Non-pharmacological pain relief - Copy

In this podcast, the host, Isabel Cagney, is joined by midwives Natalia and Michelle to discuss non-pharmacological pain relief in labor. They talk about techniques such as acupressure using a comb, TENS machines, and sterile water injections. They discuss the effectiveness and evidence behind these methods, as well as the potential risks. They emphasize the importance of informed decision-making and giving women choices in pain relief during labor. They also mention counter pressure as another technique for relieving back pain during labor. Hello, and welcome to this podcast. My name is Isabel Cagney, and I'm a fourth year student midwife here in UCC, and I'll be your host for today. With me, I have Natalia and Michelle, who are both midwives, and Michelle has just had her first baby, so she's going to give an extra added perspective to this discussion. Thank you both for being here and taking time out of your, no doubt, busy schedules to be here today. Hi, Isabel. Thank you for having us here today. We are going to discuss non-pharmacological pain relief in labor, which is a big word. Non-pharmacological pain relief, in essence, although it's a big word, it's a really simple concept, is just anything other than medication or drugs to relieve pain. We have all used non-pharmacological pain relief before, even if we weren't aware of it. We might have put a hot water bottle or an ice pack on a sore muscle or joint, drank water, dimmed the lights when we have a headache, or focused on our breathing to help us manage pain better. For most of human history, the only effective pain relief in labor has been non-pharmacological pain relief. Most women would have some knowledge of pharmacological pain relief in labor, which is the drugs and medications, such as paracetamol, petidine, or maybe an epidural, but I think people can often forget that there are many other ways of reducing and managing pain that don't involve drugs and all the risks that come with using them. So, Michelle, you as a midwife encourage women to use other techniques to manage pain in labor, and I'm sure they'd be fascinated to hear about the ones you'd recommend for women and that you see every day, and the ones that you used yourself in your own labor. So, one of the methods that I used in my own labor, and I actually encourage women to use all the time, and it really has gained popularity over the last few years, is a comb in labor. It's really simple to use. You just get the woman to hold the comb, with the teeth pointing just below where the fingers meet the palm. This is used for what we call acupressure, the idea being that our brains can only process a certain amount of sensation at any one time, and if it is feeling the pressure of the comb, it will focus on that instead of another pain sensation, such as contraction. Okay, very interesting. Is there any evidence to support this, or is it just a bit of an old wives' tale? Well, non-pharmacological pain relief is less studied than medications, but there is evidence that it is... I'll pause that and we can cut that. There is evidence that it is very effective, and having seen it in practice and using it myself, I would say it does work for a lot of women. Studies have found that acupressure can significantly reduce pain in active labor, and may even help reduce the length of labor without any documented risks. Wow, that is really amazing. Thank you for that. You also told me that you used a TENS machine in labor. Could you tell us a bit more about that? So... So yeah, another method that I use that is quite similar actually to the comb in its tactics, but I used it in my own labor and I use it with women, is the TENS machine, and it also works on the basis that our brains can only cope with a limited amount of signals at a time. The TENS machine consists of little pads that stick on your back, which are connected to a little battery-powered machine that delivers tiny electrical waves to the body. The idea being that if your brain has to focus on these... So the idea being that if your brain has to focus on these electrical signals, it won't be able to focus on the pain of contraction as much. Okay, so I have heard of the TENS machine before and seen it used way more often than I've seen the comb, especially in early labor. Is there any evidence to support the use of these machines, or is there any risks that you think people should be aware of? Actually, the evidence really supports the use of TENS machines and shows that they really can help women cope with labor pains. However, a lot of women don't find they give any relief at all, but they are non-invasive and usually available in the hospital, so they are worth a try. They are... Okay, thank you for that. That was really interesting. Okay, so I have heard of the TENS machine before and seen it used way more often than I've seen the comb, especially in early labor. Is there any evidence to support the use of these machines, or is there any risks that you think people should be aware of? Actually, the evidence really supports the use of TENS machines and shows that they really can help women cope with labor pains. However, a lot of women don't find they give any relief Okay, thank you for that. That was really interesting. So, Natalia, you were going to discuss one that I am not so familiar with, which is sterile water injections. They're something that I've never seen used or even heard of anyone using them, apart from in the textbooks. First of all, I think it would be useful for all of us to know what they are and how exactly they work. Yeah, so I'll talk a little bit about those now. So, basically, these consist of sterile water, which is injected just below the skin, around the sacrum or the lower back. Now, they're used mainly to relieve what is called back labor, which just means where labor pains are felt mainly in the back, which is the case in about a third of all the labors, so that's a significant amount. Now, it's only a tiny amount of water that is being injected, between 0.1 to 0.5 mils of water injected into four areas of the lower back, forming a sort of blister just below the skin. Now, understanding how they work is significantly – it's slightly early. Yeah, I can pause that. Just actually leave it, take a breath, we'll have a little silence and then just go into this. And did you pause? No, you didn't. No, I didn't. Yeah, because it was slightly, I was like – Yeah. So you can edit that out. Yeah. Okay. Great. So, understanding how they work is slightly more difficult to answer, as there seems to be differing opinions on how they work. Now, one theory is that when they are injected, they block pain signals going to the brain and therefore reduce the amount of pain felt. Another theory is that the irritation to the skin caused by the injection itself releases endorphins, which are happy hormones that help us cope better with pain. Okay. I think I'm still a bit skeptical about these. What does the research say about them? Now, so there actually was a meta-analysis done in 2009 of eight randomised control tests, which, as you might not know, are the gold standard, so to speak, of studies. And it had some really interesting results. So this study found that in these trials, women who had sterile water injections reportedly had significantly less pain than those who did not have the injections. And women who had the injections also had a really significant reduction in the need for a cesarean section than those who didn't have the sterile water injections. Wow. I wasn't expecting those results. Why do you think, though, with these results that we've seen, that they aren't more widely used or even known about? Yeah. So, like you said yourself, you're still a bit sceptical about this method. And I think women who are keen to avoid pharmacological pain relief are also keen to avoid injections as they are sceptical because it feels invasive. So having four injections in your lower back is something that not a lot of people would opt for. Now, there is also a lack of awareness and training among midwives and maybe some scepticism about its use. There are also risks associated with having an injection. And even if they are a small risk, such as infection and pain, there is also a risk that this won't be effective. So I think the overall... Take a break. Yeah. So I think overall there needs to be more discussion around this method so that women can make an informed decision about whether or not this is something that would suit them during their labour. Okay. And I like what you said about informed decision making because that's something that is really important in our job as midwives is informing women on all their options so they can make a decision that is best for them and for their baby. Well, thank you both for all that. Oh, I don't know what to say there now. Okay. Thank you both for being here and for having that lovely discussion. I think we're all a bit more educated than we were when we came in here. I think a lot of people would be fascinated, as I was, by what we've talked about today. And hopefully it will get people thinking outside the box a bit when it comes to pain relief in labour. Well, thank you for that. And I think you said something really important there about informed choice and decision making. It is really important that we as midwives give people choice, whether it's about pain relief or any other aspect of care. I know there's loads of other options for pain relief that we could talk about for women in labour. Is there one last thing that you think might be useful for our listeners who are thinking about pain relief for their labours? Yeah, there's actually something I'd love to discuss. And now this is called counter pressure. So counter pressure consists of steady strong force applied to one spot on the lower back during contractions using the heel of the hand or pressure on the side of each hip using both hands. Counter pressure helps alleviate back pain during labour, especially in those women experiencing back labour, as we mentioned before. And now this is a lovely way for your partner to be involved in the labour process. And we must keep in mind that touch can convey pain. Sorry, say it again. Actually, no. Yeah. Yeah. So, okay. So this is a lovely way to get your partner involved in the labour process. And it's important to remember that touch can convey pain reducing messages. So a hand placed on a painful spot, a pat of reassurance or stroking the cheek in an affectionate gesture or a tight embrace can communicate a message of caring to the labouring woman. Oh, that's lovely. Thank you for including the partner because I think we often forget in our birth plans to include the partner. The poor partners often get left out and they don't know what to do. And that is really important to think about when you are a partner, if you're a partner listening to this, that what you can do for your birthing partner in labour. Thank you both for joining us here today. I think this is a really important issue to discuss and it often isn't discussed enough because we focus on medication and drugs in labour. But there are many more that we could discuss here, but we can't today. So thank you again for joining me here. So just to sum up, thanks Isabel for raising this topic. I think it's a very relevant one. And I suppose through my years working in the maternity unit, I've noticed that women come in and they have already made a decision that they want to use pharmacological pain relief in labour. But I suppose they might not be aware that this might not be as effective as they think. So through my years working in the maternity unit, I've noticed that women come in having made the decision to use pharmacological pain relief in labour, but they are often not aware that this might not be as effective as they want it to be. So I suppose it's very important to have some other options to fall back on in case pharmacological pain relief doesn't work for you. That's a very good point. Thank you very much for that. Michelle, thank you very much for being here as well. Have you anything to add? So I really love what Natalia said there and I'm glad you brought us in to discuss this topic because it is a really important thing to discuss and to educate people about. Thank you Elizabeth. You're very welcome. Thank you for being here and taking time out of your day and away from your baby to be here with us. Thank you all for listening at home and I hope you enjoyed this podcast.