Acupunct

ure
Fourrecentsy stematicstudi
esoft heef fi
cacyandusef ulnessoft heuseof
acupunct ureandacupr essureforpai nreli
eforpai ncont rolinlabourhav e
beenr eportedbySmi t
hetal .[
38].Theaut hor sconcludedt hatv ari
abili
tyin
thenat ureoft hesampl emadei nterpretationchal l
engi ngandt heywer e
theref
or eunabl etomakear ecommendat i
on.I ncont rasttot heot herthree
revi
ews whi ch assessed t he suppor tivef unction ofacupunct ure and
acupressur ei nl abouranal gesi
a,t he sy stemat i
cr ev i
ew byCho etal .
concent rat
edondet er
mi ni
ngt heef fectivenessofacupunct ur eforl abour
analgesia.Oh,Choet .Acupunct urewasconcl udedt obeunsuccessf ulin
minimisingpai nscor esabove30mi n[39].Howev er,t
heuseofacupunct ure,
eit
herbyepi duralorot hermet hods,wasassoci atedwi thasubst antial
reducti
oni nanal gesicrequir
ement s.Thekeyuseofacupunct uref orlabour
painreliefisnotendor sedint hecur rentliter
ature;acupunct ure,howev er
maypl ayani mpor tantroleasanadj unctt herapyt ohelpwomenmanage
l
abour .

Hy
pnot
ism
Antenat alsel f
-hy pnosi sprepar ationwaswi delyappreciatedbywomenand
foundt obeef fectiv
edur i
ngl abourandbi r
th[40]
.Resear chersr eport
ed
seven r andomi sed t r
ialsi n 1213 women i nvesti
gating t he impactof
hypnosi sonl abouri nar ecentCochr anedat abaser eview [ 41].Fort he
primar yout comes, nomaj ordi ffer enceswer eobser vedbet weenwomeni n
the hy pnosi s communi ty and t hose int he controlgr oup:use of
phar macol ogicalpai nreli
ef,spont aneousv aginalpregnancy , andpai nrel
ief
satisfact i
onf orasenseofcopi ng.I nonet ri
alinvolvi
ng60par ti
cipants,
l
owerpai ni ntensi tyandshor terl abourper i
od( 5cm dil
at i
ont obirth)inthe
hypnosi sgr oupwer er ecorded.I nv esti
gat
or sconcludedt hathi gh- qual
ity
resear chi nv estigatingt heresul tsoft heuseofhy pnosisdur i
ngl abourhad
i
nadequat e pr oof .The i mpact s of sel f-hypnosis on l abour epi dural
analgesi cr equi rement swer eev aluat edbyt wor ecentRCTs[ 42,43] .
At28-
32weeksgest ation,Downeetal .randomi sed680nul l
iparousf emal est o
eit
herr egul
arcareorusualcar eplussel f
-hypnosis[
42].Nomaj orreducti
on
i
n i nt
rapartum epi dur al analgesi
c r equi
rements was not i
ced by
i
nvest i
gators.Resear chersr andomi sed pat i
entsi nt
ot hree groups in
another RCT i nvolvi
ng 1222 nul l
iparous women[ 43]
, self-
hypnosis,
rel
axationtechniques, andast andardcaregr oup.Inepidur
alanalgesicuse
orsel f-r
eported pain,no maj ordi ff
erences wer e observed.Ther eis
currentl
yinsuffi
cientresearchofhi ghqual i
tytoindi
catehypnosisinlabour
painmanagement .

Yoga
Researchersreport
edoneRCT( i
ncludi
ng74par ents)examiningthei mpact
ofper i
natalyogaonanalgesicrequir
ement sandpai nscor esinast udyof
theef f
ectsofy ogaonpregnancyandchi ldbir
th[44].Six,1hsessi onsat
recommendedweeksofgest ationwer eincludedi nthey ogacur ri
cul um.
Dur i
nglabourand2haf t
erlabour ,
theyogagr oupwasf oundtohav ehi gher
l
ev el
s ofmat er
nalsati
sfacti
on and exper i
enced less subject-assessed
l
abourpai nthant hecontrolgroup.Nodi fferenceswer enot ed,howev er
,
betweent hegroupswit
hregardt oanalgesi
cuse.

Ther
eisal ackofhigh-
qual
it
yresear
chexamini
ngtheimpactofyogaon
l
abouranal
gesia,
li
kel
yli
nkedtot
heunusualpr
act
iseofpr
egnancyy
oga[45]
.

Exer
cisedur
ingpr
egnancy
Theuseofbi rt
hbal lexercisehasbeenshownt oal leviatelabourpai n;t
he
gatecont r
oltheory[46]wasapot enti
almechani sm ci ted.Makv andietal .
i
dentif
iedt hr
eestudi esthatreportedsubstantialdifferencesi npai
nscor es
duri
ngl abourbetweent hebirt
hbal landcontrolgr oups[46]i nasyst emati
c
rev
iewandmet a-anal y
sisofRCTsconduct edtoassesst heuseoft hebirt
h
bal
lasasuppor t
iveanal gesictoolduringlabour .Foratl east20mi nut
es
duri
ngl abour,oneRCTr eport
edont heuseofbi r t
hbal lexer
cisesand
anotherRCTr eportedoni tsusedur ingtheantenat alphaseov eraper i
odof
8 weeks.Bot hthese RCTs showed t hatint he bi rt
h bal lcommuni ty,
recor
dedpai nscoreswer esubstanti
all
ylower.Therewer ehowev er,no
substant
ialvar
iat
ionsbetweent hetwosampl egroupsinmat ernalr
equest
andanalgesiaadministr
ati
on.At hi
rdRCTshowedasubst ant
ialincr
easein
painscoresafterexerci
singwiththebi r
thballat30,60,and90mi nutes;
howev er
,inv
esti
gatorsdidnotreportonanalgesi
cusag.

Hy
drot
her
apy
Invest i
gat orsf ound f ourst udi es t hatdocument ed pai n sev erityi na
Cochr anedat abaser eview of11st udi es[47]i nv ol vi
ngwat eri mmer sion
duringl abour( 3146women) .Nodi scr epanci eswer ef oundbet weent he
wat eri mmer sionandcont rol gr oupsi nr ecor dedpai nr atings.Fr om t hef our
tri
alst hatpr oducedt heser esul ts,ther ewasal sonosubst ant i
aldi fference
i
nnar cot i
cusage.Si xst udiespr ovideddat aont heuseofepi dur al/spinal
anal gesi a/ anest hesi a and,r elat ivet o cont rols,t her e wasa subst ant ial
reduct ion i n t he i nci dence of epi dur al/spinal /
par acer vi
cal
anal gesi a/ anest hesi aamongwomenassi gnedt owat eri mmer si ondur ing
thef i
rstphaseofchi l
dbi rt
h.Resul tsr el atedt owat erusedur i
ngt hef i
rst
andsecondst agesofl abour ,r elat edt oi nter ventionandout comev ariabili
ty,
arecur rent lylimi ted,andf ur therst udyi swar r
ant ed. Theef fi
cacyofst eril
e
wat eri njectionsi nt heal lev iat i
onofl ow backpai ndur i
ng l abourwas
exami nedi nt wor ecentsy st emat icr ev iews[ 48,49] .Der ryetal .concl uded
i
nacochr anesy st emat icr ev iew ( sev enRCTsi nv olving766par turients)
that t her e was cl ear ev idence f rom Bl ittl
et hat i ntracut aneous or
subcut aneousst er i
lewat eri nj ect ioni sbenef icialf orl abourpai n[48] .No
variationswer ef oundbet weent hest erilewat erandsal i
negr oupsi nt he
threest udi espubl ishedonanal gesi cconsumpt ioni nt hi sst udy.Si xst udies
hav er epor t
edadecr easei npai nsev erity,f i
ndi ngt hatst eri
lewat eri s
preferabl et osal ine.Theuseofmul tiplescal es,howev er,suggest st hat
met a-anal ysiswasi nappr opr iat e.Inar elat edst udy ,Hut t
onetal .assessed
thei mpactofst er i
lewat eri nject iononcaesar eansect i
onr atesf orl ow
backpai ndur ingl abor [49].Thei ncl usi onr equirement swer emetbyei ght
RCTs.Whenst erilewat erinj ect ionswer eusedt ot r
eatl ow backpai ni n
l
abour ,t
herewasasubst antialdecreaseint hei ncidenceofcaesar ean
sectionrelati
v etot heuseofi sotonicsali
neinject
ionoral t
ernati
vether
apy
(acupunct ureorTENS) .Thev isualanaloguescalewasusedbysi xofthe
studiesr ecordedonpai nscor es.Inthest eri
l
ewat ergr oup,therewasa
subst ant
ialdecreasei nthemeanormedi anpai nscor ecompar edwi t
h
placeboorot herinterv
enti
ongr oupsatallti
mesaf t
ert heinterv
entionwas
admi nist
ered.Anal gesi
cuse, howev erwasnotment ionedi nthi
sstudy.

MassageandRef
lexol
ogy
Sixstudieshav er eport
edont heimpactofmassageonl abourpai nina
Cochraner evi
ewofRCTsr evi
ewingcur r
entlyavai
l
abl eevi
dencesuppor ting
theuseofmanualheal ingapproaches,incl
udingmassageandr eflexology
forlabourpai n cont r
ol,with noner eport
ing on refl
exol
ogy[ 50].When
compar edwi t
hnor malt reat
mentdur i
ngt hefir
ststageoflabour ,lesspai n
duri
nglabourwasr eportedfr
om massage.I nonemassaget r
ialcompar ed
withmusi c,l
abourpai nwasdecr eased,andonemassaget ri
alf oundl ess
anxiet
ycompar edtonor mal t
reat
ment .Massagecanpl ayar ol
ei nr educing
painandi mprovingt heemot i
onalexper i
enceofwomendur ingl abour;
mor estudy,howev erisrequir
ed