الفهرس 
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Abstract
Pain during childbirth is one of the most excruciating pain experiences that women encounter during their lives (Eriksson et al., 2006). It is a result of many complex interactions. Although not fully determined, the pain arises from distension of the lower uterine segment and cervical dilatation; it has different locations and quality. Up to 74% of parturients experience contraction-related low back pain that for some is continuous, troublesome and even annoying between contractions (Labrecque et al., 1999).
Labor pain may have many adverse physiological and psychological consequences also labor pain can affect the progress of delivery (Rudra, 2004). For this reason, one of the basic principles of modern obstetrics is to provide adequate analgesia (Kamyabi et al., 2003).
There are two general approaches of labor pain management: pharmacologic and non pharmacologic (Lowe, 2002). Each pharmacological method has many hazards on the fetus and the mother, especially narcotics as Pethidine which is the most common method during the first of stage labor. So the interest toward the non pharmacological methods, which are simple, safe and effective without serious side effects, is increasing. Intradermal sterile water injection is one of non pharmacological alternatives for management of labor pain (Fogarty, 2008).
The aim of this study was to evaluate the efficacy of intradermal sterile water injection representing the non pharmacological method versus intramuscular Pethidine representing the pharmacological method in relieving low back pain during labor.
The study included 48 women presenting in labor to the emergency ward of obstetrics and gynecology department at Suez Canal University Hospital and who fulfilled the inclusion and exclusion criteria. The study participants were randomly assigned alternatively to one of two groups.
Group (1): ”Intradermal sterile water group”, twenty four (24) women who received 0.1ml of sterile water intradermally into four sites in the Michael’s Rhomboid or lumbar sacral region of the spine. Group (2): ”Pethidine group”, twenty four (24) women who received 100 mg Pethidine intramuscularly
The assessment of pain was done by using the Visual Analogue Scale (VAS) at 10, 45 and 90 min after injection.
The results of the current study showed that intradermal sterile water injection had significant decrease of all VAS values with lowest value at 45 min. Pethidine also reduced the VAS significantly in all values. By comparing VAS in both groups, sterile water showed significant rapid action 10 min after injection, this may be due to direct effect of the injection at the skin area supplied by the same nerve supply (counter irritant), not cortical effect as in Pethidine which showed some delay of action. There were no significant differences regarding VAS values at 45min and 90 min between both groups.
Some of maternal adverse effects was recorded in our study the first group of intradermal water injection had significant incidence of burning sensation at the sites of injection only at 10 min after injection. Although nausea and vomiting more commonly reported in the Pethidine group (2), there were no statistically significant differences between both groups regarding the incidence of nausea and vomiting
The fetal out come by using Apgar score reported that one min Apgar score was significantly higher in sterile water group than pethidine group but there was no statistically significant difference between both groups in five min Apgar score.
So the Intradermal sterile water injection is more effective than intramuscular Pethidine in relieving low back pain during labor