#AskAugustine | What are Sterile Water Papules and How Do you Use Them? @MidwiferyWisdom
#AskAugustine | What are Sterile Water Papules and How Do you Use Them?  @MidwiferyWisdom
Uploaded February 2025 | Updated September 2026, 3 weeks ago
Back pain in labor can be such a pain in the back! Midwives have a secret trick up their sleeves that can literally take away back pain. Check it out!

Sterile water papules sometimes called sterile water injections (SWI) are an effective method for the relief of back pain in labour. The procedure involves a small amount of sterile water (0.1ml to 0.3 ml) injected under the skin at four locations on the lower back (sacrum).

The injections cause a brief but intense stinging sensation, like a wasp sting, that lasts for about 30 seconds and then wears off completely. As the stinging sensation eases, relief from the back pain is felt. To distract from the stinging sensation the injections are done during a contraction by two midwives. Women benefit from support and encouragement as the injections are being given.

This demo is being given to a willing volunteer during a live class as she was suffering from non-acute kidney stones while taking the class as a midwife.

SWI provides effective pain relief for up to 85 per cent of women with back pain in labour and can last for up to two hours.

Advantages of SWI
Often immediate effect.
No effect on mother's state of consciousness.
No effect on baby.
Does not limit mobility.
Does not adversely effect labour progress.
A simple procedure that can be administered by your midwife.
Can be repeated as needed.
Sterlie water injections are an excellent alternative for relief of back pain in labour. Though SWI will not provide pain relief from contraction pain, once the back pain is alleviated, you may cope better with labour pain. As the back and pelvic muscles relax following the relief of pain, this may assist with the progress of your labour.

As sterile water is not a drug and there are no known side effects for mother or baby, SWI may become the preferred choice for the relief of back pain in labour for many women.

References
Melzack R & Schaffeberg D (1987) Low-back pain during labour Am J Obstet Gynecol
156. 901-5
Mårtensson L & Wallin G. (2008) Sterile water injections as treatment for low-back
pain during labour: A review. Australian and New Zealand Journal of Obstetrics and
Gynaecology; 48: 369–374
Fogarty, V. Intradermal sterile water injections for the relief of low back pain in labour:
A systematic review of the literature. (2008) Women and Birth; 21: 157-163
Hutton EK, Kasperink M, Rutten M, Eitsma A, Wainman B (2009) Sterile water injection
for labour pain: a systematic review and meta-analysis of randomised controlled trials.
British Journal of Obstetrics and Gynecology (Published Online: 14 May, 2009).

More resources for midwives can be found on MidwiferyWisdom.com

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#AskAugustine | What are Sterile Water Papules and How Do you Use Them?

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