Running head : STERILE WATER PAPSULES FOR BACK PAIN IN LABOR 1

Sterile Water Papsules for Back pain in labor

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STERILE WATER PAPSULES FOR BACK PAIN IN LABOR 2

Introduction

Back pain has been a major phenomenon among pregnant women. The back pains

have resulted in immense pain during labor that hinders effective birth delivery of their

children. Various pharmacological and non-pharmacological treatments have been designed

to alleviate back pain experienced by pregnant women during labor. Women have been

subjected to immense pain, and Sterile Water Injections (SWIs) have become common

techniques utilized to reduce back pain during labor. Various evidence-based research has

been conducted showcasing sterile water injections' viability towards alleviating back pain

for pregnant women during labor. The Sterile Water Injection technique has been widely

accepted throughout the world as most doctors and midwives have adopted the approach to

help reduce back pain for pregnant women during labor. Throughout the years,' numerous

analgesics have been developed to help reduce pain for pregnant women; however, this is not

the case as most of them have proved ineffective and rather temporary.

Hence, this paper shall focus on the sterile water injections (SWIs) technique and its

efficiency in reducing back pain among pregnant women during labor. The paper shall

implement a rather thorough literature review approach that focuses on the critical analysis of

evidence-based research articles on the effectiveness of Sterile Water Injections (SWIs) for

pregnant women during labor to reduce back pain. Additionally, the paper shall provide a

comprehensive analysis of three articles on sterile water injections and provide thorough

statistical analyses for each information supporting the information.

Synthesis of Articles

Article 1: Comparative Analgesics Effects of Intradermal and Subdermal Injection of

Sterile Water on Active Labor Pain

STERILE WATER PAPSULES FOR BACK PAIN IN LABOR 3

The article focuses on the comparison of the effectiveness of analgesics through

administration intradermally or sub-dermally in nature. The sample size employed within the

research study consisted of 121 nulliparous women having a gestational age of about 37

weeks or less (Almassinokiani et al., 2020). The research design utilized for the research is a

randomized clinical trial whereby the sample of 121 nulliparous women was divided into

three groups based on the variation of administration of sterile water injections in various

parts of the body. The first group consisted of 40 nulliparous women who were administered

a dose of 0.5 cc of sterile water injections delivered sub-dermally at for sacral points via

insulin needles (Almassinokiani et al., 2020). The second group comprised 39 nulliparous

women who were administered 0.5 cc of sterile water intradermally, while the final group of

42 participants entails needle contact with the mentioned points as the placebo. The

utilization of the randomized clinical trials as a research design focused on reducing any form

of bias while testing the efficiency and effectiveness of Sterile Water Injections (SWIs)

towards eradicating back pain during labor for pregnant women (Almassinokiani et al.,

2020). The level of evidence in the research study is level II because there is only one

randomized controlled trial experiment incorporated in the study. The incorporation of the

single RCT encompasses level II evidence from the article.

Intervention

The study showcased the level foe effectiveness of administering sterile water

injections whether intradermally or sub-dermally to have an effective impact on alleviating

back pain during labor during 90 minutes after the administration of the injections t the

sample. The use of distilled water has strong positive implications towards significant

reduction of labour pain during 90 minutes after administration of medication

(Almassinokiani et al., 2020).

STERILE WATER PAPSULES FOR BACK PAIN IN LABOR 4

Findings

There were minimal information and knowledge among midwives towards

administering sterile water injections in reducing back pains during Labor(Almassinokiani et

al., 2020). The injection of distilled water, whether intradermally or sub-dermally, leads to a

high degree in reducing pain severity during Labor (Almassinokiani et al., 2020).

Nevertheless, there was no significant disparity between the level of pain education among

the pregnant women upon administration of Sterile Water Injections (SWIs), whether sub-

dermally or intradermally.

Article 2: Effects of Intradermal Sterile Water Injections in Women with Low Back

Pain in Labor: A Randomized, Controlled Clinical Trial

The research study focuses on the effects of intradermal sterile water injections

among women suffering from back pain during labor. The sample size derived for the study

is 168 healthy women with intense labor pain and severe back pain who were randomized for

the research study (Genç Koyucu et al., 2018). The research study involved administering

four intradermal injections of 0.1 ml of sterile water into the skin surrounding the rhombus of

Michaelis over the sacral area. The research design employed in the research study is a

randomized controlled trial design. Out of 1354 women presenting in labor, 168 women were

randomized to the study (Genç Koyucu et al., 2018). The level of evidence in the research

study is level II. The research study encompasses one randomized controlled trial experiment.

Thus, the level of evidence is level II due to the presence of one randomized controlled trial.

Interventions

During the study, two midwives were given injections to both sides simultaneously

and at the peak point of contractions. Visual analog scales were utilized in pain scoring. The

pain scores were evaluated before and 10,30,60,120, and 180 minutes after injections. The
STERILE WATER PAPSULES FOR BACK PAIN IN LABOR 5

single researcher undertook the pain scoring evaluation (Genç Koyucu et al., 2018). The

study showcased that the administration of the injections helped in the reduction of the mean

pain scores. The sterile water injections played a significant role in reducing pain among

women in Labor (Genç Koyucu et al., 2018).

Findings

The research study revealed the Sterile Water Injections (SWIs) are effective

methods of relieving pain without having no detrimental impact on the mode of delivery or

duration of labor or having negative side effects on the newborn infant. The Sterile Water

Injections had no negative implications for the mother; thus, the research study proved the

technique safe and reliable for pregnant women Genç Koyucu et al., 2018). SWI is also cost-

effective as compared to other analgesics utilized towards pregnant women. Another positive

phenomenon derived from the research study is that the participating pregnant women widely

recommended the sterile water injection approach and a high prevalence for future use (Genç

Koyucu et al., 2018). Thus, the administration of Sterile Water Injections(SWIs) positively

impacts relieving pain among pregnant women suffering from back pains during labor.

Article 3: "No Pain, no gain": The experience of women using sterile water injections.

The research design employed within the research is randomized controlled trials. The

article focuses on the effects of sterile water injections on pregnant women. .Nevertheless, the

pain induced by the injections has shunned most women from affecting birth experience (Lee,

Kildea & Stapleton, 2017). Hence, the article focuses on determining the relevance and level

of sterile water injections towards relieving pain among women in labor. The sample of

participants involved in the research study is women enrolled at two Metropolitan hospitals in

Queensland, Australia. The research article's level of evidence is level V I(Lee, Kildea &

Stapleton, 2017). Mainly because the entire research study is founded on one solemn
STERILE WATER PAPSULES FOR BACK PAIN IN LABOR 6

qualitative study. Thus, the information collected for the research study is first hand and

provides a first-hand description of the situation regarding the administration of Sterile Water

Injections (SWIs) among pregnant women (Lee, Kildea & Stapleton, 2017)

Intervention

The use of sterile water in labor is greatly associated with analgesic and relaxation

effects on pregnant women. The use of Sterile Water Injections (SWIs) has an analgesic role

in relieving pain among individuals (Lee, Kildea & Stapleton, 2017). The research study

focused on collecting information from expectant women concerning the use of Sterile Water

Injections (SWIs). Sterile Water Injections (SWIs) have proved to be beneficial in alleviating

pain among pregnant women. The approach focused on reducing back pains during labor and

the injections of sterile water, significantly bringing positive birth outcomes to pregnant

women (Lee, Kildea & Stapleton, 2017). The need for effective birth delivery and reduced

induced back pains shall help ensure that there are reduced back pains for the expectant

women, plus the efficacy of the Sterile Women Injections (SWIs).

Findings

Sterile Water Injections play a significant role in ensuring that women experience

early labor and returning home soon. Another major advantage of using Sterile Water

Injections (SWIs) does not need any form of patient admission for the technique to be

executed. Sterile Water Injections (Lee, Kildea & Stapleton, 2017). Sterile Water Injections

shall lead to positive health outcomes among pregnant women since less time frame is spent

during delivery and administration in hospitals. Thus, the implementation of Sterile Water

Injections (SWIs) has many positive implications for reducing pain among pregnant women.

Additionally, despite the impact of emotions and feelings during delivery, there are no

negative implications towards back pains during Labor (Lee, Kildea & Stapleton, 2017).
STERILE WATER PAPSULES FOR BACK PAIN IN LABOR 7

Comparison and contrast in findings

Refika in his study encompasses the positive outcome linked towards the use of sterile

water injections, but it lasts up to 120 minutes plus the technique has no effects towards the

pregnant women while Feriba showcases the administration of sterile water injections

subdermal and intradermally have positive effects in pain reduction. Finally, Nigel Lee

depicts that the sterile water injections have no negative side effects to the patients. Hence, all

researches have proven that Sterile Water Injections (SWIs) have a positive impact in

reducing pain without any side effects.

Maternal-Child Intervention

The use of Sterile Water Injections has been linked to positive birth outcomes during

labor. The use of sterile water in injections has helped provide pain relief and thus facilitate

easiness while giving birth, thus ensuring a healthy newborn. There is numerous complication

that occurs between the mother and infant during childbirth. However, Sterile Water

Injections has not led to any complications or side effects for the infants (Genç Koyucu et al.,

2018). Due to the positive nature of the sterile water injections towards the birth process, it is

crucial for positive techniques implemented to enhance the infant's well-being.

Maternal-child interventions are focused on enhancing the mother-child relationship.

Nurses need to encourage practices such as touch-massage after the first postpartum hour to

increase and strengthen the bond and to improve relaxation between the mother and child

(Botero, Langley & Venta, 2020). The touch-massage approach has positive implications for

ensuring that the child's stress levels are significantly reduced, plus it relieves the stress levels

that build up during delivery. The massage has been proved to help provide a robust stress-

reducing effect, and thus the massage shall ensure positive health outcomes for both the child

and mother (Botero, Langley & Venta, 2020).

STERILE WATER PAPSULES FOR BACK PAIN IN LABOR 8

Nursing Actions for implementation of evidence-based intervention

Nursing action 1- Creating awareness and educating health professionals

The use of sterile water injections has been proven to relieve back pains experienced

by expectant mothers during labor effectively. However, there is poor dissemination of

information concerning the technique (Lee, Kildea & Stapleton, 2017). Thus, a minimal

number of midwives have been well-equipped with the skills and knowledge of effectively

administering the sterile water injections. Research has shown the positive birth outcomes

experienced from the intradermal and subdermal injection of sterile water are positive pain

relievers. Hence, nursing practitioners need to educate midwives on effectively administering

the sterile water injections during Labor (Lee, Kildea & Stapleton, 2017). Having adequate

knowledge concerning the sterile water injections shall aid in providing effective analgesic

for expectant mothers. Also, since it is cost-effective, the majority of pregnant women can

access the outcome.

Nursing action 2

Another major important nursing intervention is the monitoring of pain scores

experienced by women in labor. The nursing professionals must carry out tests to measure the

degree of pain experienced by the pregnant women (Almassinokiani et al., 2020). This is very

crucial for the nursing professionals because it helps in ensuring the appropriate analgesia is

administered to the pregnant women (Almassinokiani et al., 2020). The pain scores also help

in monitoring the state of the women in labor, and thus the appropriate course of action is

implemented to help in inducing the pain. Measuring the pain scores is essential as this helps

in the administration of correct dosages of sterile water to the women in labor.

Nursing action 3
STERILE WATER PAPSULES FOR BACK PAIN IN LABOR 9

Nursing practitioners need to monitor the physiological functions of the women

during birth as some of the research studies have showcased that sterile water injections have

some side effects on the pregnant women in labor. Hence, upon administration of the sterile

water injections, the nursing practitioners need to monitor the vital signs and other

physiological processes of the women in labor at intervals of 30,60, 90 mins to ensure that

there are no detrimental side effects of the sterile water injections (Genç Koyucu et al., 2018).

The rationale behind monitoring any side effects shall help in ensuring positive birth

outcomes and overall health well-being of the women in labor.

Summary

The use of sterile water injections has provided to be significant in the relieving of

pain towards pregnant women in labor suffering from back pains. The sterile water injections

have been effective analgesics that have served the majority of the pregnant women in

relieving back pain. The evidence-based practices have showcased the administration of

sterile water injections either intradermally, or sub dermally have been incorporated in

reducing back pain while in labor. The Sterile Water Injections (SWIs) have been linked to

effectively reducing pain during labor. Another major phenomenon is that it is cost-effective

thus shall help millions of pregnant women to deliver with reduced back pain.

Roles of nurses in the implementation

Nursing practitioners play a crucial role in alleviating pain among pregnant women

during labor. The role of nurses is the improvement of quality of care among patients. Nurses

need to help midwives through effective practice sessions and dissemination of information

concerning sterile water injections. The effective educational programs by nurses shall help

in creating awareness on the cost-effective analgesics. Effective communication by nurses

STERILE WATER PAPSULES FOR BACK PAIN IN LABOR 10

shall help in reducing pain during birth as over 60% of participants stated that they would use

the technique in future while delivering.

Another major role of the nurses is the execution of high-level competency and skills

to e ensure that the injections of sterile water are administered accordingly to avoid any form

of complication experienced by the delivering mother. Their level of professionalism and

competency is crucial for the nursing practitioners shall aid in reducing medical errors and

effective monitoring of the progress of delivering mothers.

STERILE WATER PAPSULES FOR BACK PAIN IN LABOR 11

Reference

Almassinokiani, F., Ahani, N., Akbari, P., Rahimzadeh, P., Akbari, H., & Sharifzadeh, F.

(2020). Comparative Analgesic Effects of Intradermal and Subdermal Injection of

Sterile Water on Active Labor Pain. Anesthesiology And Pain Medicine, 10(2). doi:

10.5812/aapm.99867

Botero, M., Langley, H., & Venta, A. (2020). The untenable omission of touch in maternal

sensitivity and attachment research. Infant And Child Development, 29(2). doi:

10.1002/icd.2159

Genç Koyucu, R., Demirci, N., Yumru, A., Salman, S., Ayanoğlu, Y., Tosun, Y., & Tayfur,

C. (2018). Effects of Intradermal Sterile Water Injections in Women with Low Back

Pain in Labor: A Randomized, Controlled, Clinical Trial. Balkan Medical

Journal, 35(2), 148-154. doi: 10.4274/balkanmedj.2016.0879

Lee, N., Kildea, S., & Stapleton, H. (2017). "No pain, no gain": The experience of women

using sterile water injections. Women And Birth, 30(2), 153-158. doi:

10.1016/j.wombi.2016.09.010