Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Background:
For several decades childbirth educators and midwives have focused on the
alleviation or reduction of pain and suffering during the childbirth experience (Brown,
Douglas & Flood 2001:1). Nursing professionals who care for labouring women
require current, evidence-based knowledge regarding pain management options,
including mode of action, benefits, risks and efficacy (Florence & Palmer 2003:238).
Objectives:
This study examined the effects of non-pharmacological pain relief strategies for pain
management during labour.
Search methods:
The researcher conducted a search between February and May 2010 on PubMed,
CINAHL and CENTRAL for randomised controlled trials published from inception to
2010. The Medical Search Headings (MeSH) included non-pharmacological,
alternative, pain management, labour, pregnant, complementary, randomised,
randomly, midwifery, natural birth, relaxation, breathing, positioning, hypnosis, water
birth, acupuncture, aromatherapy.
Selection criteria:
The studies included reported on pregnant women, primigravida or multigravida,
term (37 weeks and more), spontaneous labour (first or second stage) without any
complications in previous or current pregnancies. The researcher searched for
randomised controlled trials with an intervention and a control group. Due to
financial restrictions the researcher assessed studies that were published in English
only. Interventions were childbirth education, continuous support, relaxation,
breathing techniques, movement and positioning, music, manual healing,
aromatherapy, hydrotherapy, hypnosis and acupuncture.
Data collection and analysis:
Meta-analysis was performed using Relative Risks and 95% Confidence Interval for
dichotomous outcomes and Weighted mean differences and 95% Confidence
Interval for continuous outcomes. Review Manager (RevMan), a statistical software
was used. Where meta-analyses were impossible results were presented in
narrative form. The outcome measures were a decreased need for pharmacological
pain relief, maternal satisfaction with the overall childbirth experience, length of
labour (normal or shorter progress), incidence of postnatal depression, incidence of
postpartum haemorrhage, an Apgar score of more than seven at five minutes,
resuscitation of the neonate and admission to the neonatal intensive care unit.
Results:
Thirteen (13) eligible RCT’s were included in the systematic review. Four trials
involved hydrotherapy (n=585), two trials involved acupuncture (n=480), two trials
involved childbirth education (n=6398), one trial involved continuous support
(n=2844), one trial involved aromatherapy (n=513), one trial involved maternal
positioning (n=2547), one trial involved music, massage and relaxation (n=90) and
one trial involved hypnosis (n=82). In the Freeman trial (1986) women in the
hypnosis group required less pharmacological pain relief 15/29 compared to women
in the control group 20/36. Women in the intervention group also experienced
greater satisfaction with the childbirth experience 15/29 (52%) compared to women
in the control group 8/36 (23%). The trials of acupuncture showed a decreased need
for pharmacological pain management in Skilnand (2002) (n=208) for epidural
11/106 (10%) for the intervention and 27/102 (26.5%) for the control group as well as
Pethidine 15/106 (14%) for the intervention and 36/102 (35%) for the control group.
In the Borup trial (2009) it was reported that acupuncture during labour reduced the
need for pharmacological pain management for the intervention group 185/314
(58.9%) compared to control 124/149 (83.2%) without affecting the birth outcome.
The secondary outcome of length of labour (minutes) in the Skilnand trial is
significantly in favour of the acupuncture group with a mean value of 212 (SD, 155),
compared to the control group with a mean value of 283 (SD, 225) with a p-value of
0.01.
Conclusions:
Acupuncture may relieve labour pain and also shorten the duration of labour, and
women experience greater satisfaction with the childbirth experience. Hypnosis may
decrease the need for pharmacological pain relief requirements, and may also
increase an overall maternal satisfaction with the childbirth experience. There is
insufficient evidence about the benefits of childbirth education, continuous support,
aromatherapy, music, massage, movement and positioning, breathing and
relaxation. / AFRIKAANSE OPSOMMING: Agtergrond:
Vir talle dekades het die verloskundiges en vroedvroue gefokus op die verligting of
vermindering van pyn en lyding gedurende die ervaring van kindergeboorte (Brown,
Douglas & Flood 2001:1). Professionele verpleegkundiges wat omsien na vrouens
wat kraam het die huidige, bewyslewerende kennis aangaande pynbestuuropsies
nodig, insluitende die wyse van optrede, voordele, risiko en effektiwiteit (Florence &
Palmer 2003:238).
Doelstellings: Hierdie studie het die effekte van nie-farmakologiese pynverligtingstrategieë vir die
beheer van pyn gedurende die kraamproses nagevors.
Ondersoekmetodes: Die navorser het gedurende Februarie en Mei 2010 ’n ondersoek gedoen na
PubMed, CINAHL en CENTRAL vir ewekansigbeheerde proewe gepubliseer vanaf
die aanvang tot 2010. Die Mediese Ondersoekhoofde het farmakologiese,
alternatiewe, pynbeheer, kraam, swangerskap, komplementêre, ewekansigheid,
toevalligheid, verloskunde, natuurlike geboorte, ontspanning, asemhaling,
posisionering, hipnose, watergeboorte, akupunktuur en aromaterapie ingesluit.
Seleksie kriteria:
Die studies het navorsing oor swanger vroue, primigravida of multigravida, tydperk
(37 weke en meer), spontane kraam (eerste of tweede stadium) sonder enige
komplikasies in vorige of huidige swangerskappe ingesluit. Die navorser het
ewekansigbeheerde toetsing met ’n intervensie en ’n kontrole groep ondersoek. As
gevolg van finansiële beperkings het die navorser studies wat alleenlik in Engels
gepubliseer is, geassesseer. Intervensies soos die opvoeding oor kindergeboorte,
deurlopende ondersteuning, ontspanning, asemhalingstegnieke, beweging en
posisionering, musiek, handegenesing, aromaterapie, hidroterapie en akupunktuur is
bestudeer.
Data-insameling en analise:
Meta-analise is uitgevoer deur gebruik te maak van Relatiewe Risiko’s en 95%
Betroubaarheidsinterval vir tweeledige uitkomste en Gewigdraende gemiddelde
afwykings en 95% Betroubaarheidsinterval vir deurlopende resultate. Review
Manager (RevMan), ’n statistiese sagteware is gebruik. Waar dit ontmoontlik was om
meta-analise uit te voer, was resultate gepresenteer in narratiewe vorm. Die
uitkomste meting is ’n afname in die behoefte vir farmakologiese pynverligting,
moederskapbevrediging met die algehele geboorteskenkervaring, die duur van die
bevalling (normale of korter vordering), gevalle van postnatale depressie, voorkoms
van postpartum bloeding , ’n Apgartelling van meer as sewe teen vyf minute,
resussitasie van die neonaat en toelating tot die neonatale intensiewe sorgeenheid.
Resultate:
Dertien (13) geskikte ewekansigbeheerde proewe is ingesluit in die sistematiese
oorsig. Vier proewe het hidroterapie (n=585), twee proewe akupunktuur (n=480),
twee proewe die opvoeding van kindergeboorte (n=6398), een proef deurlopende
ondersteuning (n=2844), een proef aromaterapie (n=513), een proef moederlike
posisionering (n=2547), een proef musiek, massering en ontspanning (n=90) en een
proef het hipnose (n=82). Die proef vir hipnose het ‘n afname in die behoefte vir
farmakologiese pynbeheer met 15/29 vroue in die hipnose groep en 20/36 vroue in
die kontrole groep getoon. Vroue in die hipnose groep het ook groter bevrediging
gevind met die ervaring van die geboorteskenking met 15/29 (29%) in vergelyking
met 8/36 (23%) in die kontrole groep. Die proewe vir akupunktuur het ’n afname in
die behoefte vir farmakologiese pynbeheer Skilnand (2002) (n=208), met ‘n
gemiddelde waarde van 11/106 (10%) vir epiduraal en 15/106 (14%) vir Pethidien in
die intervensie groep en ‘n gemiddelde waarde van 27/106 (26.5%) vir epidural en
36/102 (35%) in die kontrole groep. Borup (2009) (n=384) toon ook ‘n afname in die
behoefte van farmakologiese pynbeheer met ‘n waarde van 185/314 (58.9%) in
vergelyking met die kontrole groep 124/149 (83.2%). Die sekondêre uitkomste van
die duur van die kraamproses (minute) in Skilnand (2002), is noemenswaardig ten
gunste van die akupunktuurgroep met ’n gemiddelde waarde van 212 (SA, 155) in
die intervensie groep en ’n gemiddelde waarde van 283 (SA, 225) in die kontrole
groep met ’n p-waarde van 0.01.
Gevolgtrekkings:
Akupunktuur mag kraampyn verlig en ook die duur van die kraamproses verkort,
vandaar dat vrouens groter bevrediging mag ervaar met die ervaring van
geboorteskenk. Hipnose mag die begeerte na farmakologiese pynverligting
verminder en sodoende vroue groter ervaring met geboorteskenk mag ervaar. Daar
is onvoldoende bewys aangaande die voordele van die opvoeding van
kindergeboorte, deurlopende ondersteuning, aromaterapie, musiek, massering,
beweging en posisionering, asemhaling en ontspanning.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/6696 |
| Date | 03 1900 |
| Creators | Abelgas, Marjorie Caroline |
| Contributors | Taha, Marinda, Khondowe, Oswell, University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science. |
| Publisher | Stellenbosch : University of Stellenbosch |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 100 p. |
| Rights | University of Stellenbosch |
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