Sterile water injections - back labor

[queenanneslace, ADN, MSN, APRN, CNM]

Sterile water injections for back labor: I'm going to assume no one is doing this except some midwives somewhere - outside of the hospital OB unit.

https://allnurses.com/ob-gyn-nursing/sterile-water-injections-40288.html

https://allnurses.com/ob-gyn-nursing/intradermal-water-injections-334035.html

I have witnessed this work amazingly well (freestanding birth center labor) - and it is rare that I have a patient in the hospital who isn't walking in demanding an epidural. But there are times when a woman is having back labor, likes being active and moving in labor, and for that reason does not want to be confined to bed with an epidural. It seems like intradermal water injections would be a place to start.

Had a patient recently where I thought intradermal water injections would have helped her - but as far as I know, **we don't do that**. We don't have CNMs on our unit - we practice old-school obstetrics, well, with epidurals.

Anyway - a couple of questions.

1) Any hospitals offering this?

2) How do you 'sell' this idea to the powers-that-be so you can offer a little something for our back-laboring patients?

This will really pertain to so few patients - because the overwhelming majority want epidurals ASAP. But there are a few who want something different, and it would be nice to have a few more tools in the toolbox. I think I asked once when I started about sterile water injections - and the charge nurse looked at me like I had 2 heads.

[klone, MSN, RN]

The last hospital at which I worked L&D, we offered it and even had a P&P on it. I never ever saw it used, but I had heard from others that it hurt like a SOB being injected, but worked remarkably well. I wonder how much of its effects is "gate theory"

[melmarie23, MSN, RN]

We still do this on my unit. It's part of our standing orders for labor. It's not often we do do it...but we can and do.

It hurts the patient like no other and it's why we have two RNs to do it so that it's as quick as can be. But it usually works and gives them some relief for a good while after.

[melmarie23, MSN, RN]

As for "selling it," show them the evidence. It's a low cost procedure and doesn't really require any specialized skill set to do. It doesn't interfere with monitoring mom or fetus. My advice is to try and get but in from a physician or two, as well as your unit leadership, and go from there.

[nursejoy1, ASN, RN]

I am not an L&D nurse, but it was offered at the hospital where I delivered my son a little over three years ago.

[eden]

My large teaching hospital uses them. I love them and as much as they burn I'd say they work well for 8/10 women who try them. I've given them at all stages of labour and even during pushing. I've had one pt who loved them so much we probably did them at least half a dozen times before I left my shift.

I tell my patients that it does burn but that it is over in less then a minute. I tell them it's not a drug so don't need orders and that in my experience it helps 8/10 women. I sell them on it by saying that if it works for them awesome, we can keep doing it and if not we tried and can move on to other things.

[RNAngelaF]

Who is the one that gives the sterile water injections into the back? Where does it get placed?

[JoyfulRN14, BSN, RN]

Anyone have a policy they would be able to share? Would like to bring this up to our educator and they sure love policies on my unit.

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[queenanneslace, ADN, MSN, APRN, CNM]

Who is the one that gives the sterile water injections into the back? Where does it get placed?

I have seen it done OOH with two people (a midwife and an apprentice) on either side of the mother - each person makes two blebs during a contraction. In a hospital I suppose it would be RNs doing this. Whoever can and is authorized to perform an intradermal injection would be who would do it.

This webpage shows the location of the blebs - on the edge of the sacrum.

The Nature and Management of Labor Pain: Part I. Nonpharmacologic Pain Relief - American Family Physician