Nonpharmacological Methods to Reduce Pain During Active Labor in A Real-life Setting

Abstract

Objective To evaluate the association between pain intensity in the active phase of the first stage of labor with the use or not of nonpharmacological methods for pain relief in a real-life scenario.

Methods This was an observational cross-sectional study. The variables analyzed were obtained by a questionnaire with the mothers (up to 48 hours postpartum) to investigate the intensity of pain during labor using the visual analog scale (VAS). The nonpharmacological pain relief methods routinely used in obstetric practice were evaluated by consulting medical records. The patients were separated into two groups: Group I – patients who did not use nonpharmacological methods for pain relief and Group II –patients who used these methods.

Results A total of 439 women who underwent vaginal delivery were included; 386 (87.9%) used at least 1 nonpharmacological method and 53 (12.1%) did not. The women who did not use nonpharmacological methods had significantly lower gestational age (37.2 versus 39.6 weeks, p < 0.001) and shorter duration of labor (24 versus 114 min, p < 0.001) than those who used the methods. There was no statistically significant difference in the pain scale score using the VAS between the group that used nonpharmacological methods and the group that did not (median 10 [minimum 2–maximum 10] versus 10 [minimum 6–maximum 10] p = 0.334).

Conclusion In a real-life setting, there was no difference in labor pain intensity between the patients who used nonpharmacological methods and those who did not use them during the active phase of labor.

Resumo

Objetivo Avaliar a associação da intensidade da dor na fase ativa da dilatação do parto em mulheres de acordo com a utilização ou não de métodos não farmacológicos para alívio da dor em cenário de vida real.

Métodos Trata-se de um estudo observacional de corte transversal. As variáveis analisadas foram obtidas através de questionário com as puérperas (até 48 horas pós-parto) investigando a intensidade da dor no parto pela escala visual analógica (EVA). As medidas não farmacológicas de alívio da dor, utilizadas rotineiramente na prática obstétrica, foram avaliadas pela consulta aos prontuários. As pacientes foram separadas em dois grupos: Grupo I – pacientes que não utilizaram medidas não farmacológicas para alívio da dor e Grupo II - pacientes que utilizaram estas medidas.

Resultados Foram incluídas 439 mulheres que tiveram parto vaginal, sendo que 386 (87,9%) utilizaram, pelo menos, uma medida não farmacológica e 53 (12,1%) não utilizaram. As mulheres que não utilizaram as medidas não farmacológicas apresentaram idade gestacional significativamente menor (37,2 versus 39,6 semanas, p < 0,001) e menor duração do trabalho de parto (24 versus 114 minutos, p < 0,001) quando comparadas às que utilizaram as medidas. Não houve diferença estatisticamente significativa na pontuação da escala da dor pela EVA de acordo com a categorização pelo uso ou não de métodos não farmacológicos (mediana 10 [mínimo 2–máximo 10] versus 10 (mínimo 6–máximo 10), p = 0,334].

Conclusão Em cenário de vida real, as pacientes submetidas aos métodos não farmacológicos não apresentaram diferença em relação à intensidade da dor quando comparadas às que não os utilizaram durante a fase ativa do trabalho de parto.

Keywords

labor delivery - pain - intensity - visual analog scale

Palavras-chave

trabalho de parto - parto - intensidade - escala visual analógica

Contributors

All authors participated in the concept and design of the study, in the analysis and interpretation of data, in the draft or revision of the manuscript, and they have approved the manuscript as submitted. All authors are responsible for the reported research.

Publikationsverlauf

Eingereicht: 12. November 2021

Angenommen: 25. August 2022

Artikel online veröffentlicht:
06. März 2023

• References

• 1 Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S. et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 2020; 161 (09) 1976-1982
• 2 Lowe NK. The nature of labor pain. Am J Obstet Gynecol 2002; 186 (5, Suppl Nature): S16-S24
• 3 Gau ML, Chang CY, Tian SH, Lin KC. Effects of birth ball exercise on pain and self-efficacy during childbirth: a randomised controlled trial in Taiwan. Midwifery 2011; 27 (06) e293-e300
• 4 Leung RW, Li JF, Leung MK, Fung BKY, Fung LCW, Tai SM. et al. Efficacy of birth ball exercises on labour pain management. Hong Kong Med J 2013; 19 (05) 393-399
• 5 Makvandi S, Latifnejad Roudsari R, Sadeghi R, Karimi L. Effect of birth ball on labor pain relief: A systematic review and meta-analysis. J Obstet Gynaecol Res 2015; 41 (11) 1679-1686
• 6 Chang MY, Chen CH, Huang KF. A comparison of massage effects on labor pain using the McGill Pain Questionnaire. J Nurs Res 2006; 14 (03) 190-197
• 7 Taghinejad H, Delpisheh A, Suhrabi Z. Comparison between massage and music therapies to relieve the severity of labor pain. Womens Health (Lond Engl) 2010; 6 (03) 377-381
• 8 Silva Gallo RB, Santana LS, Jorge Ferreira CH, Marcolin AC, Polineto OB, Duarte G. et al. Massage reduced severity of pain during labour: a randomised trial. J Physiother 2013; 59 (02) 109-116
• 9 Smith CA, Levett KM, Collins CT, Jones L. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database Syst Rev 2012; (02) CD009290
• 10 Davim RM, Torres GV, Dantas JC, Melo ES, Paiva CP, Vieira D. et al. [Showering as a non-pharmacological strategy to relief the parturients pain]. Rev Eletrônica Enferm 2008; 10 (03) 600-609
• 11 Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 2001; 8 (12) 1153-1157
• 12 Wadhwa Y, Alghadir AH, Iqbal ZA. Effect of antenatal exercises, including yoga, on the course of labor, delivery and pregnancy: a retrospective study. Int J Environ Res Public Health 2020; 17 (15) 5274
• 13 Czech I, Fuchs P, Fuchs A, Lorek M, Tobolska-Lorek D, Drosdzol-Cop A. et al. Pharmacological and non-pharmacological methods of labour pain relief-establishment of effectiveness and comparison. Int J Environ Res Public Health 2018; 15 (12) 2792
• 14 Martinez JE, Grassi DC, Marques LG. Analysis of the applicability of different pain questionnaires in three hospital settings: outpatient clinic, ward and emergency unit. Rev Bras Reumatol 2011; 51 (04) 299-303 , 308
• 15 Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol 2014; 123 (03) 693-711
• 16 Lopes F, Nakamura MU, Nomura RMY. Women's satisfaction with childbirth in a public hospital in Brazil. Birth 2021; 48 (02) 251-256
• 17 Yuksel H, Cayir Y, Kosan Z, Tastan K. Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial. J Integr Med 2017; 15 (06) 456-461
• 18 Smith CA, Levett KM, Collins CT, Dahlen HG, Ee CC, Suganuma M. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database Syst Rev 2018; 3 (03) CD009290
• 19 Pawale MP, Salunkhe JA. Effectiveness of back massage on pain relief during first stage of labor in primi mothers admitted at a Tertiary care center. J Family Med Prim Care 2020; 9 (12) 5933-5938
• 20 Kaçar N, Özcan Keser N. Comparison of the effect of mechanical massage and warm mechanical massage application on perceived labor pain and childbirth experience: A randomized clinical trial. Eur J Midwifery 2021; 5: 5
• 21 Boateng EA, Kumi LO, Diji AK. Nurses and midwives' experiences of using non-pharmacological interventions for labour pain management: a qualitative study in Ghana. BMC Pregnancy Childbirth 2019; 19 (01) 168
• 22 Kumarilohar S, Deepak Y, Vaishnav A. An experimental study to assess effectiveness of music therapy in labor pain reduction among primigravida Mothers in first stage of labor in selected hospitals at Udaipur, Rajasthan. IOSR J Nurs Health Sci 2018; 7 (04) 28-32
• 23 Khatony A, Soroush A, Andayeshgar B, Saedpanah N, Abdi A. Attitude of primiparous women towards their preference for delivery method: a qualitative content analysis. Arch Public Health 2019; 77: 38
• 24 Skeide A. Experiences as actors: labor pains in childbirth care in Germany. Med Anthropol 2021; 40 (05) 446-457