1. J Physiother. 2018 Jan;64(1):33-40. doi: 10.1016/j.jphys.2017.11.014. Epub 2017
Dec 27.

Sequential application of non-pharmacological interventions reduces the severity 
of labour pain, delays use of pharmacological analgesia, and improves some
obstetric outcomes: a randomised trial.

Gallo RBS(1), Santana LS(1), Marcolin AC(1), Duarte G(1), Quintana SM(1).

Author information: 
(1)Department of Gynecology and Obstetrics, Ribeirão Preto Medical School,
University of São Paulo, Brazil.

QUESTION: Among women in labour, does sequential application of
non-pharmacological interventions relieve labour pain, shorten labour, and delay 
pharmacological analgesia use?
DESIGN: Randomised trial with concealed allocation, assessor blinding, and
intention-to-treat analysis.
PARTICIPANTS: Eighty women admitted in labour at the end of a low-risk pregnancy.
INTERVENTION: Participants in the experimental group received three interventions
for up to 40minutes each in particular stages of labour: exercise on a Swiss ball
at 4 to 5cm of cervical dilation; lumbosacral massage at 5 to 6cm dilation; and a
warm shower at >7cm dilation. Participants in the control group received usual
maternity unit care. Participants in both groups were encouraged to try not to
avoid or delay use of pharmacological analgesia.
OUTCOME MEASURES: Pain severity was reported on a visual analogue scale. Maternal
and neonatal data were collected from official birth records. Satisfaction with
care was recorded with a questionnaire.
RESULTS: Some participants took analgesic medication before the study was
complete, so pain was analysed with a last observation carried forward approach. 
In this analysis, the experimental group had significantly lower pain severity
immediately after: exercises (MD 24mm, 95% CI 15 to 34), massage (14mm, 95% CI 4 
to 25), and showering (17mm, 95% CI 5 to 29), which allowed delayed and reduced
use of analgesic medication. Other significant benefits included: faster
expulsion (MD 18minutes, 95% CI 5 to 30), improved neonatal status, and higher
maternal satisfaction. No adverse effects were identified.
CONCLUSION: This sequence of non-pharmacological interventions significantly
reduced labour pain from 4cm to beyond 7cm of cervical dilation, as reflected in 
decreased and delayed use of analgesic medication. Women in labour could be
encouraged to use these interventions, especially if they seek to minimise or
delay use of analgesic medication.
TRIAL REGISTRATION: NCT01389128. [Gallo RBS, Santana LS, Marcolin AC, Duarte G,
Quintana SM (2018) Sequential application of non-pharmacological interventions
reduces the severity of labour pain, delays use of pharmacological analgesia, and
improves some obstetric outcomes: a randomised trial. Journal of Physiotherapy
64: 33-40].

Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V.
All rights reserved.

DOI: 10.1016/j.jphys.2017.11.014 
PMID: 29289579