Sterile Water Injection for the Management of Back Pain During Labour

Abstract

Introduction: As many as 70% of women experience back pain during labour, and around 30% report severe back pain during delivery. Back pain has been reported to increase risk of obstetric complications such as severe perineal trauma and emergency caesarean section. For women who wish to delay or avoid pharmacological analgesia such as epidural, the use of sterile water injections (SWI) may be an attractive alternative to manage back pain. SWI uses intradermal injections of sterile water in 2-4 locations around the sacrum. Aim(s): To evaluate the effectiveness of SWI in reducing pain scores, and its impact on obstetric outcomes such as caesarean section. Method(s): The SWI protocol was introduced at Auburn Hospital as part of routine care in August 2018. Labouring women experiencing significant back pain were offered SWI and asked to score their pain in the contraction immediately before and after administration. Data collection spanned 18 months and pain scores were obtained for each woman. Demographic and obstetric data was obtained from e-Maternity and was compared to publicly available data from the baseline obstetric population. Finding(s): There was a significant reduction in pain scores (Pre-SWI Mean = 8.8 vs Post-SWI Mean = 4.4; p < 0.0001) pre and post SWI. There was no significant change in obstetric outcomes between the SWI group and baseline population; however, there was a higher rate of IV Narcotic Use in the SWI group (26% SWI vs 5.9% AH; p < 0.05). Discussion(s): SWI is a promising means of pain relief; however, larger studies are needed to evaluate obstetric outcomes.