• Lena B Mårtensson, Eileen K Hutton, Nigel Lee, Sue Kildea, Yu Gao, and Ingrid Bergh.
• School of Health and Education, University of Skövde, Sweden. Electronic address: lena.martensson@his.se.
• Women Birth. 2018 Oct 1; 31 (5): 380-385.

BackgroundAbout 30% of women in labour suffer from lower back pain. Studies of sterile water injections for management of low back pain have consistently shown this approach to be effective. The objective of this evidence-based guide is to facilitate the clinical use of sterile water injections to relieve lower back pain in labouring women.MethodsTo identify relevant publications our search strategy was based on computerised literature searches in scientific databases. The methodological quality of each study was assessed using the modified version of the Jadad scale, 12 studies were included.FindingsRecommendations regarding the clinical use of sterile water injections for pain relief in labour are reported in terms of the location of injection administration, various injection techniques, number of injections used, amount of sterile water in each injection and adverse effects.DiscussionBoth injection techniques provide good pain relief for lower back pain during labour. The subcutaneous injection technique is possibly less painful than the intracutaneous technique administered, but we are unsure if this impacts on effectiveness. The effect seems to be related to the number of injections and the amount of sterile water in each injection.ConclusionThe recommendation at present, based on the current state of knowledge, is to give four injections. Notwithstanding the differences in injection technique and number of injections the method appears to provide significant levels of pain relief and can be repeated as often as required with no adverse effect (apart from the administration pain) on the woman or her foetus.Copyright © 2017. Published by Elsevier Ltd.

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