Relaxation techniques for pain management in labour

Sounds of comfort: the impact of music therapy on labor pain and anxiety in primigravida women during vaginal delivery: a systematic review and meta-analysis

BACKGROUND

Music therapy has been widely used in medical practices, demonstrating positive effects on diverse medical procedures. In the context of labor pain management, evidence suggests that music can positively influence pain perception and overall well-being during labor, serving as a distraction and stress reducer. This systematic review and meta-analysis aim to comprehensively evaluate the impact of music therapy on labor pain in primigravida women during vaginal delivery.

METHODS

Following PRISMA guidelines, a thorough literature search was conducted in Google Scholar, PubMed, and Cochrane Central Register of Controlled Trials up to November 2023. Nine randomized control trials (RCTs) met the inclusion criteria, involving primigravida women undergoing vaginal delivery with music therapy intervention. Quality assessment was performed using the Cochrane Risk of Bias assessment tool.

RESULTS

A meta-analysis of the fixed effects was performed using mean differences (MD). Pooled analysis of Visual Analog Scale (VAS) scores revealed statistically significant reductions in pain intensity during latent (MD: - 0.73; 95% CI - 1.01; - 0.45); during the active phase (MD: - 0.56; 95% CI - 1.06; - 0.07) and the second stage (MD: - 0.69; 95% CI - 0.85; - 0.54). The findings indicated no statistically significant variances related to the integration of music therapy in addressing anxiety, both in the latent phase (MD: - 0.88; 95% CI - 1.86; -2.02) and the active phase of labor (MD: -0.30; 95% CI - 1.74; 1.13).

CONCLUSIONS

In conclusion, the collective evidence presented in this systematic review underscores the potential of music, especially for women giving for the first time. in mitigating labor pain and anxiety across different stages, offering a holistic approach to enhance the overall childbirth experience for women.

The effect of intrapartum care model given in line with world health organization (WHO) recommendations on labor pain, fear of labor, comfort of labor, duration of labor, administration of oxytocin and perception of midwifery care: a randomized controlled study

OBJECTIVES

This study aimed to assess the impact of a WHO-aligned intrapartum care model on labor aspects, including pain, fear, comfort, labor duration, oxytocin use, and perceptions of supportive care.

METHODS

This is a randomized controlled study. The study was conducted with 124 primiparous pregnant women (intervention group n = 62, control group n = 62) who were admitted to the maternity unit of a hospital in Central Anatolia, Türkiye. The intervention group was subjected to the intrapartum care model, once cervical dilatation reached 5 cm. The control group received only standard intrapartum care in the hospital.

RESULTS

The Visual Analog Scale (VAS) scores for the pregnant women in the intervention group who received intrapartum care in accordance with WHO recommendations were significantly lower than those for the control group (p < 0.001). The pregnant women in the intervention group exhibited lower fear of labor scores and higher comfort of labor scores during the active phase than those in the control group (p < 0.001). Furthermore, the duration of the first, second, and third stages of labor was observed to be significantly shorter in the intervention group compared to the control group (p < 0.001). Additionally, the use of oxytocin was found to be less prevalent in the intervention group compared to the control group (p < 0.001). Furthermore, the mean scores of the scale measuring women's perception of supportive care during labor were found to be significantly higher in the intervention group compared to the control group (p < 0.001).

CONCLUSION

In alignment with these findings, it is recommended that midwives and obstetricians implement the intrapartum care model in accordance with the World Health Organization's (WHO) recommendations. The implementation of this model aims to reduce labor pain, fear, and oxytocin use, enhance women's perception of birth comfort and care, and transform the birth experience into a more positive one.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov identifier NCT06681675.

Labor Pain Management in Ethiopia: A Systematic Review and Meta-Analysis

OBJECTIVES

Labor pain is a subjective phenomenon that varies based on women's expectations. To have a positive childbirth experience, laboring women should have pain relief based on their request. Therefore, this study aimed to determine the utilization of labor pain management and associated factors among obstetric caregivers in Ethiopia DATA SOURCES: Different electronic databases (i.e., PubMed, Scopus, Embase, CINAHL, DOAJ, Web of Science, MEDLINE, Cochrane Library, ScienceDirect, and CAB Abstracts) were searched for published studies, whereas Google Scholar and Google Search were used for unpublished studies.

REVIEW/ANALYSIS METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used throughout this work. Duplicate results were removed using EndNote X8. Quality was assessed by the JBI tool. Stata 17 was used for analysis. A random effects model was used, and the results were presented using a forest plot. Heterogeneity and publication bias were evaluated using Cochran's Q test and I2 test.

RESULTS

The pooled utilization of pharmacological pain management was 28% (95% CI [12, 43]), whereas the pooled estimate of nonpharmacological pain management was 43% (95% CI [37, 49]). Obstetric care provider attitude was positively associated with both pharmacological and nonpharmacological labor pain management (adjusted odds ratio = 1.73, 95% CI [1.20, 2.26], adjusted odds ratio = 2.94, 95% CI [2.01, 3.87], respectively).

CONCLUSIONS

Labor pain management utilization among obstetric care providers in Ethiopia was poor. Health care provider attitude was positively associated with labor pain management. On-site training was recommended for obstetric care providers to improve the practice of labor pain management. © 20XX by the American Society for Pain Management Nursing.

Benefits of yoga in pregnancy: a randomised controlled clinical trial

OBJECTIVES

Modern obstetrics confronts a rise in caesarean sections (CS). Prevention of unnecessary primary CS is a global priority. Women face intense psychological and physiological challenges during childbirth. Fear and anxiety during labour reduce women's self-confidence and empowerment. Yoga is a body-mind practice that lowers maternal fear and anxiety and helps relax pelvic floor muscles during labour. The study examined whether yoga practice in pregnancy influences CS rate in primiparous singleton pregnant women, labour pain intensity and epidural analgesia requests at delivery ward admission.

METHODS

We conducted a single-blind, randomised, controlled clinical trial comparing yoga to standard obstetric care in pregnancy. A total of 214 participants were randomised, 106 in yoga and 108 in controls. Weekly 90-min yoga classes were led by a certified yoga teacher's supervision. Every pregnant woman in the interventional group completed 12 yoga sessions.

RESULTS

Yoga group had a lower total CS due to less frequent In-labour CS (p=0.004) and a higher rate of spontaneous vaginal birth (p=0.009). They experienced less pain intensity during labour (p<0.001), and there was no difference in epidural analgesia requests.

CONCLUSIONS

Engaging in yoga during pregnancy reduces the rate of In-labour CS, decreases discomfort and encourages spontaneous vaginal birth in primiparous singleton pregnant women.

Pain Displays in Childbirth: How First-Stage Contractions are Interactionally Managed in Midwife-Led Births

Birthing is an exemplary setting for investigating how non-pathological painful sensations are intersubjectively established. Contractions are integral to giving birth and are physiologically normal events that can range from mild to intensely painful sensations. This conversation analytic study is the first to examine how first-stage labor contractions are made recognizable and shape interaction between laboring women, birth partners, and attending clinicians. Drawing on recordings from two British midwife-led units, we show how participants convey and recognize contraction pain through breathiness, pain cries, (limited) talk, and visible bodily actions. Contractions can be prospectively announced and/or retrospectively noticed. We demonstrate that breathing patterns become central to how participants collectively orient to and manage contractions, with the onset of pain temporarily suspending ongoing activities in favor of breath work. Data are in British English.

Construction and Validation of a Model for Predicting Fear of Childbirth: A Cross-Sectional Population Study via Machine Learning

Background

Fear of childbirth (FOC) is a psychological state of fear and distress that pregnant women experience when they approach labor. This fear can have significant negative effects on both the mother and the newborn, making it crucial to study the influencing factors of FOC to implement early interventions.

Objective

First, identify the risk factors for FOC occurrence, then construct a predictive model for FOC and evaluate its predictive efficiency.

Methods

A total of 901 pregnant women who underwent regular prenatal check-ups at Anhui Women and Children's Medical Center were selected. Participants completed questionnaires. General information and relevant medical data of the patients were collected for data aggregation. The data was randomly divided into a training set (n = 632) and a testing set (n = 269) in a 7:3 ratio. Univariate analysis of risk factors for FOC was performed on the training set data. Using univariate logistic regression and multivariate logistic regression to analyze the risk factors associated with the occurrence of FOC, we constructed a FOC risk predictive model via ten different machine learning methods and evaluated the predictive performance of the model.

Results

Our study indicated that educational level, history of adverse pregnancy outcomes, history of cesarean section, planned pregnancy, assisted reproduction, income, payment, SAS scores, and age are independent risk factors for FOC. The risk predictive model included six factors, such as gravidity, history of adverse pregnancy outcomes, history of cesarean section, planned pregnancy, payment, and SSRS scores. The model was built using ten types of machine learning and was evaluated to perform well.

Conclusion

Gravidity, history of adverse pregnancy outcomes, history of cesarean section, planned pregnancy, payment method, and SSRS score are risk factors for FOC in late-pregnancy women. The risk predictive model established in this study has a high clinical reference value.

Therapeutic resources used by physiotherapists for the relief of labor pain: a cross-sectional study

Objective

The aim of the study was to identify non-pharmacological therapeutic resources used by physiotherapists for pain relief during labor and childbirth.

Methods

This is a cross-sectional study conducted from January to March 2021, followed the STROBE guidelines. It included Brazilian physiotherapists with a minimum of two years in obstetric care experience. Data were collected using a 33-item online questionnaire, which covered sociodemographic details and the utilization of non-pharmacological resources. Descriptive analysis was used to determine participant characteristics. Associations between sociodemographic variables, specialist titles, participation in scientific events, and methods for pain relief methods during childbirth were assessed using chi-square or Fisher's exact tests. Data were analyzed using SPSS version 23.0, with a significance level set at 5% (p < 0.05).

Results

A total of 114 Brazilian physiotherapists participated in this study. Participants chose to utilize non-pharmacological therapies and resources that are within the scope of physiotherapists' practice for labor pain. Kinesiotherapy with the use of devices was the most employed technique for pain relief during the birthing process.

Conclusion

The study highlights the prevalent use of non-pharmacological therapeutic resources, particularly kinesiotherapy with devices, among Brazilian physiotherapists for labor pain relief.

Comparative effectiveness of physical activity interventions on cognitive functions in children and adolescents with Neurodevelopmental Disorders: a systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

Physical activity (PA) interventions have been shown to yield positive effects on cognitive functions. However, it is unclear which type of PA intervention is the most effective in children and adolescents with Neurodevelopmental Disorders (NDDs). This study aimed to compare the effectiveness of different types of PA interventions on cognitive functions in children and adolescents with NDDs, with additional analyses examining intervention effects across specific NDD types including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

METHODS

In this systematic review and network meta-analysis, seven databases (Web of Science, PubMed, Medline, APA PsycINFO, Embase, CINAHL, and SPORTDiscus) for randomized controlled trials from database inception to September 2023 were searched. Randomized controlled trials comparing the effectiveness of PA intervention with any non-pharmacological treatment or control group on cognitive functions in children and adolescents diagnosed with NDDs aged 5-17 years were included. Frequentist network meta-analyses were performed based on standardized mean differences (SMD) using random effects models to examine post-intervention differences in cognitive functions, including attention, memory, and executive functions. Intervention dropout was assessed as a measure of treatment acceptability.

RESULTS

Thirty-one randomized controlled trials (n = 1,403, mean age 10.0 ± 1.9 years) with 66 arms were included in the network. Mind-body exercise (MBE; SMD = 1.91 for attention; 0.92 for executive functions), exergaming (SMD = 1.58 for attention; 0.97 for memory; 0.94 for executive functions), and multi-component physical activity (MPA; SMD = 0.79 for executive functions) were associated with moderate to substantial cognitive improvements compared with usual care, whereas the effectiveness of aerobic exercise (AE) was non-significant. Exergaming (SMD = 0.78, 95%CI 0.12 to 1.45) and MPA (SMD = 0.64, 95%CI 0.11 to 1.18) were more effective than AE for executive functions. When analyzing specific NDD types, exergaming lost its superiority over usual care for attention and memory in ADHD, nor for executive functions in ASD. Instead, MPA demonstrated significant benefits across these domains and populations. The certainty of evidence for these comparisons was very low to low. No significant differences in acceptability were observed among MBE, exergaming, and MPA.

CONCLUSIONS

The findings in this study suggest that MBE, exergaming, and MPA were effective interventions for improving domain-specific cognitive functions in children and adolescents with NDDs. AE demonstrated non-significant effectiveness for all outcomes. MBE emerges as particularly advantageous for attention. MPA yielded consistent improvements in memory and executive functions across NDD types. Further high-quality randomized controlled trials of direct comparisons are needed to confirm and expand on the findings from this NMA.

TRIAL REGISTRATION

PROSPERO CRD42023409606.

The trends and hotspots of research on non-pharmacological interventions for labor pain management: a bibliometric analysis

INTRODUCTION

This study aimed to examine important points of focus, trends, and depth of research on non-pharmacological interventions for the management of labor pain worldwide from a macro perspective and present an extensive definition of research fields regarding non-pharmacological interventions.

METHODS

Bibliometric methods were used in this study. With comprehensive keyword lists, the Web of Science and PubMed databases were searched using different screening strategies for publications made until 25 February 2023.

RESULTS

Studies on non-pharmacological interventions in the management of labor pain have continued to develop since 2003 with great momentum. In this study, the most productive country in research on non-pharmacological interventions was found to be Iran, while Australia, the USA, China, and the United Kingdom were the most notable ones in terms of collaboration. The most prevalently studied non-pharmacological interventions were hydrotherapy and acupuncture. The results of the co-word analysis revealed 5 main themes about this field of research.

CONCLUSION

The results of this study showed that interest in studies on non-pharmacological interventions in the management of labor pain has increased, the quality of research in the field is high, international collaboration is increasingly higher, and technological approaches have started to emerge in relevant studies.

The role and outcomes of music therapy during pregnancy: a systematic review of randomized controlled trials

INTRODUCTION

The abundant functions of music and its effects on human's mental and physical health have been verified since ancient times, but rarely received attention as an alternative obstetric intervention.

OBJECTIVE

This study aims to investigate the benefits of music therapy on prenatal and delivery experiences of pregnant women.

METHOD

A systematic search for articles was conducted in electronic databases including CINAHL, Web of Science, PubMed/Medline, and CNKI. A total of 240 articles were identified, and 17 studies were selected for this review. The extracted data included author, year, location, sample size, intervention phase, type of music, music therapy strategy, measuring instruments, and results. The data were organized chronologically based on the publication year of each study.

RESULT

The articles indicated that music therapy has advantages in reducing pain during childbirth, lowering anxiety and stress levels in mothers, improving sleep quality, and increasing fetal movements, basal fetal heart rate, and accelerations.

CONCLUSION

Based on the findings, it can be concluded that music therapy is an effective approach to enhance the experience of pregnant women during pregnancy and delivery. Therefore, its implementation in obstetrical clinical practice is highly recommended.

Pharmacologic Analgesia for Cesarean Section: An Update in 2024

PURPOSE OF THE REVIEW

With the increasing prevalence of cesarean section globally, the importance of perioperative analgesia for cesarean section is becoming increasingly evident. This article provides an overview and update on the current status of cesarean section worldwide and associated analgesic regimens.

RECENT FINDINGS

Some recent studies unveiled potential association of neuraxial analgesia might be associated with children's autism, pharmacologic analgesia in obstetric will potentially gain some more attention. Various commonly used techniques and medications for analgesia in cesarean section are highlighted. While neuraxial administration of opioid remains the most classic method, the use of multimodal analgesia, particularly integration of nonsteroidal anti-inflammatory drugs, acetaminophen, peripheral nerve blocks has provided additional and better options for patients who are not suitable for intrathecal and neuraxial techniques and those experiencing severe pain postoperatively. Optimal pain management is crucial for achieving better clinical outcomes and optimal recovery, and with the continuous development of medications, more and better pharmacologic regimen will be available in the future.

Virtual Reality Combined with Mind-Body Therapies for the Management of Pain: A Scoping Review

When used separately, virtual reality (VR) and mind-body therapies (MBTs) have the potential to reduce pain across various acute and chronic conditions. While their combination is increasingly used, no study offers a consolidated presentation of VR and MBTs. This study aims to propose an overview of the effectiveness of VR combined with MBTs (i.e., meditation, mindfulness, relaxation, and hypnosis) to decrease the pain experienced by healthy volunteers or patients. We conducted a scoping review of the literature using PubMed, Science Direct and Google Scholar and included 43 studies. Findings across studies support that VR combined with MBTs is a feasible, well-tolerated, and potentially useful to reduce pain. Their combination also had a positive effect on anxiety, mood, and relaxation. However, insufficient research on this VR/MBTs combination and the lack of multidimensional studies impede a comprehensive understanding of their full potential. More randomized controlled studies are thus needed, with usability evaluation protocols to better understand the effects of VR/MBTs on patients wellbeing and to incorporate them into routine clinical practice.

Impact of fetal spine alignment according to maternal lateralization during early labor on maternal comfort and birth outcomes: A prospective cohort study in Kelantan, Malaysia

INTRODUCTION

Maternal positioning during labor significantly influences maternal comfort. This study aims to identify the preferred maternal lateral position during the latent phase and examine the impact of alignment between maternal lateralization and fetal spine positioning during the active phase of the first stage of labor on maternal comfort.

METHODS

Pregnant women in the first stage of labor beyond 37 weeks of gestation were recruited over six months from March to August 2020 for this prospective cohort study at Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia. Eligible individuals were randomly allocated to align with the fetal spine (n=180) or oppose it (n=180). Fetal spine positions were confirmed via transabdominal ultrasound. Maternal mean comfort scores were assessed using the established Maternal Comfort Assessment Tool. Statistical analysis was performed using IBM SPSS version 27, with a p<0.05 considered significant.

RESULTS

There was a significant association between the preferred maternal position during the latent phase and concordance with the same maternal lateralization-fetal spine alignment (p<0.001). Higher mean comfort scores were observed when the maternal lateral position matched the fetal spine alignment during the active phase of labor. There was a significant association of normal CTG tracings when the maternal position was aligned with the fetal spine (p<0.001).

CONCLUSIONS

Parturients preferred lying in alignment with the fetal spine lateralization during the latent phase. This position also offers increased comfort during the active phase of labor. It highlights the importance of considering maternal-fetal alignment as a critical factor in intrapartum care.

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

BACKGROUND

A significant number of women experience labour without effective pain management and thus suffer from unbearable labour pain to the extent they term labour as the most agonizing event in their lives. Unresolved labour pain can lead to stress, fear, and confusion, which may compromise placental perfusion and lead to birth asphyxia. Although various pharmacological and non-pharmacological labour pain management methods exist, the use of non-pharmacological methods (NPMs) to manage labour pain has remained low in low-resource settings. This paper explored the barriers for using NPMs to manage labour pain by nurse-midwives in eastern Tanzania.

METHODS

We conducted an exploratory qualitative study with 18 nurse-midwives purposefully recruited from the labour wards of two selected district hospitals in eastern Tanzania. Qualitative content analysis guided the data analysis.

RESULTS

Two categories illustrating barriers to using NPMs were generated: individual-level and institutional-level barriers. Individual-level barriers include (i) limited competencies of nurse-midwives on the use of NPMs for managing labour pain, (ii) inadequate exposure to labour pain management practices, (iii) misconceptions about labour pain relief, and (iv) a lack of opportunities for knowledge acquisition. The institutional barriers include (i) a critical staff shortage amidst many clients and (ii) an unfavourable healthcare facility environment.

CONCLUSION

The implementation of NPMs for labour pain management by nurse-midwives in eastern Tanzania faces several institutional and individual barriers. We recommend addressing both supply- and demand-side barriers. Strengthening nurse midwives' competencies in NPMs adoption and use and improving the facility environment to ensure privacy during labour can be a starting point for addressing supply-side issues. We recommend dispelling myths and misconceptions through health promotion education to address demand-side barriers.

Determinants and willingness to practice obstetric analgesia among women attending antenatal clinic at Dr. Bogalech Gebre Memorial General Hospital Central Ethiopia: a cross-sectional study

BACKGROUND

Labor pain is uniquely experienced and described by the woman giving birth, and it is often considered one of the most excruciating experiences for many women. This study aimed to evaluate factors associated with the willingness to receive labor analgesia among women attending the antenatal clinic at Dr. Bogalech Gebre Memorial General Hospital Central Ethiopia in 2022.

METHODS

An institution-based, cross-sectional study was conducted from January to March 2022. Data were collected using semi-structured questionnaires by a convenience sampling technique. Data was entered in EpiData 4.2 and exported to SPSS version 20 for analysis. Both Bivariable and multivariable logistic regressions were conducted to determine factors associated with pregnant women's willingness to choose labor analgesia. Crude odds ratio (COR) and adjusted odds ratio (AOR) were computed to assess the association between variables.

RESULTS

A total of 398 pregnant women have participated in the study with a response rate of 94%. Nearly 30%, (29.4%) of the pregnant women had a willingness to practice labor pain management. Being a housewife (AOR: 8.35, 95% CI: 2.07, 33.63). Women who live in urban (AOR: 2.60, 95% CI: 1.29, 5.29). Having had awareness about labor analgesia (AOR: 1.70, 95% CI: 1.00, 2.60) and the short duration of labor time (AOR: 1.84, 95% CI: 1.15, 2.96) were statistically significant with a willingness to practice labor analgesia.

CONCLUSION

We conclude that the willingness of pregnant mothers' toward obstetric analgesia practice was low in the study area. Being a housewife, urban residence, awareness about labor analgesia, and short duration of labor were statistically significant with the willingness of the mothers to practice labor analgesia. To increase willingness to use labor analgesia, authorities should prioritize delivering health education on pain management choices to address concerns and promote effective methods and practices.

Relaxation Therapy and Human Milk Feeding Outcomes: A Systematic Review and Meta-Analysis

Importance

Human milk feeding is a key public health goal to optimize infant and maternal/parental health, but global lactation outcomes do not meet recommended duration and exclusivity. There are connections between lactation and mental health.

Objective

To appraise all available evidence on whether the provision of relaxation interventions to lactating individuals improves lactation and well-being.

Data Sources

Embase, MEDLINE, CINAHL, Allied and Complementary Medicine Database, Web of Science, and the Cochrane Library were searched on September 30, 2023, and topic experts were consulted.

Study Selection

Two independent reviewers screened for eligibility. Inclusion criteria were full-text, peer-reviewed publications with a randomized clinical trial design. Techniques that were entirely physical (eg, massage) were excluded. A total of 7% of initially identified studies met selection criteria.

Data Extraction and Synthesis

Two independent reviewers extracted data and assessed risk of bias with the Cochrane Risk of Bias 2 tool. Fixed-effects meta-analysis and Grading of Recommendations, Assessment, Development, and Evaluations guidelines were used to synthesize and present evidence.

Main Outcomes and Measures

Prespecified primary outcomes were human milk quantity, length and exclusivity of human milk feeding, milk macronutrients/cortisol, and infant growth and behavior.

Results

A total of 16 studies were included with 1871 participants (pooled mean [SD] age for 1656 participants, 29.6 [6.1] years). Interventions were music, guided relaxation, mindfulness, and breathing exercises/muscle relaxation. Provision of relaxation was not associated with a change in human milk protein (mean difference [MD], 0 g/100 mL; 95% CI, 0; 205 participants). Provision of relaxation was associated with an increase in human milk quantity (standardized mean difference [SMD], 0.73; 95% CI, 0.57-0.89; 464 participants), increased infant weight gain in breastfeeding infants (MD, z score change = 0.51; 95% CI, 0.30-0.72; 226 participants), and a slight reduction in stress and anxiety (SMD stress score, -0.49; 95% CI, -0.70 to -0.27; 355 participants; SMD anxiety score, -0.45; 95% CI, -0.67 to -0.22; 410 participants).

Conclusions and Relevance

Results of this systematic review and meta-analysis suggest that provision of relaxation was associated with an increase in human milk quantity and infant weight gain and a slight reduction in stress and anxiety. Relaxation interventions can be offered to lactating parents who would like to increase well-being and improve milk supply or, where directly breastfeeding, increase infant weight gain.

Factors influencing the use of epidural labor analgesia: a cross-sectional survey analysis

Introduction

This study aimed to explore the personal and organizational factors influencing the lack of implementation of epidural labor analgesia (ELA).

Methods

This study was conducted at the Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China. A total of 451 women who underwent vaginal delivery without ELA between 8 October 2021 and 30 March 2022, were included. A questionnaire was used to collect the relevant data. We derived and validated the variable, without ELA, by using binary logistic regression analysis.

Results

Of the total 451 included, 355 (78.7%) initially preferred ELA, whereas 96 (21.3%) rejected it directly. Five variables were validated (p < 0.05): multiparas, ELA would lead to back pain, experienced ELA in previous delivery, the inner attitude toward labor pain, and blood routine and coagulation function not being tested within 14 days. The sensitivity and specificity of this model were 96.3 and 69.8%, respectively.

Conclusion

The corresponding training should be provided to the medical staff to identify women at high risk of rejecting ELA during the prenatal examination process using a questionnaire, then provide them with knowledge regarding ELA, so that ELA can benefit more mothers. Additionally, the existing organizational factor should be addressed in order to efficiently provide ELA services to mothers.

Clinical trial registration

This study was registered at the Chinese Clinical Trial Registry (Chi CTR 2000034625) on July 12, 2020.

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

Background

Labor pain is considered the worst pain in a woman's life. Hence, pain control should be essential to labor management at any level. There is scarce information, and there are gaps regarding the knowledge, attitude, and barriers to the utilization of nonpharmacological approaches for pain relief in Saudi Arabia. Therefore, the current study aims to evaluate nonpharmacological pain relief (NPPR)-related knowledge, attitudes, and barriers among obstetric care providers in Najran, Saudi Arabia.

Methods

A cross-sectional analytical study was performed at maternity departments in Maternal and Children Hospital (MCH), Najran, Saudi Arabia, from April 1 to May 26 2023. The study involved 186 obstetric care providers (OPCs), physicians (19), nurses (144), and midwives (23). A structured self-reported questionnaire was used to collect data and involves five main sections: demographic data, work-related data, nonpharmacological pain relief-related attitude, perceived barriers, and knowledge quiz. The adjusted odds ratio (AOR) along with 95% CI was estimated to determine the factors associated with nonpharmacological pain relief-related knowledge and attitude using multivariate analysis in the binary logistic regression.

Results

Over three-quarters (79%) of obstetric care providers had adequate knowledge of nonpharmacological pain relief methods. The majority (85.5%) of the participants had a positive attitude toward NPPR in labour pain management, with the mean scores ranging from 3.55-4.23 for all sub-items. Obstetric care providers acknowledged that patient belief, lack of time, and workload were the strongest barriers to offering nonpharmacological pain relief methods for labour pain 67.6%, 64.5%, and 61.3%, respectively. In binary logistic regression analysis, the in-service training related to nonpharmacological pain relief (AOR = 5.871 (2.174-15.857), p = 0.000), (AOR = 3.942 (1.926-11.380), p = 0.013) and years of work experience (AOR = 1.678 (1.080-2.564), p = 0.019), (AOR = 1.740 (1.188-2.548), p = 0.003) were significantly associated with obstetric care providers' knowledge and attitudes regarding nonpharmacological pain relief (p ≤ 0.05).

Conclusion

Although most OPCs have adequate knowledge and a positive attitude regarding NPPR, they need motivational strategies to enhance their utilization. In addition, an effort should be made to decrease OPCs' workload to provide more time for NPPR application and patient education. Training courses and in-service training can play an important role in enhancing NPPR knowledge and attitude and, consequently, its application. Also, in each working unit, the policymakers should provide clear guidelines and policies that enhance and control the utilization of NPPR.

The significance of positional care combined with doula delivery during childbirth in the correction of abnormal fetal position

OBJECTIVE

To explore the effects of positional care combined with doula delivery during childbirth in the correction of abnormal fetal position.

METHODS

In this retrospective study, a total 108 pregnant women with abnormal fetal orientation were included from February 2018 to February 2021 in the Jinan City People's Hospital. Among them, 54 patients who received positional care combined with doula delivery were included in the intervention group (IG), while the other 54 patients who received routine nursing were included in the control group (CG). The data of the fetal orientation correction, delivery method and the pain score of puerpera of two groups were collected. The length of delivery, delivery fear score, the degree of neonatal asphyxia and nursing satisfaction were observed as the secondary outcomes.

RESULTS

Compared with the CG, puerpera in the IG had more occipital anterior position, less occipital transverse and posterior position, higher eutocia rate, lower pain and fear scores and shorter length of delivery; the Apgar score and nursing satisfaction were higher in the IG (all P<0.05).

CONCLUSION

Positional care combined with doula delivery can effectively correct abnormal fetal orientation, improve the rate of eutocia, reduce puerpera's pain and fear, shorten the length of delivery, and improve the quality of neonatal outcome and patients' satisfaction.

Effects of foot reflexology massage on pregnant women: a systematic review and meta-analysis of randomized controlled studies

To explore the effects of foot reflexology massage on anxiety, pain, duration of labor, labor satisfaction, blood pressure, pulse rate and respiratory rate in pregnant women. We systematically searched eight databases for randomized controlled studies on the effects of foot reflexology massage on pregnant women. The inclusion criteria were as follow: participants were pregnant woman; the intervention is foot reflexology or foot massage; the control intervention is placebo, usual care, or no intervention; outcome indicators included pain, anxiety, birth satisfaction, duration of labor, blood pressure, pulse, and respiration; and study type was randomized controlled study. Studies that did not meet the above requirements were excluded. We assessed the quality of the included studies using the Physiotherapy Evidence Database scale, the risk of bias using the Risk of Bias 2.0 tool, and the level of evidence for the outcomes using the Grading of Recommendations Assessment Development and Evaluation. We used Review Manager 5.3 for data analysis and generated funnel plots to assess publication bias. In addition, sensitivity analysis was used to test the stability of the results. A total of 13 randomized controlled studies with 1189 participants were included in this study. Compared to the control group, foot reflexology massage reduced anxiety and pain in pregnant women, shortened the three stages of labor, and increased birth satisfaction. In addition, it also reduced the pulse rate and respiratory rate of pregnant women, but not for blood pressure. Foot reflexology massage can significantly reduce anxiety and pain, shorten the duration of labor, increase birth satisfaction, and stabilize vital signs in pregnant women. It is a safe and non-invasive form of complementary therapy.PROSPERO registered number: CRD42022359641. URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=359641 .

A Pharmacotherapeutic Approaches for Managing Labour Pain Using Synthetic Drugs and Natural Therapies

The birth of a child is a critical and potentially traumatic experience for women, entailing multiple physiological and psychosocial changes. The psychological effects of childbirth pain can have both immediate and long-term effects on the mother's health and her bond with her child. Many studies investigated the different ranges of synthetic drugs available for pain control in labour, inclusive of neuraxial analgesics, inhaled analgesics, and various opioids. The inadequate efficacy and unfavourable side effects of these synthetic drugs prevent appropriate pharmacotherapy, resulting in a quest for natural therapies for reducing labour pain. Herbal therapies (aromatherapy) using several essential oils obtained from various natural plants are another alternative that calms and manages the mind and body through aromatic compounds that have neurological and physiological effects. The review discussed the safety profile of various synthetic drugs with their dosage information and also deliberated on the mechanism and safety profile of various natural plants that are used in aromatherapy. The review also briefly highlighted the other non-pharmacological miscellaneous techniques such as TENS, hypnosis, immersion in water, acupuncture, massage, and different other tactics that aim to assist women in coping with pain in labour.

Beyond Fear: Unveiling the Relationship Between Fear of Childbirth and Pharmacological Pain Relief

BACKGROUND

Pharmacological analgesia is the dominant method for pain relief in labor. Fear of childbirth (FOC) may significantly affect women's preferences for and usage of pharmacological analgesia.

AIM

This study aimed to investigate the relationship between FOC in late pregnancy and preferences for, as well as actual use of, pharmacological analgesia among nulliparous and multiparous women, accounting for confounding factors.

METHODS

A total of 1,300 women participated in the study, completing questionnaires assessing preferences for pharmacological analgesia, FOC, perception of labor pain, social support, coping styles, and demographic variables. The actual use of pharmacological analgesia was followed up. The data were analyzed using univariate and multivariate regression analyses.

RESULTS

Univariate analysis revealed that women with moderate to severe FOC had a stronger preference for pharmacological analgesia compared to those with none to mild FOC. However, multivariate analysis showed no direct association between FOC and actual usage of pharmacological analgesia. Instead, a stronger preference for pharmacological analgesia increased the likelihood of its actual usage during labor.

CONCLUSIONS

Our study underscores the effect of FOC on preferences for pharmacological analgesia and its potential influence on actual usage during labor. Healthcare providers should consider women's FOC and preferences when evaluating pain management options. Targeted interventions focusing on promoting non-pharmacological techniques should be implemented to optimize labor pain management for women, particularly nulliparous women.

Non-Pharmacological Pain Management in Labor: A Systematic Review

Childbirth is a remarkable, life-changing process and is frequently regarded as an excruciating, physically and emotionally demanding experience that women endure. Labor pain management poses a significant challenge for obstetricians and expectant mothers. Although pharmacological pain management is the gold standard, it still imposes risks on the mother and baby. Recently, non-pharmacological pain management (NPPM) has emerged as a safe, effective option. Six databases were searched for articles published up to 2023 using specific related keywords and defined inclusion and exclusion criteria. The extraction and gathering of data was made so as to be categorized into physical, psychological, and complementary NPPM techniques. In light of the enormous development and diversity of NPPM techniques, the present review aims to examine contemporary NPPM knowledge and application, discussing efficacy, advantages, limitations, and potential adverse effects, with a specific focus on women's individual requirements, to strengthen obstetricians' knowledge in guiding decision-making for women in childbirth.

Comparative Efficacy of Mitchell's and Benson's Relaxation Techniques in Alleviating Pain and Improving Quality of Life Among Patients With Premenstrual Syndrome: A Randomized Controlled Trial

Background Most women of reproductive age suffer physical discomfort or distress in the weeks before menstruation. Even though symptoms are typically not severe enough to impede daily activities seriously, they occasionally can. Physical problems like breast discomfort and bloating can also be a problem. The most irritating symptoms are those that affect mood and behaviour. Women of reproductive age experience premenstrual syndrome frequently, necessitating study into non-pharmacological methods for symptom reduction. Methodology The objective of the study was to evaluate and compare the clinical efficacy of Benson's relaxation technique to Laura Mitchell's physiological approach in patients with premenstrual syndrome. Study design was comparative parallel experimental study with patient-reported questionnaire data (online) collected before and post-intervention in tertiary hospital setting. Participants were 70 adult females aged 18 to 35 with premenstrual syndrome. Patients were administered Benson's relaxation technique once a day for a month versus Mitchell's relaxation technique once a day for a month. Both techniques were first taught for one session followed by home program to be performed by patients. The premenstrual syndrome questionnaire and a numerical pain rating scale were used to quantify premenstrual symptoms pre and post-intervention. Results The result revealed significant (p<0.01) improvement in premenstrual symptoms in both groups following the intervention. However, Bensons' relaxation technique was found to be more significant while alleviating the premenstrual symptoms. Conclusions When it comes to lowering the intensity of premenstrual syndrome in young people, Benson's relaxation method is superior to Mitchell's. Both approaches should be entrenched as a regular practice and can be employed on patients to improve their menstrual well-being.

Midwives' Perception Regarding Conditions Influencing the Implementation of the Natural Childbirth Promotion Program in Iran: A Qualitative Study

Background

In Iran, the Natural Childbirth Promotion Program (NCPP) has been implemented as a component of the Health Transformation Plan (HTP) since 2014 and as an attempt to encourage natural childbirth practices and reduce cesarean section rates. The purpose of this qualitative study was to explore the perceptions of midwives about conditions influencing the implementation of NCPP.

Methods

In this qualitative study, data were collected through 21 in-depth semi-structured individual interviews with expert midwives who were selected using purposive sampling mainly from one medical university in Eastern Iran from October 2019 to February 2020. Based on the framework method as a thematic analysis approach, the data were analyzed manually. To enhance the rigor of the study, we followed Lincoln and Guba's criteria.

Results

Data analysis yielded 546 open codes. After the codes were reviewed and similar codes were removed, there remained 195 codes. Further analysis led to extraction of 81 sub-sub themes, 19 sub-themes, and eight main themes. These themes included: Responsive staff; Characteristics of the parturient; Recognition of midwifery role; Teamwork; The birthing environment; Effective management; Institutional and social context; and Social education.

Conclusion

Based on the perceptions of the studied midwives, the success of the NCPP is guaranteed by a set of conditions identified in this study. In practice, these conditions are complementary and interrelated, and they cover a wide range of staff and parturient characteristics to the social context. It seems that effective implementation of the NCPP also calls for the accountability of all stakeholders, from policymakers to maternity care providers.

Effectiveness of Jacobson Relaxation and Lamaze Breathing Techniques in the Management of Pain and Stress During Labor: An Experimental Study

Background and objective The mother's ability to tolerate labor discomfort has an impact on how the labor progresses. Good pain management will boost mothers' ability to labor collaboratively and will shorten the time it takes for the uterus to open completely. Many women prefer not to use pharmaceutical or invasive pain relief during labor, which may have contributed to the popularity of complementary pain relief approaches. This study aimed to assess the effectiveness of the Jacobson relaxation technique and Lamaze breathing technique in the management of pain and stress during labor. Methods Thirty-six women aged between 25 and 35 years were randomly assigned to two groups for the purpose of this study. Group A received the Jacobson relaxation technique while Group B received the Lamaze breathing technique for four weeks. The patients were instructed to practice breathing techniques at the time of labor. The outcomes measure included the Numerical pain Rating Scale (NPRS) and Perceived Stress Scale (PSS), which would be measured before and after the delivery. Results The subjects showed improved labor pain and anxiety following the physiotherapy intervention. The results were found to be statistically significant (p<0.05). Conclusion Based on our findings, physiotherapy intervention plays an integral role in the multidisciplinary approach to relieving labor pain and helping patients have a normal vaginal delivery.

Use of complementary and alternative medicine in pregnancy and labour pain: a cross-sectional study from turkey

Background

This study aimed to determine the prevalence and pattern of complementary and alternative medicine (CAM) use by and attitudes towards CAM of Turkish women during pregnancy and birth.

Methods

This was a descriptive, cross-sectional study that included 260 women who gave birth in a university hospital. The Personal Information Form and Complementary, Alternative and Conventional Medicine Attitudes Scale (CACMAS) were used as data collection tools.

Results

A total of 71.5% of the pregnant women received CAM. Phytotherapy, spiritual meditation and therapeutic touch techniques were the most frequently used techniques. A total of 42.7% women used herbal products. The mean score of the women on the CACMAS scale was 108.37 ± 7.71; this result indicates that pregnant women had a positive attitude. There were significant differences in attitudes according to marital status, education level and place of residence. It was determined that there was a significant difference in the CACMAS scores of the women according to the symptoms experienced during pregnancy, CAM use during pregnancy and the concerns about triggering preterm birth by using CAM methods (p < 0.05).

Conclusion

Although the women commonly used CAM methods during pregnancy, the rate of using these methods during birth considerably decreased. Despite such widespread use, pregnant women have concerns about CAM methods. Therefore, health professionals must actively provide counselling on CAM methods for the protection of maternal and infant health.

The effectiveness of skilled breathing and relaxation techniques during antenatal education on maternal and neonatal outcomes: a systematic review

BACKGROUND

Several studies have investigated the relationship between antenatal education classes and pregnancy outcomes. These studies have shown positive effects on mothers, such as a lower epidural rate in the intervention groups. However, until now, the impact on outcomes for mothers and newborns of antenatal education classes that focus on breathing and relaxation techniques has not been examined.

AIM

Investigate the effects of skilled breathing and relaxation techniques provided in antenatal education classes on maternal and neonatal birth outcomes.

METHODS

The protocol for this study was registered with PROSPERO (ID: CRD42020192289). A systematic literature search was undertaken and completed in January 2022, using the databases MEDLINE, CINAHL, clinicalTrials.gov, Cochrane Library, Embase and MIDIRS according to a priori formulated PICO criteria: population (pregnant women), intervention (antenatal education classes with integrated breathing and relaxation techniques), comparison (antenatal education classes that do not include skilled breathing and relaxation techniques), and outcome (maternal and neonatal outcomes). The quality of the studies was assessed by two reviewers using the standardised instruments RoB 2 and ROBINS-I.

RESULTS

Ten studies were included in this review, nine randomised controlled trials and one quasi-experimental study. The results indicate that skilled breathing and relaxation techniques may positively influence self-efficacy, the need for pharmacological support, specifically the use of epidural anaesthesia, and the memory of labour pain. No effects were found in relation to predefined neonatal outcomes. The quality of evidence on maternal and neonatal outcomes is inconsistent across studies, as different antenatal education classes with varying interventions, including breathing and relaxation techniques, were offered in the studies.

CONCLUSIONS

Women who attended an antenatal education class with breathing and relaxation techniques appear to benefit from the intervention. This applies to the practical implementation and use of breathing and relaxation techniques during labour, increased self-confidence and self-efficacy, and a increased feeling of being in control during labour. This demonstrates the importance of information provision and a focus on breathing and relaxation techniques in antenatal education.

Vaginal Birth at Term - Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020)

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. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered 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 the 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.

Analysis of Maternal and Infant Outcomes and Related Factors of Vaginal Delivery of Second Pregnancy after Cesarean Section

Objective

To explore the clinical effect of different delivery methods and the safety of vaginal delivery of second pregnancy after cesarean section and analyze the related factors.

Methods

A total of 738 eligible pregnant women who underwent cesarean section from September 2018 to August 2020 were randomly selected from our hospital. Among them, 527 pregnant women successfully delivered vaginally were selected as the observation group, and 211 pregnant women who failed vaginal delivery were selected as the control group. To analyze the factors that influence the success of vaginal delivery of second pregnancy after cesarean section and compare the outcomes of mother and infant in two groups.

Results

There was no significant difference in age, prenatal body mass index (BMI), and thickness of lower uterine segment between the two groups (P > 0.05). There were significant differences in fetal head orientation, fetal abdominal circumference, fetal biparietal diameter, uterine height, premature rupture of membranes, Bishop score, and epidural anesthesia during labor between the two groups (P < 0.05). Multivariate logistic regression analysis showed that fetal abdominal circumference, fetal head orientation, Bishop score, and epidural anesthesia during labor were independent factors affecting the success of VBAC (P < 0.05). There was no significant difference in the incidence of uterine rupture between the two groups (P > 0.05). The amount of postpartum hemorrhage in the observation group was significantly lower than that in the control group (P < 0.05). There was no significant difference in Apgar score, asphyxia rate, and hospitalization rate between the two groups (P > 0.05). There was no significant difference in the incidence of complications between the two groups (P > 0.05).

Conclusion

There are many factors that influence the success of vaginal delivery after cesarean section. Through prenatal comprehensive evaluation of vaginal delivery conditions, we can guide the parturient to choose a reasonable mode of delivery, reduce the incidence of complications, and improve the outcome of mother and baby.

The Effect of Listening to the Recitation of the Surah Al-Inshirah on Labor Pain, Anxiety and Comfort in Muslim Women: A Randomized Controlled Study

This study aimed to identify whether listening to the recitation of the Surah Al-Inshirah (94th Chapter of the Holy Qur'an) during labor had any effect on women's pain, anxiety and comfort levels. Designed as a randomized controlled trial, the study was performed with the participation of 126 pregnant Muslim women. The study showed that listening to the recitation of the Surah Al-Inshirah during labor had positive effects on the women's pain, anxiety and comfort levels. In this respect, it is recommended that based on individuals' religious beliefs, spiritual elements such as surahs, prayers and hymns be integrated into the midwifery care offered during labor.

Immersive virtual reality on childbirth experience for women: a randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of immersive virtual reality (VR) on patient satisfaction as a distractive tool and pain relief among laboring women.

METHODS

This was a randomized, controlled clinical trial with 42 laboring women allocated to VR intervention and control groups. Among women in the VR group, patient satisfaction with the use of VR was assessed by a Virtual Reality Satisfaction Survey, measured by a Visual Analog Scale (VAS) score and evaluated by questioning them about whether they would choose VR in future labor. As a primary outcome, patient satisfaction scores regarding the overall childbirth experience were compared between women in the two groups. A secondary outcome was pain assessed by a visual pain rating scale in the early and active phases of labor in women in both groups. Psychometric information was also collected from participants in each group using the Beck Anxiety Inventory and Beck Depression Inventory.

RESULTS

We observed a high level of patient satisfaction with the use of immersive VR during labor. The VAS revealed a mean satisfaction score of 87.7 ± 12.9 out of a maximum of 100. Twenty out of 21 (95%) women in the VR group stated that they would like to use VR again in future labor. VR improved pain scores in early labor and contributed positively to the overall childbirth experience. The mean pain score pre-VR was 2.6 ± 1.2 compared to 2.0 ± 1.3 post-VR (p < 0.01). Anxiety and depression scores were similar in participants in the intervention and control groups (p = 0.103 and p = 0.13, respectively).

CONCLUSION

Immersive VR application during labor was associated with higher patient satisfaction based on our study findings. VR also improved participants' pain scores in early labor before epidural administration. Immersive VR may find a place as an adjunct in labor and delivery units to improve lengthy labor experiences for women. Studies with larger groups of participants are needed to confirm these observations.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05032456.

Obstetric analgesia utilization in labor pain management and associated factors among obstetric care providers in the West Shewa Zone, Central Ethiopia

Objectives:

Labor pain is the worst pain that almost every woman experiences during childbirth. Labor pain management plays a crucial role in promoting maternal-wellbeing, contributing enormously to maternal satisfaction with the childbirth experience and the high quality of services. Although there have been previous studies, they have primarily been conducted at referral or general hospitals located in urban settings. Thus, this study aimed to assess the utilization of labor pain analgesia and associated factors among obstetric care providers at all levels of health facilities in central Ethiopia.

Methods:

A multicenter institution-based cross-sectional study design was employed from 1 July to 30 September 2020. Simple random sampling using the lottery method was employed to select 399 obstetric care providers. The data were entered into Epi-data version 4.2 and analyzed using SPSS version 26. Bivariate and multivariable logistic regression analysis were used to identify the associated factors. The adjusted odds ratio with its 95% confidence interval and p value ⩽ 0.05 were used to identify associated factors.

Results:

The overall utilization of obstetric analgesia was 46% (95% confidence interval: 41.2%–50.8%). Being a Midwife (adjusted odds ratio: 2.10, 95% confidence interval: 1.27–3.47), having heard of the World Health Organization pain ladder (adjusted odds ratio: 2.95, 95% confidence interval: 1.73–5.01), having favorable attitude (adjusted odds ratio: 1.89, 95% confidence interval: 1.17–3.05), the expectation of obstetric care providers about labor pain (adjusted odds ratio: 3.26, 95% confidence interval: 1.27–8.36), having training on labor pain management (adjusted odds ratio: 2.51, 95% confidence interval: 1.03–6.07), and presence of chance for preference of obstetric analgesia for mothers in the facility (adjusted odds ratio = 2.30, 95% confidence interval: 1.33–3.98) were identified as factors significantly associated with the practice of obstetric analgesia among obstetric care providers.

Conclusion:

The overall use of labor pain management methods among obstetric care providers is low. Professional category, provider attitude, labor pain severity expectations, and having training were found to be factors associated with the use of obstetric analgesia. Therefore, working on adapting and disseminating the harmonized guideline and protocols on labor pain management and provision of training for obstetric care providers on labor pain management techniques were recommended.

Pregnant women’s knowledge of non-pharmacological techniques for pain relief during childbirth

INTRODUCTION

The objective of the study was to assess knowledge of pregnant women in the third trimester of pregnancy on non-pharmacological techniques for pain relief during labor and childbirth.

METHODS

A cross-sectional study was conducted at a tertiary care facility of the University of Campinas, Brazil. The participants were 171 pregnant women, aged 18–35 years with 36 or more weeks of a singleton pregnancy. Participants responded to a questionnaire with data about sociodemographic and obstetric characteristics, knowledge on non-pharmacological techniques for pain relief during childbirth, the source of the information on these techniques, practice of physical activity and occurrence of pain during pregnancy. Parous women responded on the use of non-pharmacological techniques for pain relief during childbirth in previous deliveries. Multiple regression analysis with stepwise criteria of selection of variables was used to identify variables significantly associated with knowledge of non-pharmacological techniques for pain relief during childbirth.

RESULTS

A total of 165 (96.5%) participants reported knowledge on at least one non-pharmacological technique; 87.1% on the use of a warm shower during labor for pain relief, 80.7% on the use of the birthing ball, and 74.8% on breathing techniques. There were no significant differences between nulliparous and parous women. The main source of information reported was the Internet. Multivariate analysis showed that pregnant women who had pain during pregnancy reported more knowledge on the use of warm showers during labor (OR=2.64; 95% CI: 1.03–6.73).

CONCLUSIONS

Most women had knowledge of at least one non-pharmacological technique for pain relief during childbirth.

Efficacy of video-based psychotherapy in reducing psychological distress of COVID-19 patients treated in isolation ward

BACKGROUND Hospitalized patients with COVID-19 experience isolation during treatment, which may cause psychological distress. Thus, alternative ways to deliver psychological support are needed when face-to-face therapy is not possible. This study aimed to investigate the efficacy of video-based psychotherapy in reducing distress in COVID-19 patients treated in an isolation ward. METHODS This quasi-experimental trial without a control group included 42 COVID-19 patients aged 20–59 years. Participants were recruited conveniently in the COVID-19 isolation ward in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. They watched three brief psychotherapy videos including relaxation, managing thoughts and emotions, and mindfulness for approximately 30 min. The videos were created by the Department of Psychiatry, Faculty of Medicine, Universitas Indonesia. Subjective units of distress scale (SUDS) was measured before and after watching all videos. Data were analyzed using the Wilcoxon-signed rank test. RESULTS All 42 subjects finished watching the videos. 31 subjects experienced a significant median decrease in SUDS score after the intervention. The effect size of the psychotherapy videos for the SUDS score was 0.485 (95% CI 0.302 to 0.634). CONCLUSIONS Watching psychotherapy videos is effective in reducing the SUDS score for COVID-19 patients in an isolation ward. Our brief video-based psychotherapy intervention has reduced psychological distress in hospitalized COVID-19 patients with limited access to face-to-face consultations due to the risk of disease transmission.

[S3 guidelines on "full-term vaginal birth" from an anesthesiological perspective : Worthwhile knowledge for anesthesiologists]

The publication of the new S3 guidelines on "full-term vaginal birth" and the guidelines on cesarean section, also published in 2020, provide further steps towards the promotion of evidence-based medicine in obstetrics, even if the exact configuration of neonatal monitoring during birth, in particular, is still the subject of current discussions. The multiprofessionality in the medical supervision of a birth is also fundamentally well-represented in the compilation of the S3 guidelines by the participating actors and specialist societies. Important from an anesthesiological perspective is the fact that neuraxial procedures still represent the gold standard in obstetric analgesia. With remifentanil PCA an alternative option is available that enables a reliable analgesia to be accomplished, e.g. when there are contraindications to performing neuraxial methods, if this is appropriate under the prevailing circumstances (1:1 support and appropriate monitoring). During an uncomplicated birth the strict fasting rules are relaxed. Overall, the guidelines underline the importance of self-determination and self-control for the expectant mother and give the highest priority to the safety and well-being of mother and child; however, this presupposes that the expectant mother is sufficiently informed about the value of neuraxial analgesia. For this it appears to be of importance to initiate information proposals, which go beyond the usual information sessions for parents that are often organized exclusively by midwives.

Biofeedback-Based Connected Mental Health Interventions for Anxiety: Systematic Literature Review

Background

Connected mental health, which refers to the use of technology for mental health care and technology-based therapeutic solutions, has become an established field of research. Biofeedback is one of the approaches used in connected mental health solutions, which is mainly based on the analysis of physiological indicators for the assessment and management of the psychological state. Biofeedback is recommended by many therapists and has been used for conditions including depression, insomnia, and anxiety. Anxiety is associated with several physiological symptoms, including muscle tension and breathing issues, which makes the inclusion of biofeedback useful for anxiety detection and management.

Objective

The aim of this study was to identify interventions using biofeedback as a part of their process for anxiety management and investigate their perceived effectiveness.

Methods

A systematic literature review of publications presenting empirically evaluated biofeedback-based interventions for anxiety was conducted. The systematic literature review was based on publications retrieved from IEEE Digital Library, PubMed, ScienceDirect, and Scopus. A preliminary selection of papers was identified, examined, and filtered to include only relevant publications. Studies in the final selection were classified and analyzed to extract the modalities of use of biofeedback in the identified interventions, the types of physiological data that were collected and analyzed and the sensors used to collect them. Processes and outcomes of the empirical evaluations were also extracted.

Results

After final selection, 13 publications presenting different interventions were investigated. The interventions addressed either primarily anxiety disorders or anxiety associated with health issues such as migraine, Parkinson disease, and rheumatology. Solutions combined biofeedback with other techniques including virtual reality, music therapy, games, and relaxation practices and used different sensors including cardiovascular belts, wrist sensors, or stretch sensors to collect physiological data such as heart rate, respiration indicators, and movement information. The interventions targeted different cohorts including children, students, and patients. Overall, outcomes from the empirical evaluations yielded positive results and emphasized the effectiveness of connected mental health solutions using biofeedback for anxiety; however, certain unfavorable outcomes, such as interventions not having an effect on anxiety and patients’ preferring traditional therapy, were reported in studies addressing patients with specific physical health issues.

Conclusions

The use of biofeedback in connected mental health interventions for the treatment and management of anxiety allows better screening and understanding of both psychological and physiological patient information, as well as of the association between the two. The inclusion of biofeedback could improve the outcome of interventions and boost their effectiveness; however, when used with patients suffering from certain physical health issues, suitability investigations are needed.

Effect of media distraction (audio-visual and music) for pain and anxiety control in patients undergoing shock-wave lithotripsy: A systematic review and meta-analysis

Audio-visual (AV) or music distraction may be used to reduce pain during several healthcare procedures. The present manuscript is a systematic review and meta-analysis to assess the effectiveness of media distraction in reducing pain and anxiety in extracorporeal shock wave lithotripsy (ESWL) patients. The PubMed, Embase, Scopus, BioMed Central, Ovoid and CENTRAL (Cochrane Central Register of Controlled Trials) databases were screened for studies assessing the role of media distraction (music/AV media) in reducing pain and anxiety of ESWL patients. Data were summarized using the mean difference (MD) with 95% confidence intervals (CI). A total of 11 randomized controlled trials were included. Pooled analysis indicated a statistically significant difference in pain outcomes with media distraction [mean difference (MD): -1.18; 95% CI: -2.35, -0.01; I²=96.8%)]. Subgroup analysis indicated that both AV media (MD: -2.94; 95% CI: -4.70, -1.17; I²=79.2%) and music (MD: -0.86; 95% CI: -1.37, -0.35; I²=62.5%), led to significant reduction in pain outcomes. Pooled analysis indicated a statistically significant reduction of anxiety scores with the use of media distraction (MD: -3.91; 95% CI: -6.44, -1.38; I²=77.7%). To conclude, the present review suggests that media distraction in the form of AV media or music may be beneficial in reducing the pain and anxiety of patients undergoing ESWL. Evidence is, however, weak considering the small effect size, confidence intervals being close to zero, and instability of the results on sensitivity analysis. In clinical practice, media distraction may be used during ESWL as a nursing intervention, but a clinically important reduction of pain and anxiety may not be expected.

Comparison of the effect of mechanical massage and warm mechanical massage application on perceived labor pain and childbirth experience: A randomized clinical trial

INTRODUCTION

Birth is undisputedly one of the most painful experiences many women endure in their lives. This study aimed to compare the effects of mechanical and warm mechanical massage application in reducing labor pain and enhancing childbirth satisfaction in primipara women.

METHODS

A randomized-controlled trial was conducted on 210 primipara women. Subjects were randomly divided into three groups (each group comprised 70 women) to receive either a mechanical massage, warm mechanical massage, or routine care (control). The intervention was applied twice on the lumbosacral section (relating to the back part of the pelvis between the hips) and pain level was assessed by using the visual analogue scale (VAS) before the intervention, immediately, half an hour and at 1 hour after intervention. The labor satisfaction level was assessed by using the childbirth experience questionnaire (CEQ) at 30 minutes postpartum.

RESULTS

Comparing the intervention groups, there were no significant differences in terms of VAS scores in admission to hospital and immediately after the first intervention, but there were significant differences in terms of VAS scores at half an hour and an hour after the first intervention, and immediately, half an hour and 1 hour after the second intervention, and at 30th min postpartum. The pain level and mean duration of labor for each intervention group were found to be lower than the control group, and childbirth satisfaction score points were higher than the control group.

CONCLUSIONS

Mechanical massage in the lumbosacral can be used as a reliable and effective method to reduce pain and increase childbirth satisfaction.

Effects of Midwifery Care on Mode of Delivery, Duration of Labor and Postpartum Hemorrhage of Elderly Parturients

Background:

We aimed to explore the influence of midwifery care on the mode of delivery (MOD), duration of labor and postpartum hemorrhage (PPH) of elderly parturients.

Methods:

A total of 165 elderly parturients admitted to Tongde Hospital of Zhejiang Province, China from May 2018 to Aug 2019 were allocated into a study group (n=85, midwifery care) and a control group (n=80, conventional nursing care). Visual analogue scale (VAS) was employed to estimate the pain of parturients, and self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were employed to evaluate the anxiety and depression status. The satisfaction of patients on nursing care was scored by a self-made satisfaction questionnaire.

Results:

The parturients in the study group presented higher spontaneous vaginal delivery (SVD) rate (P < 0.05), and had shortened duration of first and second stages of labor and total duration of labor (P < 0.05). The incidence of both PPH and neonatal asphyxia in the study group was lower than that in the control group (both P < 0.05). The VAS, SAS and SDS scores in the study group were significantly lower than those in the control group (P < 0.05), and the patients’ satisfaction in the study group was significantly higher (P < 0.05).

Conclusion:

Midwifery care is effective for the delivery of elderly parturients, which significantly improves VSD rate, shortens duration of labor, reduces incidence of PPH and neonatal asphyxia, as well as relives labor pain, anxiety and depression, and increases satisfaction of parturients.

Music Therapy in Pain and Anxiety Management during Labor: A Systematic Review and Meta-Analysis

Background and Objective: The study of music therapy in labor is unknown. The main objective of this research was to evaluate the effectiveness of music therapy to manage pain and anxiety during labor. Materials and Methods: A search strategy was used with PubMed/MEDLINE, LILACS, Cochrane, TRIPDATABASE, and Google Scholar. The selection criteria were based on randomized clinical trials; quasi-experimental research on pain intensity and anxiety during labor was evaluated. The primary outcomes were measured by the Visual Analogue Scale (VAS). A meta-analysis of the fixed effects was performed using mean differences (MD). Twelve studies were included for the final analysis, six (778 women) of which were meta-analyzed. Results: Decreased VAS scores for pain intensity associated with music therapy were found in the latent (MD: -0.73; 95% CI -0.99; -0.48) and active (MD: -0.68; 95% CI -0.92; -0.44) phases of labor. VAS scores for anxiety decreased both in the latent (MD: -0.74; 95% CI -1.00; -0.48) and active (MD: -0.76; 95% CI -0.88; -0.64) phases. Conclusion: Music therapy seems to have beneficial effects on pain intensity and anxiety during labor, especially for women giving birth for the first time. However, the evidence is qualified as low.

The AEDUCATE Collaboration. Comprehensive antenatal education birth preparation programmes to reduce the rates of caesarean section in nulliparous women. Protocol for an individual participant data prospective meta-analysis

INTRODUCTION

Rates of medical interventions in normal labour and birth are increasing. This prospective meta-analysis (PMA) proposes to assess whether the addition of a comprehensive multicomponent birth preparation programme reduces caesarean section (CS) in nulliparous women compared with standard hospital care. Additionally, do participant characteristics, intervention components or hospital characteristics modify the effectiveness of the programme? METHODS AND ANALYSIS: Population: women with singleton vertex pregnancies, no planned caesarean section (CS) or epidural.Intervention: in addition to hospital-based standard care, a comprehensive antenatal education programme that includes multiple components for birth preparation, addressing the three objectives: preparing women and their birth partner/support person for childbirth through education on physiological/hormonal birth (knowledge and understanding); building women's confidence through psychological preparation (positive mindset) and support their ability to birth without pain relief using evidence-based tools (tools and techniques). The intervention could occur in a hospital-based or community setting.Comparator: standard care alone in hospital-based maternity units.

OUTCOMES

Primary: CS.Secondary: epidural analgesia, mode of birth, perineal trauma, postpartum haemorrhage, newborn resuscitation, psychosocial well-being.Subgroup analysis: parity, model of care, maternal risk status, maternal education, maternal socio-economic status, intervention components.

STUDY DESIGN

An individual participant data (IPD) prospective meta-analysis (PMA) of randomised controlled trials, including cluster design. Each trial is conducted independently but share core protocol elements to contribute data to the PMA. Participating trials are deemed eligible for the PMA if their results are not yet known outside their Data Monitoring Committees.

ETHICS AND DISSEMINATION

Participants in the individual trials will consent to participation, with respective trials receiving ethical approval by their local Human Research Ethics Committees. Individual datasets remain the property of trialists, and can be published prior to the publication of final PMA results. The overall data for meta-analysis will be held, analysed and published by the collaborative group, led by the Cochrane PMA group.

TRIAL REGISTRATION NUMBER

CRD42020103857.

Complementary and alternative therapies for post-caesarean pain

BACKGROUND

Pain after caesarean sections (CS) can affect the well-being of the mother and her ability with her newborn. Conventional pain-relieving strategies are often underused because of concerns about the adverse maternal and neonatal effects. Complementary alternative therapies (CAM) may offer an alternative for post-CS pain.

OBJECTIVES

To assess the effects of CAM for post-caesarean pain.

SEARCH METHODS

We searched Cochrane Pregnancy and Childbirth's Trials Register, LILACS, PEDro, CAMbase, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (6 September 2019), and checked the reference lists of retrieved articles.

SELECTION CRITERIA

Randomised controlled trials (RCTs), including quasi-RCTs and cluster-RCTs, comparing CAM, alone or associated with other forms of pain relief, versus other treatments or placebo or no treatment, for the treatment of post-CS pain.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed study selection, extracted data, assessed risk of bias and assessed the certainty of evidence using GRADE.

MAIN RESULTS

We included 37 studies (3076 women) which investigated eight different CAM therapies for post-CS pain relief. There is substantial heterogeneity among the trials. We downgraded the certainty of evidence due to small numbers of women participating in the trials and to risk of bias related to lack of blinding and inadequate reporting of randomisation processes. None of the trials reported pain at six weeks after discharge. Primary outcomes were pain and adverse effects, reported per intervention below. Secondary outcomes included vital signs, rescue analgesic requirement at six weeks after discharge; all of which were poorly reported, not reported, or we are uncertain as to the effect Acupuncture or acupressure We are very uncertain if acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus placebo plus analgesia) has any effect on pain because the quality of evidence is very low. Acupuncture or acupressure plus analgesia (versus analgesia) may reduce pain at 12 hours (standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.64 to 0.07; 130 women; 2 studies; low-certainty evidence) and 24 hours (SMD -0.63, 95% CI -0.99 to -0.26; 2 studies; 130 women; low-certainty evidence). It is uncertain whether acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus analgesia) has any effect on the risk of adverse effects because the quality of evidence is very low. Aromatherapy Aromatherapy plus analgesia may reduce pain when compared with placebo plus analgesia at 12 hours (mean difference (MD) -2.63 visual analogue scale (VAS), 95% CI -3.48 to -1.77; 3 studies; 360 women; low-certainty evidence) and 24 hours (MD -3.38 VAS, 95% CI -3.85 to -2.91; 1 study; 200 women; low-certainty evidence). We are uncertain if aromatherapy plus analgesia has any effect on adverse effects (anxiety) compared with placebo plus analgesia. Electromagnetic therapy Electromagnetic therapy may reduce pain compared with placebo plus analgesia at 12 hours (MD -8.00, 95% CI -11.65 to -4.35; 1 study; 72 women; low-certainty evidence) and 24 hours (MD -13.00 VAS, 95% CI -17.13 to -8.87; 1 study; 72 women; low-certainty evidence). Massage We identified six studies (651 women), five of which were quasi-RCTs, comparing massage (foot and hand) plus analgesia versus analgesia. All the evidence relating to pain, adverse effects (anxiety), vital signs and rescue analgesic requirement was very low-certainty. Music Music plus analgesia may reduce pain when compared with placebo plus analgesia at one hour (SMD -0.84, 95% CI -1.23 to -0.46; participants = 115; studies = 2; I2 = 0%; low-certainty evidence), 24 hours (MD -1.79, 95% CI -2.67 to -0.91; 1 study; 38 women; low-certainty evidence), and also when compared with analgesia at one hour (MD -2.11, 95% CI -3.11 to -1.10; 1 study; 38 women; low-certainty evidence) and at 24 hours (MD -2.69, 95% CI -3.67 to -1.70; 1 study; 38 women; low-certainty evidence). It is uncertain whether music plus analgesia has any effect on adverse effects (anxiety), when compared with placebo plus analgesia because the quality of evidence is very low. Reiki We are uncertain if Reiki plus analgesia compared with analgesia alone has any effect on pain, adverse effects, vital signs or rescue analgesic requirement because the quality of evidence is very low (one study, 90 women). Relaxation Relaxation may reduce pain compared with standard care at 24 hours (MD -0.53 VAS, 95% CI -1.05 to -0.01; 1 study; 60 women; low-certainty evidence). Transcutaneous electrical nerve stimulation TENS (versus no treatment) may reduce pain at one hour (MD -2.26, 95% CI -3.35 to -1.17; 1 study; 40 women; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce pain compared with placebo plus analgesia at one hour (SMD -1.10 VAS, 95% CI -1.37 to -0.82; 3 studies; 238 women; low-certainty evidence) and at 24 hours (MD -0.70 VAS, 95% CI -0.87 to -0.53; 108 women; 1 study; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce heart rate (MD -7.00 bpm, 95% CI -7.63 to -6.37; 108 women; 1 study; low-certainty evidence) and respiratory rate (MD -1.10 brpm, 95% CI -1.26 to -0.94; 108 women; 1 study; low-certainty evidence). We are uncertain if TENS plus analgesia (versus analgesia) has any effect on pain at six hours or 24 hours, or vital signs because the quality of evidence is very low (two studies, 92 women).

AUTHORS' CONCLUSIONS

Some CAM therapies may help reduce post-CS pain for up to 24 hours. The evidence on adverse events is too uncertain to make any judgements on safety and we have no evidence about the longer-term effects on pain. Since pain control is the most relevant outcome for post-CS women and their clinicians, it is important that future studies of CAM for post-CS pain measure pain as a primary outcome, preferably as the proportion of participants with at least moderate (30%) or substantial (50%) pain relief. Measuring pain as a dichotomous variable would improve the certainty of evidence and it is easy to understand for non-specialists. Future trials also need to be large enough to detect effects on clinical outcomes; measure other important outcomes as listed lin this review, and use validated scales.

Reduction of COVID-19 Anxiety Levels Through Relaxation Techniques: A Study Carried Out in Northern Spain on a Sample of Young University Students

Since March 14, 2020, Spain has been in a state of alarm due to the crisis created by the outbreak of COVID-19. This measure has led to strict levels of lockdown. This situation has led to an increase in anxiety levels among the younger population. For this reason, an intervention was carried out on university voluntary participants in order to help lower their anxiety levels. Specifically, a telematic workshop was implemented to teach emotional literacy and relaxation techniques combined with the practice of the techniques in an autonomous manner. Anxiety measurements were taken before and after the workshop using the Generalized Anxiety Disorder – 7 (GAD-7) scale. The results show that Jacobson’s progressive relaxation techniques, Schultz’s autogenic training, abdominal relaxations, and visualizations are effective in lowering the anxiety levels of university students as an alternative to pharmacotherapy.

Touching the social robot PARO reduces pain perception and salivary oxytocin levels

Human-human social touch improves mood and alleviates pain. No studies have so far tested the effect of human-robot emotional touch on experimentally induced pain ratings, on mood and on oxytocin levels in healthy young adults. Here, we assessed the effect of touching the robot PARO on pain perception, on mood and on salivary oxytocin levels, in 83 young adults. We measured their perceived pain, happiness state, and salivary oxytocin. For the 63 participants in the PARO group, pain was assessed in three conditions: Baseline, Touch (touching PARO) and No-Touch (PARO present). The control group (20 participants) underwent the same measurements without ever encountering PARO. There was a decrease in pain ratings and in oxytocin levels and an increase in happiness ratings compared to baseline only in the PARO group. The Touch condition yielded a larger decrease in pain ratings compared to No-Touch. These effects correlated with the participants' positive perceptions of the interaction with PARO. Participants with higher perceived ability to communicate with PARO experienced a greater hypoalgesic effect when touching PARO. We show that human-robot social touch is effective in reducing pain ratings, improving mood and - surprisingly - reducing salivary oxytocin levels in adults.

Do Cochrane reviews reflect the latest evidence on meditation and mindfulness-based interventions? A snapshot of the current evidence

Growing evidence emphasizes the importance of meditation and mindfulness-based interventions (MBIs) in clinical settings. Here, we attempted to determine the clinical issues targeted by Cochrane reviews of meditation and MBIs and whether the judgements about quality/certainty as expressed by the Cochrane authors differed from that of non-Cochrane reviews and guidelines. The search database was the Cochrane Database of Systematic Reviews and the search date was December 31, 2019. Screening and selection of reviews was carried out by two independent authors. Overall, 20 reviews and four protocols were selected for this study. The effects of meditation and/or MBIs on various conditions described in the Cochrane reviews seemed ambiguous, with the exception of mindfulness-based stress reduction in breast cancer patients. However, we found some international clinical practice guidelines and latest non-Cochrane reviews describing meditation and MBIs to be more comprehensive and favorable. This gap is likely due to the priority-setting issues, which resulted in a lack of latest up-to-date evidence, as well as gaps in interventions of interest between Cochrane and non-Cochrane reviews.

Effect of music on labor and delivery in nulliparous singleton pregnancies: a randomized clinical trial

BACKGROUND

Women's experience of pain during labor varies greatly, and pain control is a major concern for obstetricians. Several methods have been studied for pain management for women in labor, including drug and non-drug interventions.

OBJECTIVE

To test the hypothesis that in nulliparous women with singleton pregnancies at term, listening to music would reduce the pain level during labor.

METHODS

Parallel group non-blinded randomized clinical trial conducted at a single center in Italy. Nulliparous women in spontaneous labor with singleton pregnancies and vertex presentation admitted in labor and delivery room between 37 0/7 and 42 0/7 weeks of gestation for active phase of labor were eligible, and were randomized in a 1:1 ratio to receive music during labor or no music during labor. Music in labor was defined listening to music from the randomization until the delivery of the baby. The primary endpoint was the pain level during the active phase of labor, recorded using the visual analogue scale (VAS) for pain, ranging from 0 (no pain) to 10 (unbearable pain). The effect of music use during labor on each outcome was quantified as the mean difference (MD) with 95% confidence interval (CI).

RESULTS

During the study period, 30 women agree to take part in the study, underwent randomization, and were enrolled and followed up. 15 women were randomized in the music group, and 15 in the control group. No patients were lost to follow up for the primary outcome. Pain level during the active phase of labor was scored 8.8 ± 0.9 in the music group, and 9.8 ± 0.3 in the control group (MD - 1.00 point, 95% CI - 1.48 to - 0.52; P < 0.01). Music during labor and delivery was also associated with a decreased pain at 1 h postpartum (MD - 2.40 points, 95% CI - 4.30 to - 0.50), and decreased anxiety level during active phase of labor (MD - 19.90 points, 95% CI - 38.72 to - 1.08), second stage of labor (MD - 49.40 points, 95% CI - 69.44 to - 29.36), and at 1 h postpartum (MD - 27.00 points, 95% CI - 47.37 to - 6.63).

CONCLUSION

In nulliparous women with singleton pregnancies at term, listening to music reduces the pain level, and the anxiety level during labor.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03779386.

Acupuncture or acupressure for pain management during labour

BACKGROUND

Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence about the use of acupuncture and acupressure for pain management in labour. This is an update of a review last published in 2011.

OBJECTIVES

To examine the effects of acupuncture and acupressure for pain management in labour.

SEARCH METHODS

For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, (25 February 2019), the Cochrane Central Register of Controlled Trials (the Cochrane Library 2019, Issue 1), MEDLINE (1966 to February 2019), CINAHL (1980 to February 2019), ClinicalTrials.gov (February 2019), the WHO International Clinical Trials Registry Platfory (ICTRP) (February 2019) and reference lists of included studies.

SELECTION CRITERIA

Published and unpublished randomised controlled trials (RCTs) comparing acupuncture or acupressure with placebo, no treatment or other non-pharmacological forms of pain management in labour. We included all women whether nulliparous or multiparous, and in spontaneous or induced labour. We included studies reported in abstract form if there was sufficient information to permit assessment of risk of bias. Trials using a cluster-RCT design were eligible for inclusion, but quasi-RCTs or cross-over studies were not.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included 28 trials with data reporting on 3960 women. Thirteen trials reported on acupuncture and 15 trials reported on acupressure. No study was at a low risk of bias on all domains. Pain intensity was generally measured on a visual analogue scale (VAS) of 0 to 10 or 0 to 100 with low scores indicating less pain. Acupuncture versus sham acupuncture Acupuncture may make little or no difference to the intensity of pain felt by women when compared with sham acupuncture (mean difference (MD) -4.42, 95% confidence interval (CI) -12.94 to 4.09, 2 trials, 325 women, low-certainty evidence). Acupuncture may increase satisfaction with pain relief compared to sham acupuncture (risk ratio (RR) 2.38, 95% CI 1.78 to 3.19, 1 trial, 150 women, moderate-certainty evidence), and probably reduces the use of pharmacological analgesia (RR 0.75, 95% CI 0.63 to 0.89, 2 trials, 261 women, moderate-certainty evidence). Acupuncture may have no effect on assisted vaginal birth (very low-certainty evidence), and probably little to no effect on caesarean section (low-certainty evidence). Acupuncture compared to usual care We are uncertain if acupuncture reduces pain intensity compared to usual care because the evidence was found to be very low certainty (standardised mean difference (SMD) -1.31, 95% CI -2.14 to -0.49, 4 trials, 495 women, I² = 93%). Acupuncture may have little to no effect on satisfaction with pain relief (low-certainty evidence). We are uncertain if acupuncture reduces the use of pharmacological analgesia because the evidence was found to be very low certainty (average RR 0.72, 95% CI 0.60 to 0.85, 6 trials, 1059 women, I² = 70%). Acupuncture probably has little to no effect on assisted vaginal birth (low-certainty evidence) or caesarean section (low-certainty evidence). Acupuncture compared to no treatment One trial compared acupuncture to no treatment. We are uncertain if acupuncture reduces pain intensity (MD -1.16, 95% CI -1.51 to -0.81, 163 women, very low-certainty evidence), assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupuncture compared to sterile water injection We are uncertain if acupuncture has any effect on use of pharmacological analgesia, assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupressure compared to a sham control We are uncertain if acupressure reduces pain intensity in labour (MD -1.93, 95% CI -3.31 to -0.55, 6 trials, 472 women) or assisted vaginal birth because the evidence was found to be very low certainty. Acupressure may have little to no effect on use of pharmacological analgesia (low-certainty evidence). Acupressure probably reduces the caesarean section rate (RR 0.44, 95% CI 0.27 to 0.71, 4 trials, 313 women, moderate-certainty evidence). Acupressure compared to usual care We are uncertain if acupressure reduces pain intensity in labour (SMD -1.07, 95% CI -1.45 to -0.69, 8 trials, 620 women) or increases satisfaction with pain relief (MD 1.05, 95% CI 0.75 to 1.35, 1 trial, 105 women) because the evidence was found to be very low certainty. Acupressure may have little to no effect on caesarean section (low-certainty evidence). Acupressure compared to a combined control Acupressure probably slightly reduces the intensity of pain during labour compared with the combined control (measured on a scale of 0 to 10 with low scores indicating less pain) (SMD -0.42, 95% CI -0.65 to -0.18, 2 trials, 322 women, moderate-certainty evidence). We are uncertain if acupressure has any effect on the use of pharmacological analgesia (RR 0.94, 95% CI 0.71 to 1.25, 1 trial, 212 women), satisfaction with childbirth, assisted vaginal birth or caesarean section because the certainty of the evidence was all very low. No studies were found that reported on sense of control in labour and only one reported on satisfaction with the childbirth experience.

AUTHORS' CONCLUSIONS

Acupuncture in comparison to sham acupuncture may increase satisfaction with pain management and reduce use of pharmacological analgesia. Acupressure in comparison to a combined control and usual care may reduce pain intensity. However, for other comparisons of acupuncture and acupressure, we are uncertain about the effects on pain intensity and satisfaction with pain relief due to very low-certainty evidence. Acupuncture may have little to no effect on the rates of caesarean or assisted vaginal birth. Acupressure probably reduces the need for caesarean section in comparison to a sham control. There is a need for further high-quality research that include sham controls and comparisons to usual care and report on the outcomes of sense of control in labour, satisfaction with the childbirth experience or satisfaction with pain relief.