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Feng Y, Zhu F, Zhang J, Zeng Z, Li Q. Efficacy of different strategies for reducing labor pain: A Bayesian analysis. Medicine (Baltimore) 2024; 103:e37594. [PMID: 38758902 PMCID: PMC11098187 DOI: 10.1097/md.0000000000037594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 02/22/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The effectiveness of different medical interventions in managing labor pain has yielded mixed results. Therefore, this systematic review and network meta-analysis aimed to provide a comprehensive summary of the available evidence on the impact of different strategies for reducing labor pain. METHODS We systematically searched 3 English databases (Pubmed, Embase and the Cochrane Library) from inception to January 2023. Randomized controlled trials (RCTs) or controlled clinical trials that investigating the effects of different strategies for reducing labor pain were included in this network meta-analysis. Risk of bias (ROB) was assessed using the Cochrane ROB tools. Network meta-analysis was performed using the R software (version 4.2.1) with gemtc package. RESULTS A total of 9 studies involving 823 patients, including 9 treatments (acupressure, birth ball exercise, Bonapace method, distraction techniques, ice pressure, LI4 acupressure, lidocaine spray, smartphone-based music intervention and placebo). The surface under the cumulative ranking (SUCRA) shows that Bonapace method ranked first (SUCRA, 79.5%), LI4 acupressure ranked second (SUCRA, 65.6%), distraction technique ranked third (SUCRA, 57.6%), birth ball exercise ranked fourth (SUCRA, 51.8%). CONCLUSIONS According to the results of the network meta-analysis, among the different strategies examined, the Bonapace Method stands out as the most effective nonpharmacological intervention for reducing labor pain. The results of this meta-analysis can aid both patients and healthcare professionals in choosing the most effective techniques to reduce labor pain.
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Affiliation(s)
- Yuanyan Feng
- Obstetrical Department, SSL Central Hospital of Dongguan City, Dongguan, Guangdong Province, China
| | - Fengjuan Zhu
- Obstetrical Department, SSL Central Hospital of Dongguan City, Dongguan, Guangdong Province, China
| | - Junfeng Zhang
- Obstetrical Department, SSL Central Hospital of Dongguan City, Dongguan, Guangdong Province, China
| | - Zishan Zeng
- Obstetrical Department, SSL Central Hospital of Dongguan City, Dongguan, Guangdong Province, China
| | - Qiumei Li
- Obstetrical Department, SSL Central Hospital of Dongguan City, Dongguan, Guangdong Province, China
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Lim J, Lee H, Kim YS. PRECIS-2 analysis of pragmatic acupuncture trials: a systematic review. BMC Complement Med Ther 2024; 24:181. [PMID: 38702632 PMCID: PMC11067076 DOI: 10.1186/s12906-024-04473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/12/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Pragmatic acupuncture trials (PATs) are a research tool for assessing the effectiveness of acupuncture treatments in a real-world setting. This study aimed to provide a comprehensive methodological analysis of PATs using the PRECIS-2(PRagmatic Explanatory Continuum Indicator Summary-2) tool to determine their pragmatism. METHODS The MEDLINE, EMBASE, Cochrane Central Register for Controlled Trials, CINAHL, Allied and Complementary Medicine Database, China National Knowledge Infrastructure, VIP, WANFANG, Taiwan Periodical Literature Database, KoreaMed, KMbase, Research Information Service System, Oriental Medicine Advanced Searching Integrated System, CiNii and ClinicalTrials.gov were searched. The search included randomised controlled trials (RCTs) and protocols of RCTs that investigated all types of acupuncture and used self-declared pragmatic design. Two authors independently collected the basic information and characteristics of the studies and assessed their pragmatism using the nine PRECIS-2 domains and the additional domain of control. RESULTS A total of 93 studies were included. The means of eligibility, recruitment, organisation, primary outcome, primary analysis, and control domains were statistically larger than three and were shown to be pragmatic. The means of setting, flexibility:delivery, and follow-up domains were not greater than three and were shown to be non-pragmatic. For flexibility:adherence domain was inappropriate for assessment owing to insufficient information in the studies. CONCLUSIONS PATs were pragmatic in the domain of eligibility, recruitment, organisation, primary outcome, primary analysis, and control and were not pragmatic in the domain of setting, flexibility:delivery, and follow-up. Future PATs need to strengthen the pragmatism in the setting, flexibility:delivery, and follow-up domains and to describe the flexibility:adherence domain in more detail. TRIAL REGISTRATION CRD42021236975.
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Affiliation(s)
- Jinwoong Lim
- Department of Acupuncture and Moxibustion, Wonkwang University Gwangju Korean Medicine Hospital, Gwangju, Republic of Korea
| | - Hyeonhoon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Suk Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Kyung Hee University, 23 Kyunghee Dae-Ro, Dongdaemun-Gu, Seoul, 02447, Republic of Korea.
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Sutton E, Detering K, East C, Whittaker A. Women's expectations about birth, requests for pain relief in labor and the subsequent development of birth dissonance and trauma. BMC Pregnancy Childbirth 2023; 23:777. [PMID: 37946106 PMCID: PMC10633977 DOI: 10.1186/s12884-023-06066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/13/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Birth is a significant event in women's lives. As Mansfield notes (2008) many women aim for a birth that avoids pharmacological pain relief because they are advised it is better for them and their baby. For women having their first baby, this may not be realistic as 3/4 of primiparous women in Australia will use pharmacological pain relief. This study examines the expectations that a group of women had regarding pain relief, how these expectations developed and what happened to requests for pain relief in labour. METHODS A longitudinal prospective study design was used to recruit 15 women who were having their first baby. Women having low risk pregnancies, hoping for a 'natural birth' (vaginal, no/minimal pharmacological pain relief) were eligible. A semi-structured interview tool was used across all three interviews that asked women about their expectations, then actual labour experience, pain management requests and how these were responded to by carers. Fifteen women were interviewed - at 36 weeks gestation; as soon after delivery of their baby as possible, then six months post-delivery (N = 43 interviews). Interviews were recorded and transcribed and coded by ES using NVivo software with hierarchical thematic analysis used. RESULTS The study found that women appear to experience a mismatch between expectations they had developed pre-birth, versus actual experience. This appears to cause a specific form of dissonance - which we have termed 'birth dissonance' leaving them feeling traumatised post birth. This is because what women expected to happen in birth was often not realised. In particular, some women requested pain relief in birth and felt that their request was not responded to as hoped, and also seemed to develop post-birth trauma. We proposed that this may have resulted from dissonance arising from their expectations about being able to birth without significant pain relief. Interventions and technology may also contribute to this sense of mismatch and post-birth trauma. CONCLUSIONS Low risk birthing women birthing in a hospital may have to engage with higher levels of technology, intervention and pain relief than that which they expected pre-birth. This could possibly be avoided with four simple changes. Firstly, better pre-birth education for women about how painful labor is likely to be. Secondly, pre-birth education which includes a detailed explanation of the utility of pharmacological and non-pharmacological pain relief. Thirdly, more egalitarian decision-making during labour and finally delivering upon women's requests for pain relief in labor, at the time that they ask for it. Further research is required to determine the extent of birth dissonance and how women making the transition to motherhood can avoid it.
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Affiliation(s)
- Elizabeth Sutton
- Monash Bioethics Centre - Monash University, Melbourne, Australia.
| | - Karen Detering
- Monash Bioethics Centre - Monash University, Melbourne, Australia
- Department of Health and Aged Care, Melbourne, Australia
| | - Christine East
- Nursing and Midwifery - La Trobe University, Melbourne, Australia
| | - Andrea Whittaker
- Sociology and Anthropology - Monash University, Melbourne, Australia
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Rukmindar D, Pekerti F, Sirvel R, Khasanah N, Dimara I, Mihardja H, Djaali W. The Role of Self-Care Acupressure in Maternal Health Problems to Support the Sustainable Development Goals Program in the Health Sector: A Narrative Review. Med Acupunct 2023; 35:170-179. [PMID: 37609550 PMCID: PMC10440639 DOI: 10.1089/acu.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Objective This narrative review discusses several studies that demonstrated the effect of self-care acupressure, especially on maternal-health problems in antenatal, labor, and postpartum times, as well as the mechanism of acupressure, the points used, and treatment strategies to support the Sustainable Development Goals (SDGs) program in the health sector. Methods PubMed and Google Scholar were searched for randomized controlled trials and systematic reviews/meta-analyses from the date of their inception to February 2022. Results The 14 studies that were included showed the possibility that acupressure could have a positive impact on maternal health. This self-care can be the main alternative in overcoming the gap in solving health problems in the world. Conclusions Self-care acupressure at various acupoints has been shown to be feasible to reduce problems during antenatal, labor, and postpartum times. Additional research on the use of acupressure during pregnancy and cross-sectional collaboration to increase the awareness of acupressure techniques are needed.
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Affiliation(s)
- Dion Rukmindar
- Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fransisca Pekerti
- Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ray Sirvel
- Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nur Khasanah
- Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Imelda Dimara
- Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hasan Mihardja
- Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Wahyuningsih Djaali
- Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Universitas Negeri Jakarta, Jakarta, Indonesia
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Socha MW, Flis W, Pietrus M, Wartęga M. Results of Induction of Labor with Prostaglandins E1 and E2 (The RIPE Study): A Real-World Data Analysis of Obstetrical Effectiveness and Clinical Outcomes of Pharmacological Induction of Labor with Vaginal Inserts. Pharmaceuticals (Basel) 2023; 16:982. [PMID: 37513894 PMCID: PMC10384291 DOI: 10.3390/ph16070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Despite extensive knowledge of the mechanisms responsible for childbirth, the course of labor induction is often unpredictable. Therefore, labor induction protocols using prostaglandin analogs have been developed and tested to assess their effectiveness in labor induction unequivocally. A total of 402 women were collected into two groups-receiving vaginal Misoprostol or vaginal Dinoprostone for induction of labor (IOL). Then, the patients were compared in groups depending on the agent they received and their gestational age. Most patients delivered within 48 h, and most of these patients had vaginal parturition. Patients who received the Dinoprostone vaginal insert required statistically significantly more oxytocin administration than patients who received the Misoprostol vaginal insert. Patients who received the Misoprostol vaginal insert used anesthesia during labor statistically more often. Patients who received Misoprostol vaginal inserts had a statistically significantly shorter time to delivery than those with Dinoprostone vaginal inserts. The prevalence of hyperstimulation was similar in all groups and remained low. Vaginal Misoprostol-based IOL is characterized by a shortened time to delivery irrespective of the parturition type, and a lower need for oxytocin augmentation, but also by an increased demand for intrapartum analgesia administration. A vaginal Dinoprostone-based IOL protocol might be considered a more harmonious and desirable option in modern perinatal care.
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Affiliation(s)
- Maciej W Socha
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert's Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Wojciech Flis
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert's Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Miłosz Pietrus
- Department of Gynecology and Oncology, Jagiellonian University Medical College, 31-501 Kraków, Poland
| | - Mateusz Wartęga
- Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie- Skłodowskiej 9, 85-094 Bydgoszcz, Poland
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Socha MW, Flis W, Wartęga M, Stankiewicz M, Kunicka A. The Efficacy of Misoprostol Vaginal Inserts for Induction of Labor in Women with Very Unfavorable Cervices. J Clin Med 2023; 12:4106. [PMID: 37373798 DOI: 10.3390/jcm12124106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The purpose of the present study was to evaluate the effectiveness of a misoprostol vaginal insert as an induction-of-labor (IOL) agent in women with an unfavorable cervix (Bishop score < 2) in achieving vaginal delivery (VD) within 48 h, depending on the gestational week, with particular emphasis on the cesarean section (CS) percentage, intrapartum analgesia application and possible side effects, such as tachysystole ratio. METHODS In this retrospective observational study involving 6000 screened pregnant patients, 190 women (3%) fulfilled the study inclusion criteria and underwent vaginal misoprostol IOL. The pregnant women were collected into three groups: patients who delivered at up to 37 weeks of gestation (<37 Group)-42 patients; patients who delivered between 37 and 41 weeks of gestation (37-41 Group)-76 patients; and patients who delivered after 41 weeks of gestation (41+ Group)-72 patients. The outcomes included time to delivery and mode of delivery, rate of tachysystole, need for intrapartum analgesia, and need for oxytocin augmentation. RESULTS Most of the patients delivered vaginally (54.8% in <37 Group vs. 57.9% in 37-41 Group vs. 61.1% in 41+ Group). A total of 89.5% (170/190) of patients delivered within 48 h (<37 Group-78.6% vs. 37-41 Group-89.5% vs. 41+ Group-95.8%). Statistical significance was demonstrated for the increased rate of vaginal deliveries and shortened time to delivery in the 41+ weeks group (p = 0.0026 and p = 0.0038). The indications for cesarean section were as follows: abnormal CTG pattern vs. lack of labor progression: 42.1% vs. 57.9% in <37 Group, 59.4% vs. 40.6% in 37-41 Group and 71.4% vs. 28.6% in 41+ Group. Statistical significance was demonstrated for the increased rate of abnormal CTG patterns as cesarean section indications in the 41+ Group (p = 0.0019). The need for oxytocin augmentation in each group was: 35.7% in <37 Group vs. 19.7% in 37-41 Group vs. 11.1% in 41+ Group. Statistical significance was shown for decreased need for oxytocin augmentation in +41 Group (p = 0.0016). The need for intrapartum anesthesia, depending on the group, was: 78.6% in <37 Group vs. 82.9% in 37-41 Group vs. 83.3% in 41+ Group. Statistical significance was demonstrated for increased need for intrapartum anesthesia application during labor in +41 Group (p = 0.0018). The prevalence of hyperstimulation was similar in all three groups (4.8% vs. 7.9% vs. 5.6% p > 0.05). CONCLUSIONS The misoprostol vaginal regimen for IOL used in our study is effective in achieving vaginal delivery within 48 h. In post-term women, the use of this regimen is characterized by an increased rate of vaginal deliveries, a shorter time to delivery and a lower need for oxytocin.
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Affiliation(s)
- Maciej W Socha
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert's Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Wojciech Flis
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert's Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Mateusz Wartęga
- Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
| | - Martyna Stankiewicz
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
| | - Aleksandra Kunicka
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
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Chang CY, Gau ML, Huang CJ, Cheng HM. Effects of non-pharmacological coping strategies for reducing labor pain: A systematic review and network meta-analysis. PLoS One 2022; 17:e0261493. [PMID: 35061717 PMCID: PMC8782482 DOI: 10.1371/journal.pone.0261493] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Facilitating the childbirth process is a global issue. Many strategies have been developed to cope with labor pain and improve the delivery experience and satisfaction of pregnant women. The results of different types of medical intervention on women's expectant pain have been varied. Therefore, this systematic review was aimed at summarizing the body of evidence regarding the effects of various non-pharmacological coping strategies for reducing labor pain. METHODS The review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We systematically searched the articles published between 1989 and 2020 in six electronic databases: PubMed, MEDLINE, CINAHL, WOS, PsycARTICLES, and Airiti Library, and the reference lists of the Clinical Trial Registry. Twenty studies were identified, with eight eligible studies included in the Bayesian network meta-analysis. RESULTS Eight studies with 713 participants were included in the meta-analysis with nine different non-pharmacological strategies for reducing labor pain. The traditional meta-analysis demonstrated that the non-pharmacological coping strategies were effective in reducing labor pain. Of these interventional strategies, the ranking probabilities analysis of the network meta-analysis suggested that the Bonapace Method may be the most effective strategy in reducing labor pain, followed by acupressure. CONCLUSIONS Non-pharmacological coping strategies can reduce labor pain while maintaining an effective and satisfactory delivery experience. This systematic review, by synthesizing the body of evidence, demonstrated that non-pharmacological coping strategies are effective in reducing labor pain. Furthermore, as demonstrated in the network meta-analysis, the Bonapace Method, modulating birth pain by involving the father, is the most effective non-pharmacological intervention for reducing labor pain.
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Affiliation(s)
- Ching-Yi Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Meei-Ling Gau
- Department of Midwifery and Women Health Care, National Taipei University of Nursing and Health Sciences
| | - Chi-Jung Huang
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-min Cheng
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Effect of Regiosacralis Counterpressure Treatment on the Pain and Interleukin-6 Levels Among Primigravid Mothers During the First Stage Labor. INTERNATIONAL JOURNAL OF CHILDBIRTH 2021. [DOI: 10.1891/ijcbirth-d-20-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDSevere pain experienced by mother during the labor can cause fear and anxiety which can interfere with the overall labor process. Controlling pain during the labor process is important. Regiosacralis counterpressure pain management without altering the interleukin-6 (IL-6) level is expected to reduce the pain.OBJECTIVEThis study was aimed to investigate the effects of regiosacralis counterpressure on the pain and IL-6 levels during the first stage of labor among primigravid mothers.METHODA quasiexperiment method with pretest–posttest control group design was applied. Regiosacralis counter-pressure pain management was applied to all study participants who non-randomly recruited by consecutive sampling methods. A total of 52 primigravid mothers were selected and divided into both the intervention group (n = 26) and the control group (n = 26).RESULTThe statistical analysis of the intervention on the pain and IL-6 level revealed a significant difference between the pretest and posttest in the intervention group (p < .001; M pretest pain = 8.96 ± .528; M posttest pain = 6.96 ± .774; M pretest IL-6 = 175.539 ± 92.281; M posttest IL-6 = 170,764 ± 70,026).CONCLUSIONRegiosacralis counterpressure treatment is effective in controlling and reducing the pain level during the first stage labor.
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Levett KM, Lord SJ, Dahlen HG, Smith CA, Girosi F, Downe S, Finlayson KW, Fleet J, Steen M, Davey MA, Newnham E, Werner A, Arnott L, Sutcliffe K, Seidler AL, Hunter KE, Askie L. The AEDUCATE Collaboration. Comprehensive antenatal education birth preparation programmes to reduce the rates of caesarean section in nulliparous women. Protocol for an individual participant data prospective meta-analysis. BMJ Open 2020; 10:e037175. [PMID: 32967876 PMCID: PMC7513601 DOI: 10.1136/bmjopen-2020-037175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/09/2020] [Accepted: 08/14/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Rates of medical interventions in normal labour and birth are increasing. This prospective meta-analysis (PMA) proposes to assess whether the addition of a comprehensive multicomponent birth preparation programme reduces caesarean section (CS) in nulliparous women compared with standard hospital care. Additionally, do participant characteristics, intervention components or hospital characteristics modify the effectiveness of the programme? METHODS AND ANALYSIS: Population: women with singleton vertex pregnancies, no planned caesarean section (CS) or epidural.Intervention: in addition to hospital-based standard care, a comprehensive antenatal education programme that includes multiple components for birth preparation, addressing the three objectives: preparing women and their birth partner/support person for childbirth through education on physiological/hormonal birth (knowledge and understanding); building women's confidence through psychological preparation (positive mindset) and support their ability to birth without pain relief using evidence-based tools (tools and techniques). The intervention could occur in a hospital-based or community setting.Comparator: standard care alone in hospital-based maternity units. OUTCOMES Primary: CS.Secondary: epidural analgesia, mode of birth, perineal trauma, postpartum haemorrhage, newborn resuscitation, psychosocial well-being.Subgroup analysis: parity, model of care, maternal risk status, maternal education, maternal socio-economic status, intervention components. STUDY DESIGN An individual participant data (IPD) prospective meta-analysis (PMA) of randomised controlled trials, including cluster design. Each trial is conducted independently but share core protocol elements to contribute data to the PMA. Participating trials are deemed eligible for the PMA if their results are not yet known outside their Data Monitoring Committees. ETHICS AND DISSEMINATION Participants in the individual trials will consent to participation, with respective trials receiving ethical approval by their local Human Research Ethics Committees. Individual datasets remain the property of trialists, and can be published prior to the publication of final PMA results. The overall data for meta-analysis will be held, analysed and published by the collaborative group, led by the Cochrane PMA group. TRIAL REGISTRATION NUMBER CRD42020103857.
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Affiliation(s)
- Kate M Levett
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- NICM Health Research Institute, University of Western Sydney, Penrith South, New South Wales, Australia
| | - Sarah J Lord
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Parramatta, New South Wales, Australia
| | - Caroline A Smith
- NICM Health Research Institute, University of Western Sydney, Penrith South, New South Wales, Australia
- Graduate Research School, University of Western Sydney, Kingswood, New South Wales, Australia
| | - Federico Girosi
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Capital Markets CRC, New South Wales, Australia, Sydney, New South Wales, Australia
| | - Soo Downe
- School of Midwifery and Community Health, University of Central Lancashire, Preston, Lancashire, UK
| | | | - Julie Fleet
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Mary Steen
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Mary-Ann Davey
- Obstetrics & Gynaecology, Monash Health, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Elizabeth Newnham
- School of Nursing & Midwifery, Griffith University, Medowbrook, Queensland, Australia
| | - Anette Werner
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Leslie Arnott
- The B.E.A.R. Program, Lamaze Australia, Melbourne, Victoria, Australia
| | - Kerry Sutcliffe
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kylie Elizabeth Hunter
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lisa Askie
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Chen Y, Xiang XY, Chin KHR, Gao J, Wu J, Lao L, Chen H. Acupressure for labor pain management: a systematic review and meta-analysis of randomized controlled trials. Acupunct Med 2020; 39:243-252. [PMID: 32811182 DOI: 10.1177/0964528420946044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy/effectiveness of acupressure as an adjunct to standard procedures during labor and delivery, compared with standard procedures with/without sham acupressure, in randomized controlled trials (RCTs). METHODS Ten main databases were searched from their inception until 31 January 2018. Two reviewers independently extracted data concerning the effects of acupressure on pain intensity, labor duration, mode of delivery, use of medications and adverse events. A meta-analysis of these measures was performed using RevMan 5.3. Pooled standardized mean differences (SMDs) or odds ratios (ORs) for the above outcomes were estimated with a fixed or random effects model, according to the heterogeneity. RESULTS A total of 13 RCTs including 1586 enrolled patients met the eligibility criteria. Acupressure plus standard procedures (ASP) for labor management significantly reduced pain sensation, compared with sham acupressure plus standard procedures (SASP) and standard procedures (SP) alone. The analgesic effect of acupressure was immediate and persisted for at least 60 min (all p < 0.01). Compared with the untreated control groups, the acupressure group had a shorter duration of labor, especially the first stage of labor (SMD = -0.76, 95% confidence interval (CI) = -1.10 to -0.43; p < 0.001; I2 = 74%) and second stage of labor (SMD = -0.37, 95% CI = -0.59 to -0.18; p < 0.001; I2 = 0%). Data suggesting that acupressure reduced the Cesarean section rate was inconclusive. The use of pharmacologic agents (oxytocin and analgesics) did not differ between the ASP, SASP and SP groups. No adverse events were reported in this limited number of studies. CONCLUSION Moderate evidence indicates that acupressure may have promising effects on labor pain and duration. However, high-quality trials to verify these findings are warranted.
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Affiliation(s)
- Yao Chen
- Health and Rehabilitation College, Chengdu University of Chinese Medicine, Chengdu, China.,The 2nd Sichuan Provincial Hospital of Chinese Medicine, Chengdu, China
| | - Xiang-Yin Xiang
- Health and Rehabilitation College, Chengdu University of Chinese Medicine, Chengdu, China.,Ruian Hospital of Traditional Chinese Medicine, Ruian, China
| | - Kien Howe Robert Chin
- Department of Obstetrics and Gynaecology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jing Gao
- Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Junmei Wu
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,School of Chinese Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lixing Lao
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,School of Chinese Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Haiyong Chen
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,School of Chinese Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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11
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Abstract
Pain perception and preferences for pain management are unique to each woman in labor. This article provides an overview of the physiology of labor pain, discusses available nonpharmacologic and pharmacologic approaches to managing pain during active labor, and discusses potential benefits and risks for each option.
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Affiliation(s)
- Tammy Farnham
- Tammy Farnham is an instructor at The College at Brockport in Brockport, N.Y
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12
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Cheng FK. Using Acupuncture in Labor Pain and Childbirth-Related Issues: A Narrative Review. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-19-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDLatent threats, such as prolonged labor duration and postpartum hemorrhage, endanger women and newborns during and post childbirth, which produce burdens on natal care and public health expenditures. Acupuncture, a traditional Chinese medical practice, has increasingly been used for labor delivery in various countries to cope with these problems.METHODThis narrative review searched 29 English and Chinese electronic databases. Thirty-one empirical studies, carried out in Asia, America, Africa, the Middle East, Europe, and Australia were reviewed according to inclusion and exclusion criteria.RESULTSAcupuncture is adopted with positive signs toward labor pain relief, delivery mode, labor duration, postpartum hemorrhage, APGAR score (an evaluation for a neonatal evaluation), and birth weight.DISCUSSIONWith support of earlier studies, the satisfactory effects of acupuncture on labor delivery reviewed in this research have been noted by obstetric researchers and scholars, physicians, nurses, and midwives.CONCLUSIONThis review recommends the use of acupuncture in obstetric profession with respect to maternal-related healthcare.
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13
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Raana HN, Fan XN. The effect of acupressure on pain reduction during first stage of labour: A systematic review and meta-analysis. Complement Ther Clin Pract 2020; 39:101126. [DOI: 10.1016/j.ctcp.2020.101126] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/28/2020] [Accepted: 02/27/2020] [Indexed: 01/24/2023]
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14
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Smith CA, Collins CT, Levett KM, Armour M, Dahlen HG, Tan AL, Mesgarpour B. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev 2020; 2:CD009232. [PMID: 32032444 PMCID: PMC7007200 DOI: 10.1002/14651858.cd009232.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence about the use of acupuncture and acupressure for pain management in labour. This is an update of a review last published in 2011. OBJECTIVES To examine the effects of acupuncture and acupressure for pain management in labour. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, (25 February 2019), the Cochrane Central Register of Controlled Trials (the Cochrane Library 2019, Issue 1), MEDLINE (1966 to February 2019), CINAHL (1980 to February 2019), ClinicalTrials.gov (February 2019), the WHO International Clinical Trials Registry Platfory (ICTRP) (February 2019) and reference lists of included studies. SELECTION CRITERIA Published and unpublished randomised controlled trials (RCTs) comparing acupuncture or acupressure with placebo, no treatment or other non-pharmacological forms of pain management in labour. We included all women whether nulliparous or multiparous, and in spontaneous or induced labour. We included studies reported in abstract form if there was sufficient information to permit assessment of risk of bias. Trials using a cluster-RCT design were eligible for inclusion, but quasi-RCTs or cross-over studies were not. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 28 trials with data reporting on 3960 women. Thirteen trials reported on acupuncture and 15 trials reported on acupressure. No study was at a low risk of bias on all domains. Pain intensity was generally measured on a visual analogue scale (VAS) of 0 to 10 or 0 to 100 with low scores indicating less pain. Acupuncture versus sham acupuncture Acupuncture may make little or no difference to the intensity of pain felt by women when compared with sham acupuncture (mean difference (MD) -4.42, 95% confidence interval (CI) -12.94 to 4.09, 2 trials, 325 women, low-certainty evidence). Acupuncture may increase satisfaction with pain relief compared to sham acupuncture (risk ratio (RR) 2.38, 95% CI 1.78 to 3.19, 1 trial, 150 women, moderate-certainty evidence), and probably reduces the use of pharmacological analgesia (RR 0.75, 95% CI 0.63 to 0.89, 2 trials, 261 women, moderate-certainty evidence). Acupuncture may have no effect on assisted vaginal birth (very low-certainty evidence), and probably little to no effect on caesarean section (low-certainty evidence). Acupuncture compared to usual care We are uncertain if acupuncture reduces pain intensity compared to usual care because the evidence was found to be very low certainty (standardised mean difference (SMD) -1.31, 95% CI -2.14 to -0.49, 4 trials, 495 women, I2 = 93%). Acupuncture may have little to no effect on satisfaction with pain relief (low-certainty evidence). We are uncertain if acupuncture reduces the use of pharmacological analgesia because the evidence was found to be very low certainty (average RR 0.72, 95% CI 0.60 to 0.85, 6 trials, 1059 women, I2 = 70%). Acupuncture probably has little to no effect on assisted vaginal birth (low-certainty evidence) or caesarean section (low-certainty evidence). Acupuncture compared to no treatment One trial compared acupuncture to no treatment. We are uncertain if acupuncture reduces pain intensity (MD -1.16, 95% CI -1.51 to -0.81, 163 women, very low-certainty evidence), assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupuncture compared to sterile water injection We are uncertain if acupuncture has any effect on use of pharmacological analgesia, assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupressure compared to a sham control We are uncertain if acupressure reduces pain intensity in labour (MD -1.93, 95% CI -3.31 to -0.55, 6 trials, 472 women) or assisted vaginal birth because the evidence was found to be very low certainty. Acupressure may have little to no effect on use of pharmacological analgesia (low-certainty evidence). Acupressure probably reduces the caesarean section rate (RR 0.44, 95% CI 0.27 to 0.71, 4 trials, 313 women, moderate-certainty evidence). Acupressure compared to usual care We are uncertain if acupressure reduces pain intensity in labour (SMD -1.07, 95% CI -1.45 to -0.69, 8 trials, 620 women) or increases satisfaction with pain relief (MD 1.05, 95% CI 0.75 to 1.35, 1 trial, 105 women) because the evidence was found to be very low certainty. Acupressure may have little to no effect on caesarean section (low-certainty evidence). Acupressure compared to a combined control Acupressure probably slightly reduces the intensity of pain during labour compared with the combined control (measured on a scale of 0 to 10 with low scores indicating less pain) (SMD -0.42, 95% CI -0.65 to -0.18, 2 trials, 322 women, moderate-certainty evidence). We are uncertain if acupressure has any effect on the use of pharmacological analgesia (RR 0.94, 95% CI 0.71 to 1.25, 1 trial, 212 women), satisfaction with childbirth, assisted vaginal birth or caesarean section because the certainty of the evidence was all very low. No studies were found that reported on sense of control in labour and only one reported on satisfaction with the childbirth experience. AUTHORS' CONCLUSIONS Acupuncture in comparison to sham acupuncture may increase satisfaction with pain management and reduce use of pharmacological analgesia. Acupressure in comparison to a combined control and usual care may reduce pain intensity. However, for other comparisons of acupuncture and acupressure, we are uncertain about the effects on pain intensity and satisfaction with pain relief due to very low-certainty evidence. Acupuncture may have little to no effect on the rates of caesarean or assisted vaginal birth. Acupressure probably reduces the need for caesarean section in comparison to a sham control. There is a need for further high-quality research that include sham controls and comparisons to usual care and report on the outcomes of sense of control in labour, satisfaction with the childbirth experience or satisfaction with pain relief.
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Affiliation(s)
- Caroline A Smith
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
| | - Carmel T Collins
- South Australian Health and Medical Research InstituteWomen and Kids72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Kate M Levett
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
- University of Notre DameSchool of MedicineSydneyAustralia
| | - Mike Armour
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
| | - Hannah G Dahlen
- Western Sydney UniversitySchool of Nursing and MidwiferyLocked Bag 1797PenrithNSWAustralia2751
| | - Aidan L Tan
- National University HospitalDepartment of Preventive MedicineSingaporeSingapore
| | - Bita Mesgarpour
- National Institute for Medical Research Development (NIMAD)Cochrane Iran Associate CentreTehranIran
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15
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Levett KM, Sutcliffe KL, Betts D. Using Forbidden Points in Pregnancy: Adverse Outcomes and Quality of Evidence in Randomized Controlled Trials-A Systematic Narrative Review. Med Acupunct 2019; 31:346-360. [PMID: 31871522 DOI: 10.1089/acu.2019.1391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: Pregnancy is a complex physical and hormonal condition. Many women experience back and pelvic pain, reflux, and headaches during pregnancy. There has been a significant rise in the popularity of acupuncture for pain conditions in pregnancy, wherein nonpharmacologic options are important. Concerns have been raised by both traditional and medical acupuncturists about using "forbidden points" during pregnancy and the risk of preterm contractions (PTC), as this could limit women's and practitioners' willingness to continue treatment during pregnancy. There is also a risk of bias introduced into clinical trials when participants are highly selected or they drop out of studies due to adverse outcomes. This review examined randomized controlled trials (RCTs) of acupuncture using forbidden points prior to 37 weeks of pregnancy to treat pain conditions, with the primary outcome of PTC. Methods: A database search identified RCTs, including trials of penetrating acupuncture that used forbidden points in their protocols to treat pregnancy-related pain conditions. STRICTA [Standards for Reporting Interventions in Clinical Trials of Acupuncture] and GRADE [Grades of Recommendation, Assessment, Development, and Evaluation] criteria were used to assess the quality of evidence. This review includes 8 RCTs reporting on 713 women. Results: Only 2 studies reported on the primary outcome of PTC, and there were insufficient data to perform a primary analysis. In these 2 studies, 6 participants withdrew due to PTC. No study was at a low risk of bias for all GRADE domains, and 3 studies were at high or unclear risk of bias in all domains. Conclusions: PTC is an important clinical outcome and should be reported routinely. The strength of evidence to date is insufficient to recommend using forbidden points prior to 37 weeks of pregnancy. Highly selected patient populations, risk of bias in study design, and participant withdrawal rates, suggest that high-quality trials are required.
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Affiliation(s)
- Kate M Levett
- School of Medicine Sydney, University of Notre Dame Australia, New South Wales, Australia.,NICM Health Research Institute, Western Sydney University, Penrith South, New South Wales, Australia
| | - Kerry L Sutcliffe
- School of Medicine Sydney, University of Notre Dame Australia, New South Wales, Australia
| | - Debra Betts
- NICM Health Research Institute, Western Sydney University, Penrith South, New South Wales, Australia.,New Zealand School of Acupuncture, Wellington, New Zealand
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16
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Türkmen H, Çeber Turfan E. The effect of acupressure on labor pain and the duration of labor when applied to the SP6 point: Randomized clinical trial. Jpn J Nurs Sci 2019; 17:e12256. [DOI: 10.1111/jjns.12256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Hülya Türkmen
- Department of Midwifery, Faculty of Health Sciences Balıkesir University Balikesir Turkey
| | - Esin Çeber Turfan
- Department of Midwifery, Faculty of Health Sciences Ege University İzmir Turkey
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17
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Kim M, Moss D, Crawford P. Battlefield acupuncture for post-partum pain: A randomized controlled trial. Explore (NY) 2019; 15:409-414. [PMID: 31186202 DOI: 10.1016/j.explore.2019.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/06/2019] [Accepted: 05/19/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Postpartum pain affects quality of life. Clinicians are increasingly using acupuncture for management of pain. Evidence based strategies that incorporate acupuncture for postpartum pain are lacking. METHODS We performed an exploratory, randomized clinical trial of Battlefield Auricular Acupuncture (BFA) plus standard analgesia versus standard analgesia alone for reduction of pain in the immediate postpartum period. RESULTS The mean time to 50% sustained reduction of initial pain in the standard analgesia group (n = 33) was 6 days compared to 5 days in the standard analgesia plus BFA (n = 37) group (p = 0.35). The mean total morphine equivalent units (MEUs) in the standard group compared to standard plus BFA group were 88 mg and 82 mg respectively (p = 0.45). CONCLUSIONS This exploratory comparison suggests that BFA may not provide additional benefit to standard analgesia for immediate postpartum pain; however, the trend toward faster reduction in pain indicates that a larger definitive study may be required.
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Affiliation(s)
- Michael Kim
- 99th MDG, Nellis Air Force Base, Nevada 89191, United States; 375th MDG, Scott Air Force Base, Illinois 62225, United States
| | - David Moss
- 99th MDG, Nellis Air Force Base, Nevada 89191, United States
| | - Paul Crawford
- 99th MDG, Nellis Air Force Base, Nevada 89191, United States.
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18
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Williams H, Sweet L, Graham K. Acupuncture during pregnancy and the perinatal period: Women's attitudes, beliefs and practices. Women Birth 2019; 33:e286-e294. [PMID: 31080098 DOI: 10.1016/j.wombi.2019.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/17/2019] [Accepted: 04/27/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Acupuncture during pregnancy and the perinatal period aims to increase normal birth and enhance a woman's birth experience by decreasing intervention and adverse birth outcomes. Acupuncture in Australian maternity services has not been well accepted, and there is limited research evidence as to whether women are supportive of acupuncture treatment. OBJECTIVE The aims of this study were to understand childbearing aged women's attitudes, beliefs and practices to using acupuncture during pregnancy and the perinatal period, and possible acceptance of a midwife providing acupuncture treatments. DESIGN A descriptive/explorative quantitative methodology was used to gather data from childbearing aged women using an online survey. Statistical analysis was used for quantitative data and content analysis for the free-text responses. Recruitment of respondents took place in 2017 via Facebook birth and parenting groups and pages. FINDINGS Of 304 respondents, 68% (n = 206) had used acupuncture, and of these, 68% (n = 140) used acupuncture for concerns during pregnancy and the perinatal period. The majority of respondents indicated they would consider acupuncture during pregnancy and the perinatal period (89%) and 62% indicated they would have a midwife provide a treatment. The free-text responses provided mostly positive comments on the outcomes and satisfaction of acupuncture treatments (84% n = 199). CONCLUSION The majority of respondents would consider acupuncture during pregnancy and the perinatal period, were positive to trying acupuncture for various concerns, and were positive towards a midwife providing treatments. These findings raise awareness of women's desire for the choice of an acupuncture treatment during pregnancy and the perinatal period.
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Affiliation(s)
- Heidi Williams
- College of Nursing and Health Sciences, Flinders University, Australia
| | - Linda Sweet
- College of Nursing and Health Sciences, Flinders University, Australia.
| | - Kristen Graham
- College of Nursing and Health Sciences, Flinders University, Australia
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19
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Ghanbari-Homayi S, Hasani S, Meedya S, Asghari Jafarabadi M, Mirghafourvand M. Nonpharmacological approaches to improve women's childbirth experiences: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019; 34:479-491. [PMID: 30983443 DOI: 10.1080/14767058.2019.1608434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Childbirth is considered a significant experience in women's life. Different models of care and interventions without pharmacological approaches have been used to enhance women's positive childbirth experiences, but the most effective interventions have not been clearly identified.Objective: To assess the effectiveness of nonpharmacological approaches in improving women's childbirth experiences.Methods: We searched Cochrane Library, Medline, Web of Science, Embase, Scopus, ProQuest, Google Scholar, and Persian databases (Magiran, Scientific Information Database, and Barakat) from inception until December 2017. Randomized controlled trials and quasi-randomized controlled trials comparing interventions designed to improve women's childbirth experiences with standard cares were included in this review. Pharmacological interventions were excluded from the study. The outcome measure was women's childbirth experience. Heterogeneity was determined using the Cochrane's test and I2 index. The standardized mean differences were pooled based on random effect models.Results: We included 19 studies (10,141 women) in the review. Results of the meta-analysis of 18 studies (8487 women) demonstrated that all the interventions with nonpharmacological approaches improved childbirth experiences (standardized mean difference: 0.49; 95% confidence interval: 0.33-0.66). But, subgroup meta-analysis showed that different models of midwifery care, support during labor and natural therapies were the most effective interventions in improving women's childbirth experience.Conclusions: Nonpharmacological interventions that enable women to feel supported, safe and respected can lead to improved childbirth experiences. However, there is a need for further studies with larger sample sizes and standardized tool to better assess the effectiveness of specific interventions on women's childbirth experiences.
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Affiliation(s)
- Solmaz Ghanbari-Homayi
- Students' Research Committee, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sonia Hasani
- Students' Research Committee, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Meedya
- Member of South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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20
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21
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Wang PM, Hsu CW, Liu CT, Lai TY, Tzeng FL, Huang CF. Effect of acupressure on constipation in patients with advanced cancer. Support Care Cancer 2019; 27:3473-3478. [PMID: 30675666 DOI: 10.1007/s00520-019-4655-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/16/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Constipation is a common and distressing symptom for patients with advanced cancer. Few reports have focused on the symptoms of constipation in patients with advanced cancer. The aim of this study was to investigate the effect of a short-term acupressure intervention on patients with advanced cancer. METHODS This study used a non-randomized, pre-post study design to assess the effect of acupressure intervention. A total of 30 patients with advanced cancer were recruited from the hospice unit of a medical center in southern Taiwan. In addition to routine care, patients in the intervention group received an 8-min acupressure treatment daily for 3 consecutive days. Three acupoints were used in this study: Zhongwan (CV12), Guanyuan (CV4), and Tianshu (ST25). Analysis of covariance was used to compare the differences in symptoms of constipation between the two groups, adjusted for baseline values. Effect sizes were calculated using partial eta squared (η2). RESULTS Significant improvements in symptoms of constipation (partial η2 = 0.40, p < 0.001 for straining during defecation; partial η2 = 0.30, p = 0.002 for hard stools; partial η2 = 0.42, p < 0.001 for sensation of incomplete evacuation; and partial η2 = 0.29, p = 0.002 for sensation of anorectal obstruction), Bristol stool form scale scores (partial η2 = 0.40, p < 0.001), comfort levels during defecation (partial η2 = 0.82, p < 0.001), and colonic motility (partial η2 = 0.85, p < 0.001) were observed in patients receiving acupressure intervention compared with the controls. CONCLUSIONS Findings from this study indicated that short-term acupressure was effective in alleviating symptoms of constipation among patients with advanced cancer. Further, randomized controlled trials are warranted to confirm the results.
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Affiliation(s)
- Pei-Ming Wang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Dapi Road, Kaohsiung City, 83301, Taiwan
| | - Ching-Wen Hsu
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Chun-Ting Liu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Ting-Yu Lai
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Fe-Ling Tzeng
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Chih-Fang Huang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Dapi Road, Kaohsiung City, 83301, Taiwan.
- Department of Long Term Care, Chung Hwa University of Medical Technology, Tainan City, Taiwan.
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22
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Mafetoni RR, Rodrigues MH, Silva FMBD, Jacob LMDS, Shimo AKK. EFFECTIVENESS OF AURICULAR THERAPY ON LABOR PAIN: A RANDOMIZED CLINICAL TRIAL. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
ABSTRACT Objective: to evaluate the effectiveness of auricular therapy on pain in the active phase of labor. Method: a randomized, parallel and triple-blind clinical trial, conducted from April 2015 to June 2016. A total of 102 pregnant women with a gestational age ≥37 weeks, cervical dilatation ≥4 cm and two or more contractions within 10 minutes, randomly divided into three groups: intervention (auricular therapy), placebo (sham points) and control (without intervention). Auricular therapy was applied with crystal microspheres in four strategic points and pain intensity evaluated by a Visual and Analog Scale. For the analyses, the following tests were used: Kruskal-Wallis and Generalized estimating equations. Results: pain intensity averages were similar at admission (intervention: 7.2±1.6 vs placebo: 6.9±2.4 vs control: 7.5±1.8; p-value=0.4475), but with 60 minutes (intervention: 6.8±1.9 vs placebo: 7.5±2.4 vs control: 8.3±1.8; p=0.0060) and 120 minutes (intervention: 7.1±1.9 vs placebo: 8.0±2.4 vs control: 8.8±1.9; p-value=0.039), there was a significant increase in pain scores between parturients of the placebo and control groups. Conclusion: parturients who received auricular therapy during labor showed a reduction in pain intensity, which may characterize the effectiveness of the therapy in this phase. Registration: No. RBR-47hhbj.
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23
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Czech I, Fuchs P, Fuchs A, Lorek M, Tobolska-Lorek D, Drosdzol-Cop A, Sikora J. Pharmacological and Non-Pharmacological Methods of Labour Pain Relief-Establishment of Effectiveness and Comparison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2792. [PMID: 30544878 PMCID: PMC6313325 DOI: 10.3390/ijerph15122792] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022]
Abstract
Background: To evaluate the effectiveness of pharmacological and non-pharmacological pain relief methods and to compare them. Materials and methods: 258 women were included in the study and interviewed using a questionnaire and the visual analogue scale for pain. They were divided into six groups depending on chosen method of labour pain relief: epidural anaesthesia (EA; n = 42), water immersion and water birth (WB; n = 40), nitrous oxide gas for pain control (G; n = 40), transcutaneous electrical nerve stimulation (TENS) (n = 50), multiple management (MM; n = 42), none (N; n = 44). Results: The average age of the women was 29.4 ± 3.74 years and 60.47% of them were nulliparous (n = 156). Mean values of labour pain intensity were 6.81 ± 2.26 during the first stage of labour; 7.86 ± 2.06 during the second stage, and 3.22 ± 2.46 during the third stage. There was no significant difference in pain level between epidural analgesia and gas groups in the first stage of labour (p = 0.74). Nevertheless, epidural analgesia reduced pain level during the second and third stage (both p < 0.01). The highest satisfaction level pertains to water immersion (n = 38; 95%). Conclusion: Epidural analgesia is the gold standard of labour pain relief, however water birth was found to be associated with the highest satisfaction level of the parturient women. The contentment of childbirth depends not only on the level of experienced pain, but also on the care provided to the parturient during pregnancy and labour.
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Affiliation(s)
- Iwona Czech
- Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
| | - Piotr Fuchs
- Student's Scientific Organisation of Gyneacology, Obstetrics and Sexology, Medical University of Silesia, 40-752 Katowice, Poland.
| | - Anna Fuchs
- Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
| | - Miłosz Lorek
- Student's Scientific Organisation of Gyneacology, Obstetrics and Sexology, Medical University of Silesia, 40-752 Katowice, Poland.
| | - Dominika Tobolska-Lorek
- Student's Scientific Organisation of Gyneacology, Obstetrics and Sexology, Medical University of Silesia, 40-752 Katowice, Poland.
| | - Agnieszka Drosdzol-Cop
- Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
| | - Jerzy Sikora
- Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
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Fan AY, Miller DW, Bolash B, Bauer M, McDonald J, Faggert S, He H, Li YM, Matecki A, Camardella L, Koppelman MH, Stone JAM, Meade L, Pang J. Acupuncture's Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management-White Paper 2017. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2018; 15:411-425. [PMID: 29103410 DOI: 10.1016/s2095-4964(17)60378-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The United States (U.S.) is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public's opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture's cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.
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Affiliation(s)
| | - David W Miller
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA.,Pacific College of Oriental Medicine, Chicago, IL 60601, USA
| | - Bonnie Bolash
- The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA
| | - Matthew Bauer
- The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA.,The Acupuncture Now Foundation, La Verne, CA 91750, USA
| | - John McDonald
- The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA.,The Acupuncture Evidence Project, Providence, RI 02860, USA
| | - Sarah Faggert
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,The Acupuncture Society of Virginia, Vienna, VA 22182, USA
| | - Hongjian He
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,The National Federation of Chinese TCM Organizations, New York, NY 11501, USA.,The American Alliance for Professional Acupuncture Safety, Greenwich, CT 06878, USA
| | - Yong Ming Li
- The American Traditional Chinese Medicine Society, New York, NY 11501, USA
| | - Amy Matecki
- The American Alliance for Professional Acupuncture Safety, Greenwich, CT 06878, USA.,Highland Hospital, Alameda Health System, Oakland, CA 94602, USA
| | - Lindy Camardella
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA
| | - Mel Hopper Koppelman
- The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA.,The Acupuncture Evidence Project, Providence, RI 02860, USA
| | - Jennifer A M Stone
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Lindsay Meade
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA
| | - John Pang
- University of California, San Diego School of Medicine, San Diego, CA 92093, USA
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Levett K, Dahlen HG. Perspective: Childbirth education in Australia: Have we lost our way? Women Birth 2018; 32:291-293. [PMID: 29954688 DOI: 10.1016/j.wombi.2018.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kate Levett
- Notre Dame University, New South Wales, Australia
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26
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Levett KM, Dahlen HG, Smith CA, Finlayson KW, Downe S, Girosi F. Cost analysis of the CTLB Study, a multitherapy antenatal education programme to reduce routine interventions in labour. BMJ Open 2018; 8:e017333. [PMID: 29439002 PMCID: PMC5829839 DOI: 10.1136/bmjopen-2017-017333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess whether the multitherapy antenatal education 'CTLB' (Complementary Therapies for Labour and Birth) Study programme leads to net cost savings. DESIGN Cost analysis of the CTLB Study, using analysis of outcomes and hospital funding data. METHODS We take a payer perspective and use Australian Refined Diagnosis-Related Group (AR-DRG) cost data to estimate the potential savings per woman to the payer (government or private insurer). We consider scenarios in which the intervention cost is either borne by the woman or by the payer. Savings are computed as the difference in total cost between the control group and the study group. RESULTS If the cost of the intervention is not borne by the payer, the average saving to the payer was calculated to be $A808 per woman. If the payer covers the cost of the programme, this figure reduces to $A659 since the average cost of delivering the programme was $A149 per woman. All these findings are significant at the 95% confidence level. Significantly more women in the study group experienced a normal vaginal birth, and significantly fewer women in the study group experienced a caesarean section. The main cost saving resulted from the reduced rate of caesarean section in the study group. CONCLUSION The CTLB antenatal education programme leads to significant savings to payers that come from reduced use of hospital resources. Depending on which perspective is considered, and who is responsible for covering the cost of the programme, the net savings vary from $A659 to $A808 per woman. Compared with the average cost of birth in the control group, we conclude that the programme could lead to a reduction in birth-related healthcare costs of approximately 9%. TRIAL REGISTRATION NUMBER ACTRN12611001126909.
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Affiliation(s)
- Kate M Levett
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Caroline A Smith
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, New South Wales, Australia
| | | | - Soo Downe
- School of Midwifery and Community Health, University of Central Lancashire (UCLan), Preston, UK
| | - Federico Girosi
- School of Medicine, Centre for Health Research, Western Sydney University, Sydney, New South Wales, Australia
- Research, Health Market Quality program, Capital Markets CRC, Sydney, New South Wales, Australia
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Labor Pain Management. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Controlling labor pain is one of the basic goals for caregivers during the birthing process. There are many pharmacological and nonpharmacological methods that are used for controlling pain and helping the mother to cope with pain and have a favorable labor. The study was planned as a randomized, controlled experimental study to detect the effect of acupressure applied to Point LI4 on perceived labor pains. The study sample comprised 88 pregnant women (44 acupressure group, 44 control group), who complied with the study guidelines, agreed with the conditions of the study, and signed the informed consent. Acupressure was applied to the study group when cervical dilatation reached 4 to 5 cm and again when cervical dilation was 7 to 8 cm. Acupressure was applied to Point LI4 on both the hands at the same time from the beginning to the end of the contraction (16 times). Evaluation with the visual analog scale was made 6 times: when the pregnant woman was first admitted to the hospital, before and after acupressure, and within 2 hours after delivery. The control group received routine care. There were statistically significant differences between the groups in subjective labor pain scores (P < .0001). There was a significant difference between the groups in terms of total duration of labor. As shown from our study, applying acupressure to Point LI4 was found to be effective in decreasing the perception of labor pains and shortening the labor (P < .05). Mothers were pleased with this treatment, but they found it insufficient to control their pain.
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Fairchild E, Roberts L, Zelman K, Michelli S, Hastings-Tolsma M. Implementation of Robert's Coping with Labor Algorithm © in a large tertiary care facility. Midwifery 2017; 50:208-218. [PMID: 28477459 DOI: 10.1016/j.midw.2017.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 02/12/2017] [Accepted: 03/14/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE to implement use of Roberts' Coping with Labor Algorithm© (CWLA) with laboring women in a large tertiary care facility. DESIGN this was a quality improvement project to implement an alternate approach to pain assessment during labor. It included system assessment for change readiness, implementation of the algorithm across a 6-week period, evaluation of usefulness by nursing staff, and determination of sustained change at one month. Stakeholder Theory (Friedman and Miles, 2002) and Deming's (1982) Plan-Do-Check-Act Cycle, as adapted by Roberts et al (2010), provided the framework for project implementation. SETTING the project was undertaken on a labor and delivery (L&D) unit of a large tertiary care facility in a southwestern state in the USA. The unit had 19 suites with close to 6000 laboring patients each year. PARTICIPANTS full, part-time, and per diem Registered Nurse (RN) staff (N=80), including a subset (n=18) who served as the pilot group and champions for implementing the change. FINDINGS a majority of RNs held a positive attitude toward use of the CWLA to assess laboring women's coping with the pain of labor as compared to a Numeric Rating Scale (NRS). RNs reported usefulness in using the CWLA with patients from a wide variety of ethnicities. A pre-existing well-developed team which advocated for evidence-based practice on the unit proved to be a significant strength which promoted rapid change in practice. IMPLICATIONS FOR PRACTICE this work provides important knowledge supporting use of the CWLA in a large tertiary care facility and an approach for effectively implementing that change. Strengths identified in this project contributed to rapid implementation and could be emulated in other facilities. Participant reports support usefulness of the CWLA with patients of varied ethnicity. Assessment of change sustainability at 1 and 6 months demonstrated widespread use of the algorithm though long-term determination is yet needed.
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Affiliation(s)
- Esther Fairchild
- Baylor University, Louise Herrington School of Nursing, 3700 Worth St, Dallas, TX 75246, United States.
| | - Leissa Roberts
- University of Utah, School of Nursing,10 South 2000 East, Salt Lake City, Utah 84112, United States
| | - Karen Zelman
- Baylor University, Louise Herrington School of Nursing, 3700 Worth St, Dallas, TX 75246, United States
| | - Shelley Michelli
- Baylor Scott & White, Fort Worth's Andrews Women's Hospital,1400 8th Avenue Fort Worth, TX 76104, United States
| | - Marie Hastings-Tolsma
- Baylor University, Louise Herrington School of Nursing, 3700 Worth St, Dallas, TX 75246, United States
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Robinson N. Integrating acupuncture: are there positive health outcomes for women? J Zhejiang Univ Sci B 2017; 18:233-238. [PMID: 28271658 PMCID: PMC5369247 DOI: 10.1631/jzus.b1600260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/26/2016] [Indexed: 11/11/2022]
Abstract
The key health issues for women tend to be primarily associated with the female reproductive system. There are also other gender priorities and consequences associated with ageing, which require effective interventions. Acupuncture is used worldwide and its evidence base is increasing on both mechanisms of action and its effectiveness in clinical care. Although acupuncture may be a valuable addition to healthcare for some conditions, it is rarely fully integrated into mainstream Western medicine clinical practice. Inadequate design and poor reporting of clinical trials have been barriers. Additionally systematic reviews and meta-analyses have tended to be equivocal and have reported that there is insufficient evidence for its recommendation. Future research should focus on ensuring good trial design including cost effectiveness and qualitative data and using a more pragmatic stance which reflects acupuncture in clinical practice. Undoubtedly, effective interventions are always needed to ensure the best health outcomes and address preventable deaths, morbidities, and disabilities among women but integration will be compromised unless underpinned by good evidence.
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Affiliation(s)
- Nicola Robinson
- School of Health and Social Care, London South Bank University, London, SE1 0AA, UK
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31
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Schlaeger JM, Gabzdyl EM, Bussell JL, Takakura N, Yajima H, Takayama M, Wilkie DJ. Acupuncture and Acupressure in Labor. J Midwifery Womens Health 2016; 62:12-28. [PMID: 28002621 DOI: 10.1111/jmwh.12545] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 12/13/2022]
Abstract
Acupuncture and acupressure, 2 modalities of Traditional Chinese Medicine, are based on reducing pain and symptoms of disease through balancing yin and yang. Acupuncture and acupressure have been used in China for reduction of labor pain, labor augmentation, and other intrapartum indications for more than 2 millennia. This article presents a review of the current literature that has addressed the effects of acupuncture and acupressure on intrapartum events. Studies of acupuncture have demonstrated that acupuncture may reduce labor pain, the use of pharmacologic agents, the use of forceps and vacuum-assisted births, and the length of labor. Studies that examined the effect of acupuncture on labor that is induced or augmented for premature rupture of membranes have found that acupuncture may increase the degree of cervical ripening but does not reduce the amount of oxytocin or epidural analgesia administration, nor does it shorten length of induced labor. Acupressure may reduce labor pain and labor duration, but acupressure has not been found to increase cervical ripening or induce labor. There are insufficient studies about acupuncture and acupressure and their effects on labor at this time, and there is need for further research. Areas of uncertainty include efficacy, optimal point selection, best techniques, and length of time for point stimulation.
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32
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Vixner L, Schytt E, Mårtensson LB. Associations between maternal characteristics and women's responses to acupuncture during labour: a secondary analysis from a randomised controlled trial. Acupunct Med 2016; 35:180-188. [PMID: 27986648 PMCID: PMC5466917 DOI: 10.1136/acupmed-2016-011164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 12/02/2022]
Abstract
Background Patient characteristics are modulators of pain experience after acupuncture treatment for chronic pain. Whether this also applies to labour pain is unknown. Aim To examine for associations between maternal characteristics and response to acupuncture in terms of labour pain intensity in close proximity to the treatment (within 60 min) and over a longer time period (up to 240 min), and whether or not epidural analgesia is used, before and after adjustment for obstetric status upon admission to the labour ward. Methods Cohort study (n=253) using data collected for a randomised controlled trial. Associations were examined using linear mixed models and logistic regression analyses. Tests of interactions were also applied to investigate whether maternal characteristics were influenced by treatment group allocation. Results In close proximity to the treatment, advanced age and cervical dilation were associated with lower pain scores (mean difference (MD) −13.2, 95% CI −23.4 to −2.9; and MD −5.0, 95% CI −9.6 to −0.5, respectively). For the longer time period, labour pain was negatively associated with age (MD −11.8, 95% CI −19.6 to −3.9) and positively associated with dysmenorrhoea (MD 5.5, 95% CI 1.6 to 9.5). Previous acupuncture experience and advanced cervical dilatation were associated with higher and lower use of epidural analgesia (OR 2.7, 95% CI 1.3 to 5.9; and OR 0.3, 95% CI 0.1 to 0.5, respectively). No interactions with treatment allocation were found. Conclusions This study did not identify any maternal characteristics associated with women's responses to acupuncture during labour. Trial registration number NCT01197950; Post-results.
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Affiliation(s)
- Linda Vixner
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Karolinska Institutet, Stockholm, Sweden.,School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Erica Schytt
- Centre for Clinical Research Dalarna, Falun, Sweden.,Bergen University Collage, Bergen, Norway
| | - Lena B Mårtensson
- School of Health and Education, University of Skövde, Skövde, Sweden
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Makvandi S, Mirzaiinajmabadi K, Sadeghi R, Mahdavian M, Karimi L. Meta-analysis of the effect of acupressure on duration of labor and mode of delivery. Int J Gynaecol Obstet 2016; 135:5-10. [DOI: 10.1016/j.ijgo.2016.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 04/17/2016] [Accepted: 07/20/2016] [Indexed: 11/17/2022]
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Patil S, Sen S, Bral M, Reddy S, Bradley KK, Cornett EM, Fox CJ, Kaye AD. The Role of Acupuncture in Pain Management. Curr Pain Headache Rep 2016; 20:22. [PMID: 26896946 DOI: 10.1007/s11916-016-0552-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Acupuncture is a traditional Chinese practice of medicine that has gained popularity in Western culture and around the world. It involves the insertion of thin needles into the skin to stimulate nerves, muscles, and connective tissues throughout the body with the goal of alleviating pain, tension, and stress. More broadly, acupuncture is actually a family of different procedures. Conceptually, it is believed to stimulate the body's meridians, or energy-carrying channels, in an attempt to correct imbalances and to restore health. These benefits are thought to be derived from the proximity of acupoints with nerves through intracellular calcium ions. This lesson outlines a brief history of acupuncture and how it may be used to treat various types of physical and emotional pain and specific conditions, including overactive bladder and psoriasis. Acupuncture has been demonstrated to enhance endogenous opiates, such as dynorphin, endorphin, encephalin, and release corticosteroids, relieving pain and enhancing the healing process. There are associated risks; however, serious side effects are rare. When compared to traditional methods of pain management, more studies are warranted in order to establish the efficacy of acupuncture and its place in pain management.
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Affiliation(s)
| | - Sudipta Sen
- Department of Anesthesiology, LSUHSC, Shreveport, LA, USA
| | - Matthew Bral
- Department of Anesthesiology, LSUHSC, Shreveport, LA, USA
| | - Shanthi Reddy
- Department of Anesthesiology, LSUHSC, Shreveport, LA, USA
| | | | | | - Charles J Fox
- Department of Anesthesiology, LSUHSC, Shreveport, LA, USA
| | - Alan David Kaye
- Department of Anesthesiology, Louisiana State University Health Science Center, 1542 Tulane Ave, New Orleans, LA, 70112, USA.
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Levett KM, Smith CA, Bensoussan A, Dahlen HG. Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour. BMJ Open 2016; 6:e010691. [PMID: 27406639 PMCID: PMC4947718 DOI: 10.1136/bmjopen-2015-010691] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use. DESIGN Open-label, assessor blind, randomised controlled trial. SETTING 2 public hospitals in Sydney, Australia. POPULATION 176 nulliparous women with low-risk pregnancies, attending hospital-based antenatal clinics. METHODS AND INTERVENTION The Complementary Therapies for Labour and Birth protocol, based on the She Births and acupressure for labour and birth courses, incorporated 6 evidence-based complementary medicine techniques: acupressure, visualisation and relaxation, breathing, massage, yoga techniques, and facilitated partner support. Randomisation occurred at 24-36 weeks' gestation, and participants attended a 2-day antenatal education programme plus standard care, or standard care alone. MAIN OUTCOME MEASURES Rate of analgesic epidural use. Secondary: onset of labour, augmentation, mode of birth, newborn outcomes. RESULTS There was a significant difference in epidural use between the 2 groups: study group (23.9%) standard care (68.7%; risk ratio (RR) 0.37 (95% CI 0.25 to 0.55), p≤0.001). The study group participants reported a reduced rate of augmentation (RR=0.54 (95% CI 0.38 to 0.77), p<0.0001); caesarean section (RR=0.52 (95% CI 0.31 to 0.87), p=0.017); length of second stage (mean difference=-0.32 (95% CI -0.64 to 0.002), p=0.05); any perineal trauma (0.88 (95% CI 0.78 to 0.98), p=0.02) and resuscitation of the newborn (RR=0.47 (95% CI 0.25 to 0.87), p≤0.015). There were no statistically significant differences found in spontaneous onset of labour, pethidine use, rate of postpartum haemorrhage, major perineal trauma (third and fourth degree tears/episiotomy), or admission to special care nursery/neonatal intensive care unit (p=0.25). CONCLUSIONS The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence. TRIAL REGISTRATION NUMBER ACTRN12611001126909.
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Affiliation(s)
- Kate M Levett
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - C A Smith
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - A Bensoussan
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - H G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Levett KM, Smith CA, Bensoussan A, Dahlen HG. The Complementary Therapies for Labour and Birth Study making sense of labour and birth - Experiences of women, partners and midwives of a complementary medicine antenatal education course. Midwifery 2016; 40:124-31. [PMID: 27428108 DOI: 10.1016/j.midw.2016.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/03/2016] [Accepted: 06/08/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE to gain insight into the experiences of women, partners and midwives who participated in the Complementary Therapies for Labour and Birth Study, an evidence based complementary medicine (CM) antenatal education course. DESIGN qualitative in-depth interviews and a focus group as part of the Complementary Therapies for Labour and Birth Study. SETTING AND PARTICIPANTS thirteen low risk primiparous women and seven partners who had participated in the study group of a randomised controlled trial of the complementary therapies for labour and birth study, and 12 midwives caring for these women. The trial was conducted at two public hospitals, and through the Western Sydney University in Sydney, Australia. INTERVENTIONS the Complementary Therapies for Labour and Birth (CTLB) protocol, based on the She Births® course and the Acupressure for labour and birth protocol, incorporated six evidence-based complementary medicine (CM) techniques; acupressure, relaxation, visualisation, breathing, massage, yoga techniques and incorporated facilitated partner support. Randomisation to the trial occurred at 24-36 weeks' gestation, and participants attended a two-day antenatal education programme, plus standard care, or standard care alone. FINDINGS the overarching theme identified in the qualitative data was making sense of labour and birth. Women used information about normal birth physiology from the course to make sense of labour, and to utilise the CM techniques to support normal birth and reduce interventions in labour. Women's, partners' and midwives' experience of the course and its use during birth gave rise to supporting themes such as: working for normal; having a toolkit; and finding what works. KEY CONCLUSIONS the Complementary Therapies for Labour and Birth Study provided women and their partners with knowledge to understand the physiology of normal labour and birth and enabled them to use evidence-based CM tools to support birth and reduce interventions. IMPLICATIONS FOR PRACTICE the Complementary Therapies for Labour and Birth Study introduces concepts of what constitutes normal birth and provides skills to support women, partners and midwives. It appears to be an effective form of antenatal education that supports normal birth, and maternity services need to consider how they can reform current antenatal education in line with this evidence.
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Affiliation(s)
- K M Levett
- National Institute of Complementary Medicines (NICM), Western Sydney University, Sydney, Australia.
| | - C A Smith
- National Institute of Complementary Medicines (NICM), Western Sydney University, Sydney, Australia.
| | - A Bensoussan
- National Institute of Complementary Medicines (NICM), Western Sydney University, Sydney, Australia.
| | - H G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia.
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38
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Gregson S, Tiran D, Absalom J, Older L, Bassett P. Acupressure for inducing labour for nulliparous women with post-dates pregnancy. Complement Ther Clin Pract 2015; 21:257-61. [DOI: 10.1016/j.ctcp.2015.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 07/06/2015] [Accepted: 07/28/2015] [Indexed: 12/15/2022]
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39
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Asadi N, Maharlouei N, Khalili A, Darabi Y, Davoodi S, Raeisi Shahraki H, Hadianfard M, Jokar A, Vafaei H, Kasraeian M. Effects of LI-4 and SP-6 Acupuncture on Labor Pain, Cortisol Level and Duration of Labor. J Acupunct Meridian Stud 2015; 8:249-54. [DOI: 10.1016/j.jams.2015.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 08/07/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022] Open
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Mollart LJ, Adam J, Foureur M. Impact of acupressure on onset of labour and labour duration: A systematic review. Women Birth 2015; 28:199-206. [DOI: 10.1016/j.wombi.2015.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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