| 1. |
- Kildea, Sue, et al.
(författare)
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A review of midwifery in Mongolia utilising the 'Strengthening Midwifery Toolkit'
- 2012
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Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 25:4, s. 166-173
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The World Health Organization (WHO) developed the 'Strengthening Midwifery Toolkit' in response to an international emphasis on increasing midwifery's role in providing maternal newborn health services. It was used to assist a review of midwifery in Mongolia.METHOD: A rapid situational assessment included site visits to eight health facilities and four educational institutions resulting in 30 key informant interviews and six focus group discussions (67 midwives and students). A desk review of pertinent documents (n=19) was undertaken. Data collected included assessments of: midwife competency (n=96), scope of practice (n=2), health facilities (n=8), educational institutions (n=4), legislation and regulation (n=1), and midwifery (n=4) Feldsher-Nurse (n=4) and Bachelor-Nurse (n=1) curricula.FINDINGS: Stakeholders in Mongolia are committed to strengthening midwifery across the country to better align with international standards. This requires: a long-term investment in reorientating the health workforce and educational institutions, regulatory changes, educational investment, job description changes which will impact on other maternal newborn health service providers. Additional support and incentives for providers in rural and remote areas is needed and investment in health facilities to enable appropriate infection control; and adequate provision of essential equipment and drugs, are important strategies needed to protect staff. Maternity emergency training is required across the country.CONCLUSION: The Midwifery Toolkit was adapted to suit the local context and provided an excellent framework for this review.
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| 2. |
- Lee, Nigel, et al.
(författare)
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A comparison of two versus four sterile water injections for the relief of back pain in labour : A multicentre randomised equivalence trial
- 2022
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Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 35:6, s. e556-e562
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundRecent trials demonstrated the safety and efficacy of sterile water injections to provide relief from labour back pain. While four injections is the most common approach variations in technique, such as employing two injections, are also used.AimTo determine if the analgesic effect of two sterile water injections is clinically equivalent to four.Methods238 women in labour with a Visual Analogue Scale pain score (VAS) of 70 millimetres (mm) (0 = no pain; 100 = worst pain imaginable) were randomised to two or four sterile water injections. The primary outcome was pain measured on a VAS at 30 min post treatment. A priori margin of equivalence was set at ±10 mm. Secondary outcomes included the likelihood of achieving an at least 30% and 50% reduction in pain, birth and neonatal outcomes.ResultsAt 30 min post-injection the difference in VAS scores between the techniques was −5.97 (95% Confidence Interval [CI] −13.18–1.22). As the lower end of the CI exceeds the margin of −10 mm equivalence was not demonstrated. Both techniques achieved an at least 30% reduction in pain in over 75% of participants though duration of effect was longer in the four injection group. There was no difference in other birth related secondary outcomes.ConclusionFour injections provided a margin of benefit over two injections in level and duration of analgesia.DiscussionFour injections remains the technique of choice though two injections still provided significant pain relief and would be suitable where it was not possible or desirable to provide four.
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| 3. |
- Lee, Nigel, et al.
(författare)
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Caesarean delivery rates and analgesia effectiveness following injections of sterile water for back pain in labour : A multicentre, randomised placebo controlled trial
- 2020
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Ingår i: eClinicalMedicine. - : Elsevier. - 2589-5370. ; 25
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAbout a third of women experience severe back pain during labour. Injecting small volumes of intracutaneous sterile water into the lumbar region can be used to relieve this pain, however the procedure is controversial and previous reviews call for high quality trials to establish efficacy. We evaluated the impact on birth outcomes and analgesic effects of sterile water injections.MethodsA multicentre, double-blind trial undertaken between December 2012 and December 2017 in one British and 15 Australian maternity units. Women experiencing severe back-pain in labour were assigned (1:1) by an independently generated randomisation schedule stratified by site to injections of either sterile water or saline placebo. Participants and caregivers were blinded to group allocation. The primary outcome was caesarean delivery rate. Main secondary outcomes included at least 30% or 50% reduction in self-reported pain scores at 30, 60 and 90 minutes after treatment. Intention to treat analysis were used and the level of significance for the multiple clinical outcomes was set at p<0.001 with the Bonferroni correction applied. The study is registered with the ACTRN Registry number, ACTRN1261100022195FindingsBetween December 9, 2012, and December 15, 2017, 1166 women were recruited and randomised: 587 women received sterile water injections (SWI) and 579 a saline placebo. Seven women in the SWI group and 12 in the placebo group were excluded as consent was not completed, leaving 580 and 567, respectively, included in the analysis. The proportions of caesarean delivery were 17·1% (82 of 580) in the SWI group and 14·8% (82 of 567) in the placebo (RR 1·16, 95% CI 0·88–1.51; p = 0·293). At 30 min post treatment 60·8% (330 of 543) of women in the SWI group reported a 30% reduction in self-reported pain compared to 31·4% (163 of 520) placebo (RR 1·94, 95% CI 1·68–2·24; p=<0·001) and 43·3% (235 of 534) SWI reported a 50% reduction versus 18·1% (94 of 520) placebo (RR 2·39, 95% CI 1·95–2·94; p=<0·001). The analgesic effect of SWI compared to placebo remained significant at 60 and 90 min post-treatment. There were no significant differences in other maternal or neonatal outcomes.InterpretationCompared to placebo, injections of sterile water did not reduce rates of caesarean delivery. For the main secondary outcome of pain relief the intervention did result in significantly more women reporting at least 30% and 50% reduction in pain for up to 90 min. Water injections have no effect on birth outcomes though can be an effective treatment for the relief of labour-related back pain.
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| 4. |
- Lee, Nigel, et al.
(författare)
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Impact on Caesarean section rates following injections of sterile water (ICARIS) : a multicentre randomised controlled trial
- 2013
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sterile water injections have been used as an effective intervention for the management of back pain during labour. The objective of the current research is to determine if sterile water injections, as an intervention for back pain in labour, will reduce the intrapartum caesarean section rate. Methods/design: Design: A double blind randomised placebo controlled trial Setting: Maternity hospitals in Australia Participants: 1866 women in labour, >= 18 years of age who have a singleton pregnancy with a fetus in a cephalic presentation at term (between 37 + 0 and 41 + 6 weeks gestation), who assess their back pain as equal to or greater than seven on a visual analogue scale when requesting analgesia and able to provide informed consent. Intervention: Participants will be randomised to receive either 0.1 to 0.3 millilitres of sterile water or a normal saline placebo via four intradermal injections into four anatomical points surrounding the Michaelis' rhomboid over the sacral area. Two injections will be administered over the posterior superior iliac spine (PSIS) and the remaining two at two centimetres posterior, and one centimetre medial to the PSIS respectively. Main outcome measure: Proportion of women who have a caesarean section in labour. Randomisation: Permuted blocks stratified by research site. Blinding (masking): Double-blind trial in which participants, clinicians and research staff blinded to group assignment. Funding: Funded by the National Health and Medical Research Council Trial registration: Australian New Zealand Clinical Trials Registry (No ACTRN12611000221954). Discussion: Sterile water injections, which may have a positive effect on reducing the CS rate, have been shown to be a safe and simple analgesic suitable for most maternity settings. A procedure that could reduce intervention rates without adversely affecting safety for mother and baby would benefit Australian families and taxpayers and would reduce requirements for maternal operating theatre time. Results will have external validity, as the technique may be easily applied to maternity populations outside Australia. In summary, the results of this trial will contribute High level evidence on the impact of SWI on intrapartum CS rates and provide evidence of the analgesic effect of SWI on back pain.
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| 5. |
- Lee, Nigel, et al.
(författare)
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Knowledge and use of sterile water injections amongst midwives in the United Kingdom : A cross-sectional study
- 2019
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Ingår i: Midwifery. - : Churchill Livingstone. - 0266-6138 .- 1532-3099. ; 68, s. 9-14
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of sterile water injections (SWI) for the relief of pain in labour is popular amongst midwives in countries such as Sweden and Australia. Anecdotal reports suggest the procedure is used less commonly in the United Kingdom (UK) and that a number of barriers to introducing the practice may exist. Objective: The objective of this study was to explore the awareness and use of SWI amongst midwives in the UK. Design: A cross-sectional study using an internet-based questionnaire. Participants: Midwives with Nursing and Midwifery Council Registration and currently practicing. Setting: The questionnaire was distributed via the Royal College of Midwives Facebook page and Twitter account. Invitations to participate were also sent to Heads of Midwifery to distribute to staff. Findings: Three hundred and ninety-eight midwives completed the survey. Eighty-two percent of midwives did not use SWI in practice although 69% would consider learning the procedure. There was considerable variation in techniques amongst midwives that did provide SWI. The lack of available practice guidelines and the advice from the National Institute for Health and Care Excellence to not use SWI were cited as the main barriers. Key conclusions: SWI use is uncommon in the UK although midwives are interested in incorporating the procedure into practice. Implications for practice: National guidance on SWI and the lack of information and training is restricting the use of the procedure in practice, despite SWI being widely used in other countries and being effective in the treatment of pain in labour.
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| 6. |
- Lee, Nigel, et al.
(författare)
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Sterile water injections for relief of labour pain (the SATURN trial) : study protocol for a randomised controlled trial
- 2022
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Ingår i: Trials. - : BioMed Central. - 1745-6215. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Up to 80% of women use some form of pharmacological analgesia during labour and birth. The side effects of pharmacological agents are often incompatible with the concurrent use of non-pharmacological pain-relieving strategies, such as water immersion, ambulation and upright positioning, or may have negative effects on both the mother and foetus. Sterile water injections given into the skin of the lumbar region have been demonstrated to reduce back pain during labour. However, the injections given for back pain have no effect on abdominal contraction pain. The analgesic efficacy of sterile water injections for abdominal pain during childbirth is unknown. The injections cause an immediate, brief but significant pain that deters some women from using the procedure. This study aims to investigate the use of water injections given intradermally into the abdomen to relieve labour contraction pain. A vapocoolant spray will be applied to the skin immediately prior to the injections to reduce the injection pain. Methods: In this pragmatic, placebo-controlled trial, 154 low-risk women in labour at term with a labour pain score ≥ 60 on a 100-ml visual analogue scale (VAS) will be randomly allocated to receive either six injections of sterile water or a sodium chloride 0.9% solution as a placebo (0.1–0.3 ml per injection). Three injections are given along the midline from the fundus to the supra-pubis and three laterally across the supra-pubis. The primary outcome will be the difference in VAS score 30 min post-injection between the groups. Secondary outcomes include VAS score of the injection pain on administration, VAS score of labour pain at 60 and 90 min and maternal and neonatal birth outcomes. Discussion: Access to effective pain relief during labour is fundamental to respectful and safe maternity care. Pharmacological analgesics should support rather than limit other non-pharmacological strategies. Sterile water injections have the potential to provide an alternative form of labour pain relief that is easy to administer in any labour and birth setting and is compatible with other non-pharmacological choices. Trial registration: ANZCTR ACTRN12621001036808. Registered on 05 August 2021.
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| 7. |
- Mårtensson, Lena B., 1958-, et al.
(författare)
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Sterile water injections for childbirth pain : An evidenced based guide to practice
- 2018
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Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 31:5, s. 380-385
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Tidskriftsartikel (refereegranskat)abstract
- Background: About 30% of women in labour suffer from lower back pain. Studies of sterile water injectionsfor management of low back pain have consistently shown this approach to be effective. The objective ofthis evidence-based guide is to facilitate the clinical use of sterile water injections to relieve lower backpain in labouring women.Methods: To identify relevant publications our search strategy was based on computerised literaturesearches in scientific databases. The methodological quality of each study was assessed using themodified version of the Jadad scale, 12 studies were included.Findings: Recommendations regarding the clinical use of sterile water injections for pain relief in labourare reported in terms of the location of injection administration, various injection techniques, number ofinjections used, amount of sterile water in each injection and adverse effects.Discussion: Both injection techniques provide good pain relief for lower back pain during labour. Thesubcutaneous injection technique is possibly less painful than the intracutaneous techniqueadministered, but we are unsure if this impacts on effectiveness. The effect seems to be related tothe number of injections and the amount of sterile water in each injection.Conclusion: The recommendation at present, based on the current state of knowledge, is to give fourinjections. Notwithstanding the differences in injection technique and number of injections the methodappears to provide significant levels of pain relief and can be repeated as often as required with noadverse effect (apart from the administration pain) on the woman or her foetus.
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