Pain management in the first stage of labour using sensory stimulation
Severe pain during the first stage of labour can harm both the mother and fetus. Previous studies have shown that severe pain in childbirth can cause discomfort, stress, risk of depressive disorders, decreased intestinal motility and prolonged labour for the mother. For the fetus, it can cause hypoxia, metabolic acidosis, cognitive and emotional disorders and even death. Therefore, better management of labour pain during the first stage is needed.
This study aimed to assess the effect of sensory stimulation to reduce pain in the first stage of labour.
Garuda portal, the Perpustakaan Nasional Republik Indonesia e-resource, the Cochrane Central Register of Controlled Trials and Pubmed were used to search for literature. The inclusion criteria were original randomised controlled trials published in English, in 2014–2020, with a minimum sample size of 30 where the study outcome was rated on a pain scale.
Ten randomised controlled trials were included. The primary interventions using sensory stimulation to reduce pain during the first stage of labour were aromatherapy, music therapy, breathing control, focusing, and virtual reality.
Sensory stimulation by aromatherapy, music therapy, breathing control, focusing and virtual reality are effective in reducing pain in the first stage of labour.
Labour pain is a sensory and emotional experience associated with labour and delivery (Herdman and Kamitsuru, 2014). Chow et al (2013) states that pain is a subjective experience, a complex interaction between physiological, spiritual, sensory, behavioural, cognitive, psychological and cultural influences. Labour pain is caused by cervical dilation, uterine muscle hypoxia, which causes decreased perfusion during contractions, pressure on the urethra, bladder, rectum and pelvic floor muscles (Ricci et al, 2013).
During labour, the level of pain experienced is based on the mother's perception (Yulianingsih et al, 2019). A mother's perception of pain is influenced by her experience, fatigue, anticipation of pain, support, environment, cultural expectations, emotional level and anxiety (Lowdermilk et al, 2013).
The labour process consists of four stages, stage I to stage IV. The first stage of labour lasts the longest (Kurniawati et al, 2016) and in a primigravida, lasts for an average of 12 hours, while multigravidas experience labour for half this time on average (Ricci et al, 2013). The first stage of labour is divided into three phases. According to Chow et al (2013), the first is the latent phase, where the cervix dilates up to 3cm and contractions occur every 5–10 minutes, lasting for 30–45 seconds. The next phase is the active phase, where the cervix dilates 4–7cm, contractions occur every 2–5 minutes and last 45–60 seconds. The last phase is the transitional phase, where dilation is between 8–10cm, contractions occur every 1–2 minutes and last 60–90 seconds (Chow et al, 2013). Recent literature and studies have stated that the active phase begins at 6 cm of cervical dilation (Shukla et al, 2020; Hutchison et al, 2022). This change in the definition of the active phase affects labour management and the identification of abnormal labour. For example, the risk of misdiagnosing dystocia and overuse of labour-accelerating interventions is found if the Friedman criteria (cervical dilation occurs at a rate of 1cm or more per hour) are implemented. This can increase the risk of unnecessary intervention for the mother and fetus (Shukla et al, 2020).
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