Outcomes to measure the effects of pharmacological interventions for pain management for women during labour and birth: a review of systematic reviews and randomised trials

BACKGROUND

Pharmacological pain management options can relieve women's pain during labour and birth. Trials of these interventions have used a wide variety of outcomes, complicating meaningful comparisons of their effects. To facilitate better assessment of the effectiveness of labour pain management in trials and meta-analyses, consensus about key outcomes and the development of a core outcome set is essential.

OBJECTIVE

To identify all outcomes used in studies of pharmacological pain management interventions during labour and birth.

DESIGN

A review of systematic reviews and their included randomised controlled trials was undertaken.

SEARCH STRATEGY

Cochrane CENTRAL was searched to identify all Cochrane systematic reviews describing pharmacological pain management options for labour and birth. Search terms included 'pain management', 'labour' and variants, with no limits on year of publication or language.

SELECTION CRITERIA

Cochrane reviews and randomised controlled trials contained within these reviews were included, provided they compared a pharmacological intervention with other pain management options, placebo or no treatment.

DATA COLLECTION AND ANALYSIS

All outcomes reported by reviews or trials were extracted and tabulated, with frequencies of individual outcomes reported.

MAIN RESULTS

Nine Cochrane reviews and 227 unique trials were included. In total, 146 unique outcomes were identified and categorised into maternal, fetal, neonatal, child, health service, provider's perspective or economic outcome domains.

CONCLUSIONS

Outcomes of pharmacological pain management interventions during labour and birth vary widely between trials. The standardisation of trial outcomes would permit the assessment of meta-analyses for best clinical practice.

TWEETABLE ABSTRACT

Outcomes to measure pharmacological pain management options during labour are highly variable and require standardisation.

Antenatal education for childbirth: Labour and birth

INTRODUCTION

This study aimed to identify the way information is described and presented by childbirth educators during antenatal classes for expectant parents, and analyse the language structures used when discussing labour and birth.

METHODS

This cross-sectional study of antenatal education was conducted at a single tertiary referral centre for Maternity Care in Western Sydney, Australia. All childbirth educators (n=3) were recorded whilst providing information to parents during antenatal classes. Audio data were subsequently transcribed and then analysed by two researchers, independently categorising the various language structures and types of information provided. This is the second study in a series of antenatal education topics.

RESULTS

During the labour and birth class, information statements were the predominant language structure that was spoken with 241 of 655 statements; negative statements were the next most frequent at 119 while there were 79 positive statements. The second stage of labour had a greater proportion of negative statements for two educators, followed by information and positive statements combined. Misinformation statements were minimal for this topic however, and there was an absence of any statements discussing the rest period between contractions.

CONCLUSIONS

The findings further emphasise the need to examine the language used by health professionals when educating parents. Negative statements during antenatal education are still common despite research in other contexts suggesting that these are potentially unhelpful. Further research into the language and suggestions used during antenatal education is required to determine whether improved outcomes seen in other contexts are confirmed in the childbirth setting.

The lived experiences of healthcare during pregnancy, birth, and three months after in women with type 1 diabetes mellitus

Being pregnant, giving birth, and becoming a mother the first months after birth, is for women with type 1 diabetes mellitus (T1DM) a period of difficult challenges. In order to identify their need of support from healthcare, the aim of this study was to describe healthcare during pregnancy, labour, birth, and up to 12 weeks after birth as experienced by Swedish women with T1DM. We used a phenomenological reflective lifeworld research approach, and made 1-2 individual interviews with ten women in late pregnancy and/or 2-3 months after. Transcribed interviews were analysed through focusing on the meanings of the study phenomenon. The results revealed how the diabetes disease, as well as the risks and responsibility that comes with it, become more visible during the period in question, due to a constant monitoring, performed by the woman herself as well as by the healthcare professionals. The essential meaning of the phenomenon is a need to share the burden of risks and responsibilities with healthcare professionals. The complex situation that these women are in, both as experts on their illness and care and in need of care, requires a care that make women feel capable and responsible, but at the same time offers support and relieve them of their responsibility when needed.

Community-based doula support for migrant women during labour and birth: study protocol for a randomised controlled trial in Stockholm, Sweden (NCT03461640)

INTRODUCTION

Migrant women consistently rate their care during labour and birth more negatively than non-migrant women, due to communication difficulties, lack of familiarity with how care is provided, and discrimination and prejudicial staff attitudes. They also report being left alone, feeling fearful, unsafe and unsupported, and have poorer birth outcomes than non-migrant women. Community-based doulas (CBDs) are bilingual women from migrant communities who are trained in childbirth and labour support, and who facilitate communication between woman-partner-staff during childbirth. This study protocol describes the design, rationale and methods of a randomised controlled trial that aims to evaluate the effectiveness of CBD support for improving the intrapartum care experiences and postnatal well-being of migrant women giving birth in Sweden.

METHODS AND ANALYSIS

A randomised controlled trial. From six antenatal care clinics in Stockholm, Sweden, we aim to recruit 200 pregnant Somali, Arabic, Polish, Russian and Tigrinya-speaking women who cannot communicate fluently in Swedish, are 18 years or older and with no contraindications for vaginal birth. In addition to standard labour support, women are randomised to CBD support (n=100) or no such support during labour (n=100). Trained CBDs meet with women once or twice before the birth, provide emotional, physical and communication support to women throughout labour and birth in hospital, and then meet with women once or twice after the birth. Women's ratings of the intrapartum care experiences and postnatal well-being are assessed at 6-8 weeks after the birth using selected questions from the Migrant Friendly Maternity Care Questionnaire and by the Edinburgh Postnatal Depression Scale. The intervention group will be compared with the control group using intention-to-treat analyses. ORs and 95% CIs will be estimated and adjustments made if key participant characteristics differ between trial arms.

ETHICS AND DISSEMINATION

The study was approved by the Regional Ethical Review Board in Stockholm (approval number: 2018/12 - 31/2).

TRIAL REGISTRATION NUMBER

NCT03461640; Pre-results.