'Tough love': The experiences of midwives giving women sterile water injections for the relief of back pain in labour

- Midwives viewed SWI as having benefits for pain relief and supporting normal birth.
- SWI does present midwives with the dilemma of causing pain to relieve pain.
- Institutional barriers contribute to conflict for midwives when women request SWI.

ObjectiveTo explore midwives' experiences of administering sterile water injections (SWI) to labouring women as analgesia for back pain in labour.DesignA qualitative study, which generated data through semi-structured focus group interviews with midwives. Data were analysed thematically.SettingTwo metropolitan maternity units in Queensland, Australia.ParticipantsEleven midwives who had administered SWI for back pain in labour in a randomised controlled trial.FindingsThree major themes were identified including: i. SWI, is it an intervention?; ii. Tough love, causing pain to relieve pain; iii. The analgesic effect of SWI and impact on midwifery practice.Key conclusionsWhilst acknowledging the potential benefits of SWI as an analgesic the midwives in this study described a dilemma between inflicting pain to relieve pain and the challenges encountered in their discussions with women when offering SWI. Midwives also faced conflict when women requested SWI in the face of institutional resistance to its use.Implications for practiceThe procedural pain associated with SWI may discourage some midwives from offering women the procedure, providing women with accurate information regarding the intensity and the brevity of the injection pain and the expected degree of analgesic would assist in discussion about SWI with women.