Sterile Water Papule Injections

[Fi]

Well I have just heard an amazing thing!
I just had my 22w appt with the FBU midwife at hossy, and she was actually the midwife I had through my labour (the back labour which ended in epidural and forceps birth).
I hadn't actually seen her and completed a de-brief since then, so we sat and had a cry and a chat, and I talked about my concerns about my labour, and how we are going to prevent it all happening next time.

SOOOO we talked about how next time I can go in when I am 40.5w and she will do a stretch and sweep, and will repeat it a couple of days later if I want to prevent another induction. Thats a huge start. And then we talked about pain management, and how much pain I can take. What I was really happy about was in her notes she had written about my back labour, and my contractions being very intense and "strong" and she said she only does that when they are about as painful as it can get. We talked about what effect the epidural had on my labour stopping and ending in forceps, and we both agreed that the epi didn't cause it, and very few women in her 15odd years of midwifing could get through that sort of labour without one, and the reason labour stopped is cause Jenna just wouldn't turn - no matter whether I stood up or not. So big relief there, as she said, had Jenna presented normally, I would have popped her out no problems.

But the thing I was most impressed with is their use of "Sterile Water Papule Injections". She said that the midwives started using them on the sly (not telling the hossy) in the last year, but formalised it when they realised how much success they were having.
Its 4 injections of sterile water into 4 spots in the lower back, and is carried out with 2 midwifes (no OB needed!!). Apparently it feels like a wasp sting, and even a woman in hard labour will feel the sting, but within minutes most of the pain associated with back labour is gone.
Its supposed to work a little like acupuncture, and there is lots of success with it both within Geelong Hossy and around Australia (and I gather the world).

Has anyone heard of this? Has anyone been offered it? Has anyone used the technique? Have you had success??

She told me that had they been doing it when I was in labour, within minutes I would have more than likely been up and moving around, which would have course have helped with her persistent OP position, and may have meant I "naturally" birthed Jenna, which while wouldn't have been the be all and end all, may have eased my guilt and my feelings of failure throughout the last 16m.

Would love to hear others opinions on this.

Fi
PS - I did a search and didn't come up with another mention of this on the whole site, although there was one lonely result on Google - but the link wouldnt work.

[hannanat]

Ive never heard of it but it sounds fantastic.

Pain Relief From Water Injections, from aims.

A new trial from Sweden has shown that injections of sterile water under the skin are effective in relieving lower back pain in the first stage of labour

99 women with severe lower back pain were divided into three groups. One third had four injections 0.1 ml of sterile water intracutaneously (into the skin) in the lower back. Another third had four injections of 0.5 ml sterile water subcutaneously (under the skin). The final group had four injections of 0.1ml of saline subcutaneously. This was the "placebo" group. The injections were given during a contraction while the women breathed gas and oxygen.

The midwife caring for a woman did not know which treatment she had had. The women were asked to mark on a chart their pain levels before the injections, and at intervals afterwards - 10, 45 and 90 minutes. In all three groups pain had gone down 10 minutes after the injections - but it went down most in the first two groups, and least in the third, placebo group.

At 45 minutes pain was still markedly reduced in the first two groups but had gone back almost to base level for the placebo. At 90 minutes Pain levels had risen in Group 1 (though not to pre-treatment level) and had risen much less in Group 2. Group 3 had as much pain as they started with.

However, women found the injections for the placebo less painful than they found injections for Groups 1 and 2. The authors wanted to see if subcutaneous injections of water would be less painful than intracutaneous, but there seemed to be no difference.

AIMS Comment

There have been earlier studies showing that these injections can relieve back pain in labour. As so many women are unwilling to expose their babies to the effects of drugs, it is surprising that they are not more widely offered.

Jean Robinson

Sterile Water Papules for "Back Labor" - Childbirth Class Five
Back labor occurs in about 25% of labors. While you can experience back pain in labor, the majority of these cases are not back labor. The best way to be able to tell the different between back pain in labor and back labor is whether or not the back pain is continuous, meaning it even occurs in between the contractions. Back labor pain will be continuous. The majority of the time back labor will be caused by a baby in a posterior presentation. This means that rather than being face down (Please note the head is down, we're talking which direction it faces.), it is face up or sunny side up.


90% of these babies will turn on their own in labor, some can be turned by physical means, including manually and with forceps. The pain of back labor is unique and separate from the contractions. The good news is that there are ways to take care of back pain in labor.

Using many of the positions that we've talked about in previous classes we can not only help to alleviate the pain of back labor but it will also help turn the baby to an anterior, or face down position.

Positions for Back Labor

hands and knees
lunges
pelvic tilt

Other Back Labor Comfort Measures

Water
Birth Ball
Counter Pressure
Double Hip Squeeze
Heat or cold therapy

Why not an epidural?

An epidural will usually take the pain of a posterior baby away. The draw back can be that the use of the epidural, while masking the pain, does not solve the problem: the posterior presentation. In cases like this it is possible that the baby will then be much less likely to rotate into an anterior position and can be the cause of a higher cesarean rate due to the relaxation of the uterus and/or pelvic muscles.

Sterile Papule Injections

These are four sterile water injections given around the sacrum, base of the spine. There are no medications in the injections and they can be done by a doctor, nurse, midwife, or anesthesiologist. The pain from the injection is stinging and lasts about 60 seconds. The area should not be rubbed because the blister of water that will form, much like when you have a TB test, is part of the process.

Many women report remarkable pain relief from this simple procedure. It can be very beneficial for those wishing to avoid epidural anesthesia and can be used in conjunction with IV medications, if desired, though many women find that they are not needed once this procedure has been done.

I just PM'd you too.

[BellyBelly]

I've heard of it, I haven't seen them being used but my teacher has, and said that they are a great natural alternative and apparently help some women but they don't tend to last long and because they sting quite a bit it's a bit iffy as a trade off ... but anything is worth a try right? This would help out women with back labour and would not take away normal labour pain, so if you don't have a posterior bub then it may not help at all... You can always look up and try optimal fetal positioning and use that in pregnancy and birth, acupuncture also helps with this too - prevention always better than cure?

Fi have you thought about seeing a counsellor who specilises in birth de-briefing? My teacher does it - she's brilliant with it.

[Fi]

Thanks Natalie. I'd found other sites with it too, but was just really surprised that noone had talked about it on here before.
Chalk one up to the midwives at Geelong Public Hospital huh? Interestingly, Geelong is one of the busiest hospitals in all of Australia for admissions. They are a very progressive hospital offering a great standard of care for birthing mums including free lactation consultants, a family birthing unit, and a maternity support worker.
So I'm thinking this is a great thing for us, but hwo many other hossies do it?

ETA - Kelly, I did see a the maternity support worker after Jenna's birth for a bit of a debrief, and mothers group is a gem for this sort of thing. I guess I just wanted to hear from the horses mouth (ie my midwife) how she felt it all went. As she said to progress from 2cm to 5cm in 2hrs at home, and then to 10cm in another 1hr, I was labouring pretty hard.
I think I would have been fine to cope with the labour pain had I been able to move, but the fact was back pain meant I could barely move a muscle. If this option had been available at the time I think it would have been perfect for my situation as it may have been enough to take the edge off and get me off all fours.
I bet next time I go early, and the baby isn't posterior, and its all over and done with nice and easily. Ah well....

Anyway - it just seemed like a good thing for people to think about, and maybe ask their midwives about?

[BellyBelly]

Definitely - and I hope more hospitals get their staff trained up in it!!!