Author's Accepted Manuscript

Use of pharmacological and non-

pharmacological labor pain management
techniques and their relationship to maternal
and infant birth outcomes: Examination of a
nationally representative sample of 1,835
pregnant women
Jon Adams PhD, Jane Frawley, Amie Steel, Alex
Broom, David Sibbritt
www.elsevier.com/midw

PII: S0266-6138(15)00007-8
DOI: http://dx.doi.org/10.1016/j.midw.2014.12.012
Reference: YMIDW1620

To appear in: Midwifery

Received date: 26 May 2014

Revised date: 1 December 2014
Accepted date: 31 December 2014

Cite this article as: Jon Adams PhD, Jane Frawley, Amie Steel, Alex Broom,
David Sibbritt, Use of pharmacological and non-pharmacological labor pain
management techniques and their relationship to maternal and infant birth
outcomes: Examination of a nationally representative sample of 1,835
pregnant women, Midwifery, http://dx.doi.org/10.1016/j.midw.2014.12.012

This is a PDF file of an unedited manuscript that has been accepted for
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pertain.
 1

26 May 2014

Midwifery

Jon Adams

Professor of Public Health

Faculty of Health, University of Technology Sydney, Australia, 2000

jon.adams@uts.edu.au

Dear Debra Bick,

RE: Use of pharmacological and non-pharmacological labor pain management

techniques and their relationship to maternal and infant birth outcomes: Examination
of a nationally representative sample of 1,835 pregnant women

I would be most grateful if you would consider our manuscript (titled above) for publication
in Midwifery.

Our paper is the first to identify associations between the use of both pharmacological and
non-pharmacological labor pain management techniques and maternal and infant birth
outcomes while controlling for confounding factors. Analyzing data from a nationally
representative sample of 1,835 pregnant women, our study identified women’s use of water
for labor pain management as decreasing the likelihood of their baby being admitted to
special care nursery while the use of epidural increased this likelihood as well as increased
the likelihood of an instrumental delivery. Epidural and pethidine use decreased women’s
likelihood of continuing breastfeeding while the use of breathing techniques and massage for
pain control increased the likelihood of women continuing breastfeeding.

There remain significant gaps in the evidence base relating to the use of non-pharmacological
labor pain control methods and our findings provide a platform with which to develop a
broad clinical research program around this topic. We feel that the significance of our
findings will be of particularly interest to the international audience of your journal. Please
see below for author details, corresponding author and other required information.
 2

1. RE: Full title of manuscript:

Use of pharmacological and non-pharmacological labor pain management techniques

and their relationship to maternal and infant birth outcomes: Examination of a
nationally representative sample of 1,835 pregnant women

2. Authors’ names and credentials in the order of authorship for publication:

Professor Jon Adams, Professor of Public Health Faculty of Health, UTS, Level 7,
Building 10, 235-253 Jones Street, Ultimo NSW 2006 Australia, collected data,
prepared manuscript and reviewed manuscript.

Jon.adams@uts.edu.au

Jane Frawley, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street,
Ultimo NSW 2006 Australia, prepared manuscript and reviewed manuscript.

Jane.frawley@uts.edu.au

Dr. Amie Steel, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street,
Ultimo NSW 2006 Australia AND Endeavour College of Natural Health, level 2, 269
Wickham St, Fortitude Valley, Brisbane, QLD 4006 analysed data, prepared
manuscript and reviewed manuscript.
Amie.steel@uts.edu.au

Professor Alex Broom, School of Social Science, Level 3, Michie Building, St Lucia
Campus, University of Queensland, St Lucia QLD 4072collected data, prepared
manuscript and reviewed manuscript.
a.broom@uq.edu.au

Professor David Sibbritt, Professor of Epidemiology at David Sibbritt Faculty of

Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo NSW 2006
 3

Australia collected data, prepared tables, prepared manuscript and reviewed

manuscript.
david.sibbritt@uts.edu.au

3. The name, mailing address, telephone and fax numbers, and e-mail address of
the author to whom communications should be sent (corresponding author)

Professor Jon Adams

Professor of Public Health, Faculty of Health, University of Technology Sydney,

Level 7, Building 10, 235-253 Jones Street, Ultimo NSW 2006 Australia.

jon.adams@uts.edu.au

PH: +61 2 9514 7420

Fax: +61 2 9514 1088

4. Conflict of interest disclosure

All authors confirm that they have no conflicts of interest and that this manuscript has
not been previously published elsewhere and is not under consideration by another
journal. Ethics approval for the study was gained from the relevant ethics committees
at the University of Newcastle (#H-2010_0031), University of Queensland
(#2010000411) and the University of Technology Sydney (#2011-174N).

5. Acknowledgements

This project is funded by the Australian research Council’s Discovery Project funding
(DP1094765).
 4

Jon Adam

Professor of Public Health

Faculty of Health, University of Technology Sydney, Australia, 2000

jon.adams@uts.edu.au
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Birth Outcomes

Force Baby
ps / admit
vento ted to Continue
Vagi Initiated
use speci d
nal breastfe
suctio al breastfe
tear eding
Pain n care eding

managem
ent
technique OR p OR p OR p OR p OR p

(95% (95% (95% (95% CI) (95% CI)

CI) CI) CI)

Breathing 1.69 0.0 0.96 0.9 0.67 0.1 1.46 0. 1.72 0.0
techniques 1 2 6 29 1
(1.13 (0.49- (0.39 (0.73- (1.14-
(n=1087)
- 1.89) - 2.94) 2.58)
2.51) 1.17)

Massage 1.22 0.2 1.58 0.1 0.88 0.6 1.54 0. 1.62 0.0
(n=526) 2 1 3 31 2
(0.88 (0.91- (0.53 (0.67- (1.07-
- 2.76) - 3.52) 2.45)
 26

1.70) 1.47)

Hypnother 1.87 0.1 0.90 0.9 1.26 0.7 0·50 0. 1.11 0.8
apy (n=60) 5 0 1 55 8
(0.80 (0.17- (0.37 (0.05- (0.30-
- 4.68) - 4.70) 4.05)
4.37) 4.28)

TENS 0.77 0.4 0.96 0.9 0.92 0.8 1.81 0. 1.14 0.5
machine 1 4 5 44 4
(0.41 (0.35- (0.39 (0.41- (0.76-
(n=114)
- 2.69) - 8.07) 1.70
1.43) 2.16)

Bath, 1.25 0.1 1.29 0.3 0.42 0.0 1·04 0. 1.34 0.6
birthing 8 8 04 91 6
(0.90 (0.73- (0.24 (0.51- (0.36-
pool or
- 2.29) - 2.12) 4.95)
shower
1.74) 0.76)
(n=576)

Acupressu 1.34 0.5 0.58 0.5 0.26 0.2 0·79 0. 0.99 0.9
re / 1 0 1 84 6
(0.56 (0.12- (0.03 (0.08- (0.68-
Acupunctu
- 2.82) - 7.72) 1.45)
re (n=49)
3.22) 2.11)

Gas 1.32 0.1 1.29 0.3 0.75 0.2 0.80 0. 0.99 0.9
(n=775) 0 9 7 52 6
(0.95 (0.72- (0.45 (0.41- (0.68-
- 2.29) - 1.55) 1.45)
1.85) 1.24)

Pethidine 0.93 0.7 2.07 0.0 1.06 0.8 0.65 0. 0.59 0.0
(n=285) 4 3 4 24 1
(0.61 (1.09- (0·58 (0.32- (0.39-
- 3.93) - 1.32) 0.88)
1.42) 1·94)
 27

Epidural 0.45 <0. 7.27 <0. 3.38 <0. 0.61 0. 0.68 0.0
(n=825) 001 001 001 14 3
(0.31 (3.93- (1.98 (0.32- (0.47-
- 13.43 - 1.17) 0.97)
0.64) ) 5.78)


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