Terapias no farmacológicas aplicadas en el embarazo y el parto: una revisión integradora

Biana, Camilla Benigno; Cecagno, Diana; Porto, Adrize Rutz; Cecagno, Susana; Marques, Vanessa de Araujo; Soares, Marilu Correa

doi:10.1590/S1980-220X2019019703681

Brasil

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REVIEW • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2019019703681 linkcopiar

Terapias no farmacológicas aplicadas en el embarazo y el parto: una revisión integradora

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo: Identificar las terapias no farmacológicas aplicadas durante el embarazo y el parto.

Método: Revisión integradora realizada en las bases de datos PubMed, ScieLO y PEDro, buscando artículos de 2008 en inglés, español y portugués. Los descriptores utilizados fueron: embarazo, parto, fisioterapia, medicina alternativa y complementaria, terapia alternativa, terapia no farmacológica, terapia biomecánica.

Resultados: Se analizaron 41 artículos y se subdividieron en diez categorías de terapias no farmacológicas: masaje, masaje perineal, baño caliente, cuidados de apoyo, grupo de preparación al parto, técnicas de respiración, ejercicios del suelo pélvico, electroestimulación transcutánea, pelota suiza y pujo espontáneo. Seis artículos (60%) tuvieron un resultado positivo para la reducción del dolor en el trabajo de parto y todos tuvieron algún resultado positivo para diferentes variables del trabajo de parto, como la reducción del tiempo, la ansiedad y las tasas de laceración del suelo pélvico.

Conclusión: El uso de terapias no farmacológicas fue eficaz para reducir los efectos del trabajo de parto y el parto, como el dolor, la duración del trabajo de parto, la ansiedad, la laceración y la episiotomía.

Terapias Complementarias; Terapia por Ejercicio; Embarazo; Parto Normal; Enfermería Obstétrica; Revisión

Authors	Profession of therapist	Study location	Methodological design
Kimber, et al; 2008⁽¹²⁾	Midwives and therapists	Prenatal centers	Randomized pilot study
Mei-dan, et al; 2008⁽¹³⁾	Midwives and self applicable	Prenatal clinics and maternity	Controlled clinical study
Bergstrom, et al; 2009⁽¹⁴⁾	Midwives	Prenatal clinics	Randomized clinical trial
Davim, et al; 2009⁽³⁾	Nurse	Maternity	Clinical intervention study
Bahadoran, et al; 2010⁽¹⁵⁾	Not informed	Public health centers	Quasi-experimental clinical study
Peng, et al; 2010⁽¹⁶⁾	Nurse	Maternity	Non-randomized clinical study
Taghinejad, et al; 2010⁽¹⁷⁾	Midwives	Maternity	Randomized clinical trial
Dias, et al; 2011⁽¹⁸⁾	Physiotherapists	Maternity	Randomized clinical trial
Gau, et al; 2011⁽¹⁹⁾	Midwives	Maternity	Randomized clinical trial
Geranmayeh, et al; 2011⁽²⁰⁾	Midwives	Maternity	Randomized clinical trial
Dhany, et al; 2012⁽⁶⁾	Not informed	Maternity	Retrospective clinical study
Karacam, et al; 2012⁽²¹⁾	Nurses and midwives	Maternity	Randomized clinical trial
Low, et al; 2012⁽²²⁾	Nurses	Maternity	Randomized clinical trial
Mortazavi, et al; 2012⁽²³⁾	Not informed	Maternity	Randomized clinical trial
Ismail, et al; 2013⁽²⁴⁾	Obstetrician, midwives and physiotherapists	Maternity	Descriptive study
Gallo, et al; 2013⁽²⁵⁾	Physiotherapist	Maternity	Randomized clinical trial
Lee, et al; 2013⁽²⁶⁾	Nurses	Maternity	Randomized clinical trial
Miquelutti, et al; 2013⁽²⁷⁾	Physiotherapist	Maternity	Qualitative study
Akbarzadeh,et al; 2014⁽²⁸⁾	Doulas	Maternity	Randomized clinical trial
Reilly, et al; 2014⁽²⁹⁾	Physiotherapist	Prenatal clinic	Randomized clinical trial
Adams, et al; 2015⁽³⁰⁾	Not informed	Retrospective: database	Longitudinal study
Demirel, et al; 2015⁽³¹⁾	Not informed	Maternity	Randomized clinical trial
Fritel, et al; 2015⁽³²⁾	Physiotherapist or midwives	Prenatal centers	Randomized clinical trial
Gayeski, et al; 2015⁽⁵⁾	Obstetric nurse	Maternity	Cross-sectional
Hanjini, et al; 2015⁽³³⁾	Not informed	Maternity	Randomized clinical trial
Akbarzadeh, et al; 2016⁽³⁴⁾	Doulas	Maternity	Randomized clinical trial
Boaviagem, et al; 2016⁽³⁵⁾	Physiotherapists	Maternity	Randomized clinical trial
Henrique, et al; 2016⁽³⁶⁾	Obstetric nurse	Maternity	Randomized clinical trial
Karimi, et al; 2016⁽³⁷⁾	Not informed	Prenatal clinics	Randomized clinical trial
Masoumi, et al; 2016⁽³⁸⁾	Midwives	Maternity	Randomized clinical trial
Taavoni, et al; 2016⁽³⁹⁾	Midwives	Maternity	Randomized clinical trial
Santana, et al; 2016⁽⁴⁰⁾	Physiotherapist	Maternity	Randomized clinical trial
Sut, et al; 2016⁽⁴¹⁾	Not informed	Obstetric center	Randomized clinical trial
Aziato, et al; 2017⁽⁴²⁾	Nurse	Tertiary health center	Qualitative descriptive exploratory study
Cicek, et al; 2017⁽⁴³⁾	Not informed	Maternity	Randomized clinical trial
Erdogan, et al; 2017⁽⁴⁴⁾	Nurses	Maternity	Experimental study with control group
Miquelutti, et al; 2017⁽⁴⁵⁾	Physiotherapist and Obstetrician	Maternity	Randomized clinical trial
Shahoei, et al; 2017⁽⁴⁶⁾	Midwives	Maternity	Clinical study
Vanderlaan, et al; 2017⁽⁴⁷⁾	Nurses and midwives	Maternity	Retrospective cohort study
Yuksel, et al; 2017⁽⁴⁸⁾	Not informed	Maternity	Randomized clinical trial
Ugwu, et al; 2018⁽⁴⁹⁾	Self-applicable	Prenatal clinics	Randomized clinical trial

NPT	Positive outcome	Inconclusive or negative outcome
Massage	Reduction of pain in labor⁽³^,⁵^,¹⁷^, ²³^,²⁵^,³⁰^,⁴⁴⁾ Reduction of anxiety in labor⁽²³^,³³⁾ Greater satisfaction with childbirth⁽²³^,³⁴⁾ Reduced use of epidural and spinal analgesia and anesthesia⁽⁶⁾ Reduction of labor time⁽³³⁾ Reduced perception of labor time⁽⁴⁴⁾ Association with increased breastfeeding⁽³⁰⁾ Higher frequency of vaginal delivery⁽³³⁾	Association with increased laceration and use of forceps⁽³⁰⁾ Pain and satisfaction in childbirth⁽¹²⁾
Perineal massage	Reduced frequency of episiotomy⁽¹⁴^,²⁰^,³¹⁾ Reduction of the second stage of labor⁽²⁰⁾ Good technique acceptance⁽²⁴⁾ Increased incidence of perineal integrity⁽⁴⁹⁾	Increased laceration grades 1 and 2⁽²⁰⁾ No difference regarding postpartum urinary incontinence⁽¹³^,²²⁾ No differences regarding perineal trauma in general⁽¹³^,²¹⁾
Hot bath	Reduction of pain in labor⁽³^,²⁶^,³⁰^,³⁶^,⁴⁷⁾ Association with increased breastfeeding⁽³⁰⁾ Improvement of the delivery experience⁽³⁰⁾ Increased frequency of uterine contractions during labor⁽³⁶⁾ Reduction of duration of labor⁽³⁶⁾	Associated with increased laceration⁽³⁰⁾ Increased fetal heart rate⁽³⁶⁾
Supportive care	Reduction of pain in labor⁽²³^,²⁸⁾ Increased incidence of vaginal delivery⁽²⁸⁾ Reduction of duration of labor⁽³⁴⁾ Resulted in Apgar scores greater than 8⁽³⁴⁾ Reduction of anxiety⁽²³⁾
Childbirth preparation groups	Control of anxiety and feeling of security⁽²⁷⁾ Increased comfort and mobility during childbirth⁽²⁷⁾ Increased satisfaction with childbirth⁽²⁷⁾ Reduction of fear of vaginal delivery⁽⁴³⁾ Reduction of anxiety⁽⁴³⁾ Increased positive thinking⁽¹⁵⁾ Increased choice of vaginal delivery⁽³⁷^,³⁸⁾ Higher rates of non-instrumental delivery⁽³⁸⁾ Higher weight of the baby⁽³⁷^,³⁸⁾	Childbirth experience⁽¹⁴⁾ Use of analgesia⁽¹⁴⁾ Stress in maternity⁽¹⁴⁾
Breathing techniques	Reduction of pain⁽³^,⁴³^,⁴⁸⁾ Reduction of duration of labor⁽⁴⁸⁾ Reduction of anxiety in labor⁽⁴³⁾	There was no difference for anxiety, pain, fatigue, satisfaction, type of delivery, duration of labor and Apgar scores⁽³⁵⁾
Pelvic floor exercises	Less susceptibility to urinary incontinence in the postpartum period⁽²⁹⁾ Increased pelvic floor muscle strength⁽⁴¹⁾	Postpartum urinary incontinence⁽³²⁾ Type of delivery, frequency of perineal laceration and neonatal variables⁽¹⁸⁾
TENS	Reduction of pain in labor⁽¹⁶^,⁴⁰^,⁴⁶⁾ Postponement of the use of epidural analgesia⁽⁴⁰⁾ Reduced postpartum blood loss⁽¹⁶⁾
Swiss ball	Reduction of pain in labor⁽¹⁹^,³⁹⁾ Increased confidence in relation to labor⁽¹⁹⁾ Reduction of duration of labor⁽³⁶⁾ Increased frequency of uterine contractions during labor⁽³⁶⁾	Increased fetal heart rate⁽³⁶⁾
Spontaneous pushing	Reduction in the incidence of perineal laceration⁽²²⁾	Postpartum urinary incontinence⁽²²⁾

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[TFN1] Legend: NPT: non-pharmacological therapies; TENS: transcutaneous electrostimulation.