[Pain during labour: sterile water injections?]

Abstract

In the spring of 2013, the association of Dutch midwifes announced that midwifes would be offering sterile water injections for women in pain during labour. Shortly afterwards, the Dutch associations of gynaecologists and anaesthesiologists criticized this step, as the evidence for this intervention was considered insufficient. We reviewed the literature by critically appraising two recent systematic reviews. Although the overlap of included randomized trials was considerable, the reviews came to different conclusions regarding the primary outcome of one of the reviews, i.e. the proportion of unplanned caesarean sections. The order of magnitude of the effect estimated was similar, but in only one of the reviews the confidence interval encompassed 'no difference'. This discrepancy between the reviews was caused by a small difference in included trials. The results of planned and ongoing trials may reveal whether sterile water injections deserve a place in guidelines.