A systematic review of randomised controlled trials of non-pharmacological pain relief strategies for pregnant women in labour

[摘要] ENGLISH ABSTRACT: Background:For several decades childbirth educators and midwives have focused on thealleviation or reduction of pain and suffering during the childbirth experience (Brown,Douglas & Flood 2001:1). Nursing professionals who care for labouring womenrequire current, evidence-based knowledge regarding pain management options,including mode of action, benefits, risks and efficacy (Florence & Palmer 2003:238).Objectives:This study examined the effects of non-pharmacological pain relief strategies for painmanagement during labour.Search methods:The researcher conducted a search between February and May 2010 on PubMed,CINAHL and CENTRAL for randomised controlled trials published from inception to2010. The Medical Search Headings (MeSH) included non-pharmacological,alternative, pain management, labour, pregnant, complementary, randomised,randomly, midwifery, natural birth, relaxation, breathing, positioning, hypnosis, waterbirth, acupuncture, aromatherapy.Selection criteria:The studies included reported on pregnant women, primigravida or multigravida,term (37 weeks and more), spontaneous labour (first or second stage) without anycomplications in previous or current pregnancies. The researcher searched forrandomised controlled trials with an intervention and a control group. Due tofinancial restrictions the researcher assessed studies that were published in Englishonly. Interventions were childbirth education, continuous support, relaxation,breathing techniques, movement and positioning, music, manual healing,aromatherapy, hydrotherapy, hypnosis and acupuncture.Data collection and analysis:Meta-analysis was performed using Relative Risks and 95% Confidence Interval fordichotomous outcomes and Weighted mean differences and 95% ConfidenceInterval for continuous outcomes. Review Manager (RevMan), a statistical softwarewas used. Where meta-analyses were impossible results were presented innarrative form. The outcome measures were a decreased need for pharmacologicalpain relief, maternal satisfaction with the overall childbirth experience, length oflabour (normal or shorter progress), incidence of postnatal depression, incidence ofpostpartum haemorrhage, an Apgar score of more than seven at five minutes,resuscitation of the neonate and admission to the neonatal intensive care unit.Results:Thirteen (13) eligible RCT's were included in the systematic review. Four trialsinvolved hydrotherapy (n=585), two trials involved acupuncture (n=480), two trialsinvolved childbirth education (n=6398), one trial involved continuous support(n=2844), one trial involved aromatherapy (n=513), one trial involved maternalpositioning (n=2547), one trial involved music, massage and relaxation (n=90) andone trial involved hypnosis (n=82). In the Freeman trial (1986) women in thehypnosis group required less pharmacological pain relief 15/29 compared to womenin the control group 20/36. Women in the intervention group also experiencedgreater satisfaction with the childbirth experience 15/29 (52%) compared to womenin the control group 8/36 (23%). The trials of acupuncture showed a decreased needfor pharmacological pain management in Skilnand (2002) (n=208) for epidural11/106 (10%) for the intervention and 27/102 (26.5%) for the control group as well asPethidine 15/106 (14%) for the intervention and 36/102 (35%) for the control group.In the Borup trial (2009) it was reported that acupuncture during labour reduced theneed for pharmacological pain management for the intervention group 185/314(58.9%) compared to control 124/149 (83.2%) without affecting the birth outcome.The secondary outcome of length of labour (minutes) in the Skilnand trial issignificantly in favour of the acupuncture group with a mean value of 212 (SD, 155),compared to the control group with a mean value of 283 (SD, 225) with a p-value of0.01.Conclusions:Acupuncture may relieve labour pain and also shorten the duration of labour, andwomen experience greater satisfaction with the childbirth experience. Hypnosis maydecrease the need for pharmacological pain relief requirements, and may alsoincrease an overall maternal satisfaction with the childbirth experience. There isinsufficient evidence about the benefits of childbirth education, continuous support,aromatherapy, music, massage, movement and positioning, breathing andrelaxation.

[发布机构] Stellenbosch University