US Midwives' Knowledge and Use of Sterile Water Injections for Labor Pain

Lena Märtensson, CNM, PhD; Maureen McSwiggin, CNM, MS; Judith S. Mercer, CNM, DNSc


J Midwifery Womens Health. 2008;53(2):115-122. 

In This Article

Abstract and Introduction


The purpose of this research study was to identify and describe US midwives' knowledge and use of sterile water injections to relieve pain during labor. Research studies have shown that injections of sterile water to relieve low back pain during labor are effective with good maternal satisfaction. However, no knowledge is available about their use by midwives in the United States. Questionnaires were mailed to a random sample (N = 450) of midwives who were members of the American College of Nurse-Midwives (ACNM). One hundred thirty-two respondents (29%) returned the questionnaire. One-fourth (26%) of the midwives use sterile water injections, although infrequently. More than half of the midwives use the intracutaneous injection technique, and most use a total of four injections. Most midwives give the injections between contractions, with the assistance of another person, and report very good pain relief. Of those not using sterile water injections, most had no experience or training in use of the method and were interested in learning more about their use. While sterile water injections are a good treatment for back pain during labor, there is a lack of knowledge among midwives about this method of pain relief during labor and an interest in knowing more.


For most of the approximately 4 million women who give birth annually in the United States, labor pain is an issue of concern. The intermittent uterine contractions needed to expel the fetus from the uterine cavity dilate the cervix, causing pain that can radiate to the lower abdomen and/or the lower back (sacral area). Approximately 25% of laboring women experience back pain. For women who want to labor without an epidural, the back pain can be severe enough to undermine their intentions. Sterile water injection can offer significant relief from back pain in labor without concerns that the method might harm the mother and/or the fetus or slow the labor pattern.[1] The Gate Control Theory is proposed as the most plausible mechanism of action.[2] Despite these benefits, there is no information available regarding US midwives' use of sterile water injections during labor. The aim of this study was to identify and describe US midwives' knowledge and use of sterile water injections for pain relief during labor.


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