Ooops, forgot to mention that this information about pain physiology comes
from The third chapter "Physiology of Pain" by Sue Moore in the wonderful
book "Understanding Pain and its Relief in Labour". Sue Moore edited this
book as well as writing several of the chapters.
apologies for my omission. I added the information about the water
injections.
warmly, Carolyn
----- Original Message -----
From: "Heartlogic" <[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Monday, November 27, 2006 2:32 PM
Subject: Re: [ozmidwifery] Intradermal sacral sterile water injections
Hello Ramona,
The current suggestion for why the sterile water injections work is tied
to what is called the gate control theory of pain management.
Nerve fibres can be classified or categorised according to their diameter
and speed of conduction. The larger the diameter of the nerve fibre, the
faster the speed of transmission. Myelinated nerve fibres transmit
information faster than non myelinated fibres.
In the peripheral nervous system there are myelinated nerve fibres,
alpha-beta (very fast) and alpha-delta (fast) and unmyelinated nerve
fibres known as C (slow) fibres. The alpha fibres are fast conductors, the
C fibres slower conductors. In terms of pain transmission, fast fibres
transmit sharp, well defined, localised sensations (touch plus sting of
water injections). C fibres transmit slower, chronic, duller kinds of pain
signals (baby's occiput/head on sacrum pressure/pain).
The original gate-control theory proposed that a physiological gating
mechanism operates within the spinal chord's dorsal grey matter. Sensory
signals can only pass through these chemical 'gates' when the gates are
open. The gates are opened by the release of neurotransmitters which
excite the postsynaptic membrane of neurons, therefore transmitting pain
signals within the ascending 'pain tracts'. The gate is closed by
inhibitory neurotransmitters and the release of endogenous opiods.
Touch/pressure etc stimulates the fast, big diameter alpha-beta nerve
fibres, sensory signals are transmitted along with pain transmission via
the slower alpha delta and C fibres; alpha beta fibres stimulate
inhibitory neurons in the dorsal horn closing the gate to other slower
sensory and pain related information (particularly C fibres). At the same
time, descending information from the brain activate these same inhibitory
interneurons which are also involved in the release of endogenous opiods.
Mechano-reptors (touch receptors) respond to the whole variety of sensory
stimuli such as touch, heat, width of stimulus, depth of stimulus etc. The
skin is very rich in these receptors. That is why rubbing etc is helpful
with backpain or any other kind of pain. The sting of the water injections
stimulates many receptors, exciting both alpha fibres (transmitting touch
and pain from the sting) and therefore is thought to slam those gates shut
in the dorsal horn whilst the brain's feedback to the sensation of the
sting is to release of endogenous endorphins.
So the sacral water injections are thought to work because of the excitory
action of the alpha beta fibres in closing the gates, the gates closure
reinforced by inhibitory action from the brain in response to alpha delta
firing and the release of endogenous opiods.
It is important to use sterile water as sterile water has the greatest
sting. Normal saline is hardly felt as the body is mainly salt water,
therefore it doesn't excite the pathways to close the gates nor does it
stimulate the release of endogenous opiods.
Rubbing the spot of the sting also reduces the excitory nature of the
sting - very tempting to rub, we love to help! But in this situation, it
is counter productive. We want the sting - the sting is the thing that
changes the painful stimuli sensation from deeper within the woman's back
(head on sacrum), and lets the woman get on with labour.
I hope I've managed to explain this sensibly! Its all fascinating stuff.
I'm so grateful to Janice DeoCampo for bringing this to Australia from
Sweden where her daughter had her baby and used this technique.
Brilliant.
warmly, Carolyn
----- Original Message -----
From: "nunyara" <[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Friday, November 24, 2006 7:25 PM
Subject: RE: [ozmidwifery] Intradermal sacral sterile water injections
Hi all!
I was very interested to read about these sterile water injections. They
sound a great alternative to other types of pain relief but I was
wondering
just how the sterile water works?
Cheers Ramona
Nunyara
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Sue Cookson
Sent: Friday, 24 November 2006 5:54 PM
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery] Intradermal sacral sterile water injections
Thanks Pauline,
it would be great to receive the research on intradermal water
injections,
Sue
Here in Colac we have a copy of the research, and findings, that was
done to support the sterile h2o injections, if that would be of any
help. Pauline
----- Original Message ----- From: "Sue Cookson"
<[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Friday, November 24, 2006 8:51 AM
Subject: Re: [ozmidwifery] Intradermal sacral sterile water injections
Hi Carolyn,
I presented the intradermal protocol and GBS protocol to the CNC at
Lismore the other day. She asked me if you could provide evidence to
support the intradermal injections, but was interested in the concept.
Anything would be great - I haven't done looking myself as I'm just
completing my degree. Did my last official birth last night - now for
the portfolio and remaining assignments.
Thanks, Sue
Hello Andrea, thanks for your kind words.
As for the sacral water injections, we have only used them for late
first stage and second stage. So repeats haven't been an issue for
us. Yes, it does sting, but all the women, bar one, found the
injections wonderful. One of the women I saw for her three week
postnatal visit and she voluntarily told me all about the injections
with great wonder. I didn't know she had them, and when I asked her
all about her experience with our service and the birth of her baby
etc, she waxed lyrical about the change in sensation with the
injections. Very interesting.
And yes, because it stings so much, two midwives give the injection
at the same time, the women would not let you do it again
immediately after, they swat your hands away - or try to. :-) I
appreciate the logic with giving them both at the same time.
The midwives at JHH have been using them in the birth centre as
well. They reckon the injections are great too. I haven't heard any
feedback about the refusal for long labours, I'll check that out and
get back to you.
I'll send you the protocol from work, it's on my work computer,
warmly, Carolyn
----- Original Message ----- From: "Andrea Robertson"
<[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Thursday, November 23, 2006 7:06 AM
Subject: Re: [ozmidwifery] Intradermal sacral sterile water injections
Hi Carolyn,
It is so good to hear that Belmont is doing well - what a great
standard bearer for midwifery and women!
Can I ask you something about the sterile water injections? When I
was in the Colac area earlier this year doing a workshop, I was
told that although this method was brilliant at relieving the pain,
especially with posterior labours, women were often reluctant to
have the injections a second time, when the effects of the first
round had worn off (it was suggested the effect would last for 2 -3
hours). I found this interesting, and speculated that the pain of
the injections must have been bad, for women to think that a short
lived sting would be worse than long painful contractions that
often come with an OP labour.
What has been your experience with doing follow up injections,
especially during a long labour?
I was also told that it was a good idea to have two midwives do the
injections simultaneously - that way the pain was shorter (but
presumably more intense with two injections being done at the same
time). Can you shed any light on this aspect as well?
Many thanks,
Andrea
PS I would love a copy of your protocol as well, if you email it me.
At 02:00 AM 18/11/2006, you wrote:
Whilst I'm on the soapbox, I was thinking that you may be
interested in the intradermal water injections and their efficacy.
We had Janice Deocampo come to Belmont and give a seminar on the
use of this technique for women with excruciating back pain.
Midwives came from Gosford, Maitland, John Hunter and Taree.
Janice presented her information and we all practised on each
other (OUCH). It feels like a wasp sting. One of the midwives had
back pain which was cured for six hours with the injection she
received that day!
It took us MONTHS to get the procedure through clinical
governance. However, it is through.
We have used the injections for about eight women since only one
was not completely successful. We have even found them fantastic
for late first stage when the backache has stopped the woman from
progessing and even second stage when women wouldn't push because
the backache was too bad. After the injections, voila - baby!
John Hunter midwives are also now using this technique too with
great success. Janice Deo Campo did a research project and the
results are in the Birth Issues Journal from CAPERS.
It is a wonderful, effective tool which may just help someone
avoid an epidural or even make birth much more manageable for
those women with excrutiating backache.
If anyone wants the protocol and information sheet, please email
me at work
<mailto:[EMAIL PROTECTED]>[EMAIL PROTECTED]
.au
and I will send it to you.
warmly, Carolyn
Heartlogic
<http://www.heartlogic.biz>www.heartlogic.biz
Phone: +61 2 43893919
PO Box 5405 Chittaway Bay, NSW 2261
"As a single footstep will not make a path in the earth, so a
single thought will not make a pathway in the mind. To make a deep
physical path, we walk again and again. To make a deep mental
path, we must think over and over again the kind of thoughts we
wish to dominate our lives"
Henry David Thoreau
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