SDMS ID: P2010/0506-001 2.

25/09WACS Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Purpose: The administration of intradermal injections of sterile water to provide non-pharmacological relief of pain and backache in labour. Definitions: Intradermal injection - the sterile water is injected just under the skin surface to raise a small bleb in the skin. Equipment: 1 ml syringes 25g needles Sterile water for injection Alcohol swabs Gloves Kidney dish Sharps container Procedure: Explain procedure, obtain verbal consent from woman and ensure privacy. Need to wait until score is at least 6/10 to proceed, ineffective if given too early. Make sure the women understands there will be intense burning/stinging for approximately 20 seconds but the relief of back pain should occur within 1 3 minutes of the administration. Can be administered with the woman in any position where the lower sacral region is easily accessible. Draw up sterile water for injection in syringe (4 syringes each containing 0.5 ml of sterile water or 2 syringes each containing 0.5 ml sterile water) Identify the four injection sites on the sacrum by identifying the posterior superior iliac spines and then approximately 3 4 cm down and 1 2 cm in, absolute accuracy is not critical to the success of the procedure. Cleanse skin with alcohol swab. Inject 0.1 0.5 ml of sterile water intradermally to raise a small bleb in the skin with a contraction where possible. Ideally this can be done by two persons injecting simultaneously two sites at once to minimise the duration of stinging sensations experienced by the woman. Discard used syringe(s) and needle(s) into sharp container. Observe woman for the effectiveness of treatment and document in partogram and/or progress notes.
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Intradermal Sterile Water Injection Intradermal Sterile Water Injection WACSClinProc2.25/06 Sterile water injections for the relief of back pain in labour. Registered midwives, medical officers Intradermal sterile water injection

Avoid touching, rubbing, massage, and counter pressure to the area after injections. Minimum time for repeat administration is 30 minutes, and can be repeated as often as required as this is non-accumulative. Attachments
Attachment 1 Attachment 2

Diagram Location of Sterile Water Papules References

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years via Policy and Procedure working group coordinated by the Clinical and Quality improvement midwife. November 2009 Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Developed By: Stakeholders:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: 3 August 2009

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APPENDIX 1 Location of sterile water papules

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APPENDIX 2 REFERENCES Ader, L, Hansson, B, & Gunner, W, 1990, Parturition pain treated by intracutaneous injections of sterile water, Pain, vol. 41, pp. 133-8. Labrecque, M, Nouwen, A, Bergeron, M, & Rancourt, J.A. 1999 Randomised controlled trial of non-pharmacologic approaches for relief of low back pain during labour, The Journal of Family Practice, vol. 48, no. 4(Apr). Lytzen T, Cederberg, L, & Moller-Nielson J. 1989, Relief of low back in labour by using intracutaneous nerve stimulation (INS) with sterile water papules, Acta Obstet Gynecol Scand, 68:341-343. Martensson, L & Wallin, G 1991 Labour pain treated with cutaneous injections of sterile water: a randomised controlled trial, British Journal of Obstetrics & Gynaecology, vol 106, July, pp. 633-637. Reynolds, J, 2000, Sterile water injections relieve back pain of labour, Birth, vol. 27, no. 1, pp. 58-60. Reynolds, J, 1994, Intracutaneous sterile water for back pain in labour, Canadian Family Physician, vol. 40, pp 1785-1792. Reynolds, J, 1998, Practice Tips, Intracutaneous sterile water injections for low back pa in during labour Canadian Family Physician, vol. 44, Nov, pp.2391-2392. Royal Womens Hospital Policy and Procedure manual, Policy Number 9W -04-2-122 Simkin, P & OHara, M, 2002, Non-pharmacologic relief of pain during labour: Systematic reviews of five methods, American Journal of Obstetrics & Gynaecology, vol. 186, no. 5, pp. S131-159.

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