirth at a regional hospital in southern Taiwan were randomly assigned to either the experimental (n=30) or the control (n=30) group. The experimental group received massage intervention whereas the control group did not. The nurse-rated present behavioural intensity (PBI) was used as a measure of labour pain. Anxiety was measured with the visual analogue scale for anxiety (VASA). The intensity of pain and anxiety between the two groups was compared in the latent phase (cervix dilated 3-4 cm), active phase (5-7 cm) and transitional phase (8-10 cm). In both groups, there was a relatively steady increase in pain intensity and anxiety level as labour progressed. A t-test demonstrated that the experimental group had significantly lower pain reactions in the latent, active and transitional phases. Anxiety levels were only significantly different between the two groups in the latent phase. Twenty-six of the 30 (87%) experimental group subjects reported that massage was helpful, providing pain relief and psychological support during labour. Findings suggest that massage is a cost-effective nursing intervention that can decrease pain and anxiety during labour, and partners' participation in massage can positively influence the quality of women's birth experiences.
Article
To investigate acupuncture treatment during labour with regard to pain intensity, degree of relaxation and outcome of the delivery. Randomised controlled trial. Delivery ward at a tertiary care centre hospital in Sweden. Ninety parturients who delivered during the period April 12, 1999 and June 4, 2000. Forty-six parturients were randomised to receive acupuncture treatment during labour as a compliment, or an alternative, to conventional analgesia. Assessments of pain intensity and degree of relaxation during labour, together with evaluation of delivery outcome. Acupuncture treatment during labour significantly reduced the need of epidural analgesia (12% vs 22%, relative risk [RR] 0.52, 95% confidence interval [CI] 0.30 to 0.92). Parturients who received acupuncture assessed a significantly better degree of relaxation compared with the control group (mean difference -0.93, 95% CI -1.66 to -0.20). No negative effects of acupuncture given during labour were found in relation to delivery outcome. The results suggest that acupuncture could be a good alternative or complement to those parturients who seek an alternative to pharmacological analgesia in childbirth. Further trials with a larger number of patients are required to clarify if the main effect of acupuncture during labour is analgesic or relaxing.