Abstract
BackgroundLow back pain is a common challenge during childbirth, affecting approximately 30% of women in labour. Effective pain management is crucial, as inadequate pain relief can negatively impact the birthing experience. However, access to pain relief in Ghana during labour remains limited due to factors such as resource-constraints and other competing needs. Sterile water injections (SWI) have been proven effective in managing low back pain in various settings, but their applicability and acceptability in Low and Middle-Income Countries (LMICs), such as Ghana West Africa, remain largely unexplored. Investigating the effectiveness, acceptability and feasibility of SWI for low back pain in the Ghanaian context is essential to assess its potential benefits for birthing women.
Methods
A mixed-methods study underpinned by pragmatism was used to evaluate the effectivenessand acceptability of SWI at a teaching hospital in Ghana. The Promoting Action on ResearchImplementation in Health Services (PARiHS) framework was used as an implementationframework for the study and focused on training and support of midwives and clinicians toensure consistent implementation of the study. A non-randomised quasi-experimentalapproach formed the quantitative part of the study which provided the data for bothprimary and secondary outcomes of the study. Following the delivery of education on SWIfor the birthing suite midwives, women in the intervention group received four intradermalinjections of 0.1 ml sterile water at their low back, while the control group received noinjections. Pain scores were self-reported using a Visual Analogue Scale (VAS) before and at specific intervals (10, 30, 60, 90 and 120 min) after the injections for both groups.Quantitative data analysis was based on Intention to Treat (ITT) which analysed both theintervention and control groups with VAS scores together. Qualitative data includedinterviews and focus groups from women who received the intervention as well as midwivesand stakeholders in the hospital. Qualitative data were analysed using thematic analysis andmanaged by NVivo Version 12
Findings
The study sample included 73 birthing women experiencing severe back pain, with 51women in the intervention group and 22 in the control group. Pain reduction in the intervention group was statistically significant compared to the control group, with more women in the SWI group reporting at least a 50% reduction in pain. A multilevel mixed model analysis of pain levels before and after injections revealed statistically significant differences (p < 0.001) across all measured time points (10, 30, 60, 90, and 120 min) on the VAS scale, except for the pre-injection score. Additionally, a maternal satisfaction survey, conducted exclusively with the intervention group, indicated unanimous satisfaction with the intervention. Face-to-face interviews were conducted with 15 postnatal women who had received SWI during labour. Three focus groups, involving a total of 35 midwives, and individual interviews with 10 senior managers and other stakeholders were conducted. Women in the SWI group reported positive impacts on their overall labour experience and high satisfaction with the intervention. Three themes and six sub-themes emerged, capturing women’s attitudes, perceptions, and experiences with SWI, reflecting its acceptability and effectiveness. The midwives’ data yielded four themes and nine subthemes whereas stakeholders’ face-to-face interviews had three main themes with seven sub-themes. The midwives and stakeholders were overall supportive of ongoing use of SWI in Ghana and could have practical clinical implications for use in the hospital and other setting.
Conclusion
Overall, the findings indicated that SWI is a simple, effective method for managing low backpain during labour and has the potential to offer an inexpensive and accessible option in birth settings within LMICs. Additionally, the results suggest that SWI is a promising intervention for alleviating low back pain during labour, offering rapid and sustained relief with minimal side effects
| Date of Award | 2025 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Isabella Garti (Supervisor), Lee Nigel (Supervisor) & Sue Kruske (Supervisor) |