Sterile water injections for back pain in labour

Recent recommendations by the National Institute for Health and Clinical Excellence (NICE)1 regarding the use of sterile water injections for back pain during labour have sparked controversy.23 The intrapartum care guideline states that sterile water injections alleviate back pain during labour from 10 minutes after injection for up to three hours.1 However, the NICE evidence review underpinning these recommendations reveals uncertainty about the effectiveness of sterile water injections and the lack of transparency regarding the pain associated with sterile water injections is concerning.4

In its review, NICE evaluated 11 studies (10 randomised controlled trials and one Cochrane systematic review5) assessing low risk women who gave birth to a single infant at 37-42 weeks’ gestation. Using the GRADE framework,6 NICE produced detailed evidence profiles and assessed the overall certainty of evidence for each outcome of interest. These certainty assessments considered five domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias.7 Among the 11 studies, only five trials89101112 reported back pain outcomes with …