Query: Nonpharmacological methods for decreasing labor pain

title: Nonpharmacological methods for decreasing labor pain
abstract: Labor pain can be severe pain, and the use of analgesics for women during labor is often not sufficient to relieve it. Additional, nonpharamacological methods can be used to relieve pain. The nonpharmacological methods can be introduced either during pregnancy or during labor. Three main types of nonpharmacological methods in decreasing pain during labor are: 1) techniques reducing painful stimuli, such as movement and position, counterpressure, and abdominal decompression, 2) techniques activating peripheral sensory receptors, such as superficial hot and cold treatments, hydrotherapy, touching and massage, transcutaneous electrical nerve stimulation, and acupuncture and acupressure, and 3) techniques enhancing descending inhibitory pathways, such as music therapy, attention focusing and distraction, and aromatherapy.

title: Factors Affecting Midwives' Decision to Offer Complementary and Alternative Medicine/Nonpharmacological Pain Relief Methods for Labor and Birth
abstract: This study examines how characteristics of birth settings influence midwives' decision to offer complementary and alternate nonpharmacological pain relief in labor and childbirth.  This is a nonexperimental design. A convenience sample of midwives (N 520) members of the American College of Nurse Midwives (ACNM) were surveyed using a 51 item Likert type scale questionnaire. Midwives were assigned to 1 of 3 primary birth settings (hospital, birthing center, home birth) for data analysis to identify if certain characteristics (policies/protocols, use of technology, providers' knowledge and beliefs, and midwives' relationship with collaborating obstetricians) in the birth setting influence a midwife's decision to offer nonpharmacological pain relief methods in labor and birth.  Findings indicate that knowledge and beliefs of health care providers most influenced midwives' decisions. Although factors of the birth environment influence midwives' decisions to offer nonpharmacological pain management in labor, they do not prevent midwives from using most of the nonpharmacological pain relief methods during labor and birth.  It would appear that the midwives' philosophy of care more than the characteristics of the birth setting influence midwives' decisions to offer nonpharmacological pain relief methods. Educating health care providers about nonpharmacological pain relief methods would further maximize midwives' ability to use these strategies.

title: Comparison of the Effect of Three methods of Massage, Hot Compress and Normal Perineal Care on Perceived Stress and the Severity of Labor Pain in First Born Mothers
abstract: Natural childbirth is a painful experience that can be treated with nonpharmacological methods to reduce the pain and stress. The aim of this study was to compare the effect of massage, hot compress and normal perineal care methods on perceived stress and the severity of labor pain in first born mothers.  The present study was a quasi experimental study. The research population consisted of first born pregnant women in Gonbad e Kavous. A total of 150 samples were included in the study, which were randomly assigned to one of three groups of massage therapy, hot perineal compression, and routine perineal care. Perceived stress and McGill pain questionnaires were used to collect data. Data analysis was performed using descriptive and inferential statistical methods including independent t test, chi square and repeated meassure, using SPSS software version 16.  The mean stress scores were 23.78+ 3.4 in massage therapy group, 23.66+ 1.7 in hot compress group and 25.3+ 2.04 in normal care group. Statistically, there was a significant difference between the perceived stress scores of massage therapy (p=0.009) and hot compression groups (p=0.001) at different times, but in normal care group (p=0.162) this difference was not significant. In terms of pain intensity, the mean scores after 20 minutes intervention was 5.29 in massage group, 5.45 in hot compression group and 7.15 in normal care group (from a totall score of 10) Statistically, the mean scores of pain intensity before and after the intervention in the massage therapy (p=0.001) and warm compression (p=0.013) groups were significantly different.  Based on the results, hot compress method was more effective in reducing stress and massage therapy was more effective in relieving pain than other two methods. Therefore, these methods can be used as safe and secure ways to control the pain and stress of first born mothers.

title: Murotal Al Quran therapy on decreasing labor pain and anxiety in maternity mothers first phase.
abstract: Childbirth is a physiological event in every development of a woman to become a mother. This event can cause trauma because of the pain she experienced. The main factors in labor are passage, passager and power, psychological (psychological factors) and childbirth helpers. A woman needs physical, emotional, psychosexual and psychosocial maturity before marriage and becomes pregnant. Feelings of anxiety, fear of pain will make women uneasy facing pregnancy, childbirth and childbirth, non pharmacological therapy that can be given in various ways, namely; acupressure, acupuncture, cold compresses, warm compresses, hydrotherapy, hypnotherapy, endorphin massage, relaxation and distraction techniques. The effectiveness of giving murotal Al Quran audio will increase the power of faith and provide peace of mind.  The purpose of this study is to determine the effectiveness of Murotal Al Quran Therapy on Decreasing Labor Pain and Anxiety in Maternity in the First Phase in Maternity Clinic Ar Rahmah Indralaya Ogan Ilir. The population of this research was maternity inpartu when I was an active phase which amounted to 20 people.  The type of research used in this study was quasi experiment. The research design used was one group comparison pretest posttest design to test the intensity of pain intensity using Shapiro Wilk.  From the results of the study obtained the normality test obtained p=0.039 and 0.069 which showed the data did not normally distribute, the difference between before and after being given Murotal Al Quran 0.30 with p=0.008 showed that there was a difference in pain scale before and after therapy Murotal Al Quran, for the anxiety of the difference between before and after being given therapeutic Murotal Al Quran 0.021 with p=0.025 which shows that there are differences in pain scale before and after the Murotal Al Quran is concluded.  It can be concluded that Murotal Al Quran can reduce pain and anxiety in maternity when I was an active phase. It is expected that midwives can improve services through the development of midwifery care, especially for women who experience severe pain.

title: The Effectiveness of Acupressure Hegu LI 4 on Decreasing Labor Pain During Active Phase
abstract: Childbirth is a moment full of stress that causes pain, fear, and anxiety. Acupressure Hegu LI 4 is one of the techniques to reduce pain during labor. Objective of the study was to identify the difference in pain on first stage active phase of labor in acupressure Hegu LI 4 group and control group. Samples were obtained through consecutive sampling technique from parturient which fulfill inclusion criteria. The study was a quasy experiment design. Data analysis used mean and deviation standard for univariate analysis, Independent Sample T Test for bivariable analysis, and linier regretion for multivariable analysis. Mean of decrease of pain labor in aromatheraphy group was higher than control group. The mean decrease in pain score in the intervention group was 3.03 0.669 while the mean reduction in pain in the control group was 2.07 0.740. The average difference from the Independent Sample T Test obtained significant results with P values <0.001 and 95% C.I. 1,331 0,602) Analysis of external variables that affect the decrease in labor pain scores is anxiety with P value 0.020. The results of this study are expected to be the basis of studies in the field of midwifery, especially labor on effective methods to reduce labor pain in a non pharmacological manner.

title: Nonpharmacological Methods for Reducing Parental Concern for Infant Vaccine Associated Pain.
abstract: Numerous studies demonstrate that parental concern for infant pain contributes to vaccine hesitancy. The purpose of this project was to alleviate parental concern for pain and facilitate infant immunization. METHOD Pediatric nurses at an urban ambulatory clinic implemented evidence based nonpharmacological methods (breastfeeding or 24% sucrose solution) for managing vaccine pain in infants aged up to 6 months. A validated survey measured parental concern for vaccine related pain before and after the implementation of pain relief interventions.  There was a statistically significant decrease in parental concern for vaccine pain from pre to postintervention between both treatment groups (p .035) DISCUSSION Nurses can effectively use nonpharmacological methods to alleviate the pain of infants undergoing routine vaccination while reducing the parental concern for vaccine associated pain. Reducing infant pain and parental concern may increase vaccination rates.

title: Whole Health Options and Pain Education (wHOPE) A Pragmatic Trial Comparing Whole Health Team vs Primary Care Group Education to Promote Nonpharmacological Strategies to Improve Pain, Functioning, and Quality of Life in Veterans Rationale, Methods, and Implementation.
abstract: The Whole Health model of the U.S. Department of Veterans Affairs (VA) emphasizes holistic self care and multimodal approaches to improve pain, functioning, and quality of life. wHOPE (Whole Health Options and Pain Education) seeks to be the first multisite pragmatic trial to establish evidence for the VA Whole Health model for chronic pain care. DESIGN wHOPE is a pragmatic randomized controlled trial comparing a Whole Health Team (WHT) approach to Primary Care Group Education (PC GE) both will be compared to Usual VA Primary Care (UPC) The WHT consists of a medical provider, a complementary and integrative health (CIH) provider, and a Whole Health coach, who collaborate with VA patients to create a Personalized Health Plan emphasizing CIH approaches to chronic pain management. The active comparator, PC GE, is adapted group cognitive behavioral therapy for chronic pain. The first aim is to test whether the WHT approach is superior to PC GE and whether both are superior to UPC in decreasing pain interference in functioning in 750 veterans with moderate to severe chronic pain (primary outcome) Secondary outcomes include changes in pain severity, quality of life, mental health symptoms, and use of nonpharmacological and pharmacological therapies for pain. Outcomes will be collected from the VA electronic health record and patient reported data over 12 months of follow up.  2 consists of an implementation focused process evaluation and budget impact analysis.  This trial is part of the Pain Management Collaboratory, which seeks to create national level infrastructure to support evidence based nonpharmacological pain management approaches for veterans and military service personnel.

title: Effectiveness of reflexology on labor pain: A systematic review and meta analysis
abstract: Reflexology is one of the nonpharmacological methods of pain management; however, its effectiveness on labor pain is not clear. Also, reflexology is a noninvasive complementary method used for pain relief during labor, but its efficacy in alleviating labor pain has not yet been confirmed clearly. This meta analysis assessed the efficacy of this simple and noninvasive method in reducing labor pain.  A systematic search of all clinical trials studies on Cochrane, Scopus, Web of Science, Ovid, PubMed ,Google Scholar, Irandoc, ScienceDirect, Magiran, Sid, and Iran Medex was done up to June 2017. The pooled mean difference with random effects model was used for meta analyses. Heterogeneity of the studies was analyzed using the I2 calculation index. Variance between studies was analyzed using (Tau2) and STATA software.  In this study, 7 relevant studies with 1142 participants were selected for meta analysis. A significant difference was found between reflexology and pain intensity after intervention (MD= 0.54, 95% CI: 1.08 to 0.004) 6 8 cm dilation (MD 2.29, 95% CI: 2.52 to 2.07) 8 10 cm dilation (MD= 1.03, 95% CI: 1.21 to 0.85) 1 hour after intervention (MD 1.55, 95% CI: 2.94 to 0.16) 2 hours after intervention (MD= 2.81, 95% CI: 3.27 to 2.35) and in the second stage subgroup (MD= 2.14, 95% CI: 4.61 to 0.33)  This study showed reflexology is an effective method for alleviation of labor pain. Therefore, this method can be used to reduce the labor pain.

title: NON PHARMACOLOGICAL TECHNIQUES IN LABOR PAIN MANAGEMENT
abstract: Birth pain, which is acute pain, is one of the most severe types of pain known. However, this pain differs from other types of pain in that it is a part of a natural process, it occurs within a limited period time, and the mother's willingness to endure these painfully for her baby. Birth pain also adversely affects the woman's perception of labor. Failure to control birth pain causes pregnant women to perceive birth negatively, have negative experiences about birth, and decrease their satisfaction. Nonpharmacological methods affect the cognitive, emotional, behavioral, and sociocultural dimensions of the pain and lead the woman to perceive the pain at the lowest level by providing relaxation. The purpose of the methods used to relieve pain at birth is to directly reduce or regulate birth pain without any negative effects on the mother and baby. They do not slow down labor, there have no risk of side effects or allergies, they are very economical, comfortable, reliable, and easy to use.

title: Perceptions and Practice of Labor Pain Relief Methods among Health Professionals Conducting Delivery in Minia Maternity Units in Egypt
abstract: In low resource settings (LRSs) pain relief during labor is often neglected. Women and health professionals (HPs) may lack awareness of analgesic options, may not accept these options, or may have concerns regarding their safety. Furthermore, even if women or HPs preferred labor analgesia, options may not be available at the hospital. This study was carried out to explore how HPs perceive and practice pain management during labor in Minia maternity units in Egypt.  A structured, self administered questionnaire from 306 HPs in Minia maternity units from August 1, 2016, to August 30, 2017, after approval by the organizational Ethical Review Committee.  The response rate was 76.5% The majority, 78.2% of participants, believed in pain relief during labor. However, their practices are different. In the first stage of labor, almost 44.9% used nonpharmacological methods, whereas 36.8% used neither pharmacological nor nonpharmacological methods. Hospital related factors were the major barriers against using pain relief methods, as stated by HPs.  Although most HPs understand the role of analgesia in labor pain relief, there is a wide gap between the use of pain relief methods and women's need in Minia, Egypt; HPs claim this is due to health care facilities. There is an urgent need to identify the barriers against and raise the awareness among the community and HPs of the need to use pain relief methods as part of improving the quality of care during labor.