The effects, outcomes and acceptability of sterile water injections to relieve low back pain among birthing women in a tertiary hospital in Ghana: a non-randomised study.

backgroundApproximately 30% of women experience low back pain when in labour. Large placebo-controlled trials conducted in high-resource settings have demonstrated the efficacy of sterile water injections (SWI) to manage back pain in labour. The procedure has also been endorsed by influential international clinical guidelines. However, the effectiveness and acceptability of the procedure amongst women in low-resource settings such as Ghana, where access to any analgesia may be limited, has not been explored. Investigating the clinical utility of SWI, assessing effectiveness and acceptability, is essential for determining its potential benefits for birthing women in this low- and middle-income country (LMIC).

methodsA non-randomised quasi-experimental study was conducted. Women in labour at term with self-reported back pain chose either a treatment with SWI or standard care. Participants in the SWI group received intradermal injections of sterile water, 0.1 mL, four points bordering the lumbo-sacral region (Michaelis' Rhomboid). Self-reported back pain scores using a Visual Analogue Scale (VAS) were obtained prior to and following treatment up to 120 min after the injections for both groups. The difference in VAS score between groups was analysed using a multilevel repeated-measure analysis. Secondary endpoints included women's satisfaction with the intervention and maternal and neonatal birth outcomes.

resultsDuring the study period, 73 women were enrolled, 51 choosing SWI and 22 standard care. There was no difference between the two cohorts in self-reported back pain prior to treatment. Women who received SWI reported a significant reduction at 30 min (95% Confidence Interval (CI) -98.29 to -88.60; p < .001) in VAS scores compared to women opting for standard care at all time points (10, 30, 60, 90, and 120 min). The maternal satisfaction survey, conducted with the intervention group, indicated that over 90% of participants were satisfied with their treatment experience and were willing to recommend SWI to others.

conclusionSWI was clinically effective and acceptable to women birthing in Ghana, who reported satisfaction and endorsement. There was a strong association between SWI and a reduction in labour back pain with no adverse effects recorded during the study period.

trial registrationThis study was prospectively registered with the Pan African Clinical Trial Registry with the identification number PACTR202307748580298 on 28th July 2023. Prospectively registered.