Masters Degrees (Nursing and Midwifery)

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Browsing Masters Degrees (Nursing and Midwifery) by Author "Abelgas, Marjorie Caroline"

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    A systematic review of randomised controlled trials of non-pharmacological pain relief strategies for pregnant women in labour
    (Stellenbosch : University of Stellenbosch, 2011-03) Abelgas, Marjorie Caroline; Taha, Marinda; Khondowe, Oswell; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
    ENGLISH ABSTRACT: Background: For several decades childbirth educators and midwives have focused on the alleviation or reduction of pain and suffering during the childbirth experience (Brown, Douglas & Flood 2001:1). Nursing professionals who care for labouring women require 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 pain management 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 to 2010. The Medical Search Headings (MeSH) included non-pharmacological, alternative, pain management, labour, pregnant, complementary, randomised, randomly, midwifery, natural birth, relaxation, breathing, positioning, hypnosis, water birth, 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 any complications in previous or current pregnancies. The researcher searched for randomised controlled trials with an intervention and a control group. Due to financial restrictions the researcher assessed studies that were published in English only. 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 for dichotomous outcomes and Weighted mean differences and 95% Confidence Interval for continuous outcomes. Review Manager (RevMan), a statistical software was used. Where meta-analyses were impossible results were presented in narrative form. The outcome measures were a decreased need for pharmacological pain relief, maternal satisfaction with the overall childbirth experience, length of labour (normal or shorter progress), incidence of postnatal depression, incidence of postpartum 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 trials involved hydrotherapy (n=585), two trials involved acupuncture (n=480), two trials involved childbirth education (n=6398), one trial involved continuous support (n=2844), one trial involved aromatherapy (n=513), one trial involved maternal positioning (n=2547), one trial involved music, massage and relaxation (n=90) and one trial involved hypnosis (n=82). In the Freeman trial (1986) women in the hypnosis group required less pharmacological pain relief 15/29 compared to women in the control group 20/36. Women in the intervention group also experienced greater satisfaction with the childbirth experience 15/29 (52%) compared to women in the control group 8/36 (23%). The trials of acupuncture showed a decreased need for pharmacological pain management in Skilnand (2002) (n=208) for epidural 11/106 (10%) for the intervention and 27/102 (26.5%) for the control group as well as Pethidine 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 the need 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 is significantly 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 of 0.01. Conclusions: Acupuncture may relieve labour pain and also shorten the duration of labour, and women experience greater satisfaction with the childbirth experience. Hypnosis may decrease the need for pharmacological pain relief requirements, and may also increase an overall maternal satisfaction with the childbirth experience. There is insufficient evidence about the benefits of childbirth education, continuous support, aromatherapy, music, massage, movement and positioning, breathing and relaxation.