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


This descriptive study used a mail survey to collect self-reported information. The survey was adapted from a similar instrument prepared by the first author (L.M.) and used in Sweden.[34] The original survey included questions concerning acupuncture that were deleted from the questionnaire for this study. The questionnaire contained a total of 20 questions. Demographic information was collected for descriptive purposes. Four yes/no questions asked about the provider's knowledge, usage, and overall interest in sterile water injections. Eleven multiple-choice questions focused on clinical practice experiences with sterile water injections. Five questions were short answers regarding comfort level and experiences with the administration of sterile water injections and other pain relief choices used during labor. The short answer questions had space for participants to write in comments. Respondents who did not use sterile water injections were instructed to stop answering questions at a designated point. A group of 10 midwife colleagues reviewed the questionnaire for face validity, clarity, and ease of completion. After receiving the feedback, simple modifications were made and all questions were retained.

Approval for the study was obtained from the Institutional Review Board at the University of Rhode Island and from the American College of Nurse-Midwives (ACNM) Division of Research. A simple computer-randomized sample of 450 members was selected from the 4600 active members of the ACNM in January 2005. No student or associate members were included in the sample. Questionnaires were mailed to potential participants with a cover letter that informed the participants about the background of the study, that approval had been obtained from the institutional review board and the ACNM Division of Research, that their participation was voluntary, and that returning the questionnaire was evidence of their consent. To ensure confidentiality, the respondents were not asked to provide their names or practice sites. An identifying number was added to each returned survey for tracking and data entry purposes. ACNM members who returned the questionnaire before the deadline constituted the sample for this study.

Data were analyzed using univariate statistics computed in SPSS 10.0 (SPSS Inc., Chicago, IL). Descriptive statistics were calculated for all variables, including mean, median, standard deviation, range, and percentages as appropriate. Individual questions had varied response rates, so percentages were calculated using only the actual number of respondents for a particular question.


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