The use of subcutaneous injection of isotonic saline, rather than intradermal injection, has been trialled in overseas studies , where it has been reported to cause less discomfort at the time of injection ( Bahasadri etal 2006 ; Martensson and Wallin 1999 ) and while it has been efficacy is reported to be Markedly lessened. the actual stinging sensation reported by women appears to be an important factor in the effectiveness of intradermal sterile water and is likely to be related to the pain experienced at the injection site ( Melzak and Wall 1965 ; Gammon et al 1936)
This study on the effect of intradermal sterile water injections on women’s pain during labour reported similar findings to overseas research which validated itsusage as a means of managing severe back pain. In the data set, significant pain relief was reported for up to 90 minutes post injection ( Peart et al 2006) . However these results were reported from the midwives reporting pain measures during labour and not from the women themselves. Satisfaction with the use of intradermal sterile water injection from the perspective of participating women was also investigated. This paper reports on the findings from those questionnaires.
AIM OF THESTUDY
The aim of this study was to evaluate the effect of administration of intradermal sterile water injections on a women’s experience of back pian in labour. Two evaluation techniques were used to collect the data. The first was a pre and post test pain assessment undertaken by midwives who scored the level of back pain experienced by the participants receiving the sterile water injection during labour . The acceptability of the technique was evaluated with a follow – up questionnaire completed by the women two days post partum.
METHOD
Ethics approval for the study was applied for and granted at each of the three organizations involved in the study ( Colac Area Health, Wimmera Health Care Group , Horsham and University of Ballarat)
Woman were recruited during their pregnancy at each of the participating hospitals . The intradermal sterile water injection technique was discussed and and they way shown a video demonstrating the procedure. Over seven hundred women completed a consent form to participate if they experienced back pain while in labour ; 432 women in Horsham and 270 women in Colac . the women consenting to participate in the study were made aware of the probable discomfort they woud experience, that is the stinging sensation felt when the sterile water injection was administered. Staff at each maternity unit also underwent formal competency training in the technique.
Sixty (60)women (30 at Colac and 30 at Horsham) agreed to participate in the clinical study when they experienced severe back pain during their labour. Once they identified a need for the sterile water injection an assessment of pain severity usinga Visual Analogue Scale ( VAS) was undertaken immediately prior to injection , five minutes after and every 30 minutes for up to three hours. The procedure involved the intradermal injection of 0.2-0.5 ml. of sterile water into four sites in the Michaelis Rhomdoid or lumbar-sacral region of the spine. Two midxives simultaneously injected to reduce the number of stinging sensations experienced by women.
On day two post partum , satisfaction surveys were distributed to all women who used sterile water injections for pain relief during their labour . The questionnaires collected demographic information and qualitative data on the best and worst aspects of the women’s birthing experience. That data included information on their age, parity, previous births ,their current labour and birth , methods of pain relief they used and their understanding of the purpose ofsterile water injections. The questionaries were posted back to the principal research by the study participants in a self –addreesed envelope. A total of 52 were returned, giving a response rate of 87% Twenty-two (22) questionnaires were returned from women who attended Colac Hospital and 30 were returned from women who had attended Horsham hospital for their birth.