The effect of non-pharmacological analgesia and pharmacological analgesia with remifentanil on childbirth fear, experience and postpartum depression: A Randomized controlled clinical trial

Abstract

Abstract: Comparing the effects of non-pharmacological analgesia and pharmacologic analgesia with remifentanil on fear, childbirth experience and postpartum depression: a randomized controlled clinical trial Introduction: Considering the consequences of fear of childbirth, unpleasant experience of childbirth and postpartum depression, there is a need to identify and apply effective interventions on them so that pregnant mothers can be encouraged to give birth naturally. The present study aimed to compare the effect of non-drug analgesia and drug analgesia with remifentanil on fear, childbirth experience and postpartum depression. Materials and methods: This study is a randomized clinical trial with two parallel arms. Pregnant women aged 18-45 years with 37-40 weeks of pregnancy referred to Taleghani Hospital in Tabriz for normal delivery were examined in terms of inclusion criteria. The main objectives of the research were explained and written informed consent was obtained from them if they wanted to participate in the study. Demographic and midwifery questionnaires were completed by the participants. Before starting the intervention in dilatation of 4-6 cm, pain intensity was assessed using the Visual Analog Scale (VAS) and the fear of delivery using the Delivery Fear Scale (DFS). Then, the participants were assigned to two groups receiving drug analgesia with remifentanil (33 people) and non-drug analgesia (33 people) based on quotas based on the number of births with blocks of 4 and 6 with a ratio of 1:1. In the intervention group receiving drug analgesia at 4-6 cm dilatation, remifentanil infusion was performed by an anesthesiologist according to the national protocol of painless delivery using a continuous venous infusion pump until the cervix was fully dilated. For the non-pharmacological analgesia group, in the active phase of labor (in dilatation of 4-6 cm), back massage, warm water abdominal shower, pressure on the sacrum, breathing techniques and upright positions were used. Then pain and fear during labor were measured at 8 cm dilatation in both groups. Fear of childbirth was measured one month after delivery using Wijma version B, childbirth experience using Childbirth Experiences Questionnaire version 2.0 (CEQ-2.0) and postpartum depression using Edinburgh, one month after delivery. Finally, data analysis was done using SPSS 26 software. Chi-square, independent t, and ANCOVA tests were used to analyze the data. A significance level of 0.05 was considered. Findings: The average fear score during labor in the non-pharmacological analgesia group after controlling the effect of the baseline score was significantly lower than the drug group (mean difference: 6.33; 95% confidence interval: 0.12 to -12.79 p = 0.05). The average score of fear of childbirth in the postpartum period, in the non-drug analgesia group after controlling the effect of the baseline score, was significantly lower than the drug group (mean difference: -21.89; 95% confidence interval: -8.66 to -35.12 p=0.002).The average score of childbirth experience in the non-drug analgesia group after controlling the effect of confounding variables was lower than the drug group, but this difference was not significant (mean difference: 0.17; 95% confidence interval: 0.08 to 0.45;P=0/07). The average postpartum depression score in the non-drug analgesia group after controlling the effect of confounding variables was significantly lower than the drug group (mean difference: -1.93; 95% confidence interval: -0.37 to -3.48, p = 0.01). The average labor pain score in the drug analgesia group, after controlling the effect of baseline score and confounding variables, was significantly lower than the drug group (mean difference: -1.89; 95% confidence interval: -2.069 to -1.89 p = 0.03). Conclusion: The findings of the present study indicate that although pharmaceutical analgesia methods are more effective in reducing the pain of labor and childbirth compared to non-pharmacological analgesia methods, it seems that pharmaceutical methods make it possible for the mother to cooperate due to feeling dizzy and sleepy. due to medication, they decrease and the mother cannot actively cooperate in the birthing process. On the other hand, the findings of the present study showed that the fear of childbirth and postpartum depression are less in women who actively participated in the childbirth process. According to the aforementioned research, it is suggested that programs including combined methods of drug pain reduction with less side effects and non-pharmacology in order to provide sufficient analgesia in childbirth and create a satisfactory experience of childbirth with the aim of promoting natural childbirth are developed and implemented. .